Inside Out Mental Illness Series:  Anxiety with Dr. Mach

Inside Out Mental Illness Series: Anxiety with Dr. Mach


There’s basic like three really, or four basic categories of mental health issues. One is mood disorders, that includes bipolar, depression. There’s anxiety disorders that include PTSD, OCD, generalized anxiety, panic disorder. And then there’s thought disorders that include schizophrenia or psychotic disorders, delusional disorders. So then there’s substance use disorders. So there’s four really major classes of mental health diagnosis. So anxiety is a set of symptoms that include muscle tension, apprehension, chronic worry, tremor. It is kind of the big as the main realm of the symptoms. Panic disorders usually, again another variant of anxiety, but it’s a surge of fear. It can happen from 2 to 10 minutes. It’s like a burst of anxiety and fear that you get shortness of breath, you get heart racing, you get really sweaty. You feel like you got to leave this situation or you’re losing control and you’re gonna die. And that can, in most of these disorders, usually when they start to disable you, whether you can socialize or work or do school, that’s when you want to get treatment for them. There’s specific phobias like fear of heights, fear of spiders, for your snakes are very common. And then there’s a fear of in a plane, you know, there’s phobias about flying or bus rides or cars. And so phobias are just basically in the area where you’re avoiding situations that bring on this anxiety. The problem with phobias is the more you hold yourself back from going to these areas, the fear itself grows. And so some of the treatment is actually what they call desensitization and exposure. They kind of get you back into those situations again and teach you how to deal with that anxiety, the feelings of anxiety. Because the anxiety is usually far excessive of the actual threat. There’s several theories of why anxiety’s growing in depression and I think a lot of it has to do with certainly lifestyle. I don’t think people are getting as much physical exercise as they used to. The social media puts a lot of pressure on kids, there’s a lot of comparison. And there’s a lot of bullying going on in social media too. And I think for adults it’s kind of indirect, you don’t always notice it, but there’s a lot of comparative, lot of competition, in that area. But the other thing about social media or in technology is the more laptops, the more iPhones, the more screen time you have, the less time you have for your mind to rest. And so now the big one of the antidotes for all this screen time is mindfulness, you’ll hear mindfulness, and that’s the ability to let your mind be still, shut off all the technology. A lot of times in children and adolescents anxiety can manifest in irritability. And of course a lot of times they don’t have the insight to really know what it is and so it’s often gone untreated. And the elderly you can see, you know, people will shut down and start to isolate. And with adults and young adults, it really depends upon the person’s personality Some people are more irritable. Some people will, you know, start to isolate. So there’s a lot of variation within the person themselves, but generally irritability is a little more common in the adolescence. Physical exercise is very important in mental health and it decreases anxiety, improves mood. There’s such a good relationship and physiology on that, that we really encourage that now. Other lifestyle of course is diet. So you don’t want to eat too many high processed foods, because that can cause inflammation and that makes a lot of our medications less effective. So diet is a huge part of it too, when again back to the caffeine you want to watch that. Now a lot of the kids are using Red Bulls, power drinks and that’s having a tremendous impact on anxiety. So people underestimate the level of caffeine use and the relationship to anxiety, so that’s just one thing you have to look for. We look for quite commonly, is how much caffeine are you using? And especially as you get older, you lose your tolerance to caffeine. So some people, some adults, will have caffeine and they’ll use a pot a day. By the time they get in their 70s, 75, 80s, they can’t tolerate it and they’ll have tremendous anxiety. So we try to rule that out right away. And of course other substances like marijuana, even alcohol, can increase anxiety. Now we have medications, you have psychotherapy and even lifestyle, all affect your anxiety. Are all part of the treatment. Harvard said 60% of mental health problems is lifestyle. So 60%. So that puts a lot of the ownership back in our court. So the watch your diet, get more physical exercise, and we need to keep growing, learning. And in the mindfulness now they’re saying we have to have time of downtime, to literally be still. And I think that really helps a lot of people. So it’s kind of the lifestyle, psychotherapy and medications. And you don’t already have to go to medications first. The time we really do the medications is when it gets severe and people can’t get out of bed or they’re crippled, and then we do some medications. In the case of medications we’ll start an antidepressant, antidepressants work for both anxiety and depression. And then we’ll give them a medication that says what they call ‘As Needed’. So you can take it and it kind of helps that anxiety until the other medication takes effect. So there’s fast-acting medications and then there’s the long-acting medications. And so you use both of those until the long-acting medication starts doing the job. Most therapy now is really current, what’s going on now? What are your thought processes now? What are your basic beliefs? You know and they try to draw out those fears and what kind of things are you telling yourself? You can tell yourself things that are not true and that could make you more anxious. So the therapist will try to evaluate some of your thoughts, and whether they’re accurate or not, and they’ll mirror that back to you, so you can start to learn to check your thoughts. But a lot of times emotions also affect your thoughts. So sometimes the emotions themselves, anxiety can change the way you see things, and you know things will be catastrophic. Where you know the day before if you weren’t anxious, there wasn’t a problem. Only in psychotherapy do you learn to really think about the way you think. And that’s very healthy. So if you don’t grow emotionally, in other words you don’t really get to know how your brain thinks, no man’s going to teach you that. Okay, but for a physiological and inherited anxiety in depression, sometimes people can’t even enter psychotherapy without some medication assistance. So in that case we use medications. If they come to you with mental illness or anxiety or depression and they are sharing it with you, you want to listen. And you want to normalize it to some degree, because it is very normal to be depressed and anxious. Okay, now if you notice it and they’re embarrassed by it, it depends upon the person. You want to know if they could tolerate a little input, you know. So it’s really kind of variable depending upon if they’re a close person or an open person. If they’re an open person just share with them, “I’m concerned about this, And you are showing us some signs that we don’t see around as much. You’re not at work as much or I don’t see you at school.” Now if they’re close minded, then you might have to work with somebody who cares for them. A family member or friend that they do trust. So it really kind of depends upon that situation, but I would never ignore it. The time to intervene with somebody you suspect is having too much anxiety or depression is when it interferes with their ability to function socially, academically occupationally. So that’s when you want to intervene. At that time, I would first broach it with them and see if they’re aware of it. A lot of times people aren’t aware of their depression and anxiety, because it’s inside their own mind. So a lot of times they don’t recognize it. So point it out to them, especially if you’re a good friend and they trust you. And then mention some psychotherapy or some interventions, come in and see a psychiatrist or even your family doctor. Just start mentioning it, then the family doc can kind of to see if there’s anything they want to address and they might refer you to a specialist. As we gain more neuroscience and understanding of how the brain works, there’s going to be less stigma. Because you’re gonna see the exact spot or the circuit in your brain or the gene that’s causing it and you’ll feel less embarrassed. And that is exactly what we’re finding. We’re finding out more and more causes of people’s mental health problems; anxieties inherited, depressions inherited, bipolar, substance use is definitely inherited. And so there’s less shame once you reveal to people that you actually inherited this and this is a disease rather than a mental weakness. I think the fun thing about working with mental health is that there’s tremendous potential for improvement. And because of some of the stigmas and the embarrassment that comes along with it, it’s fun to to reveal that this is a physiological problem. Some of it’s stress-related, but a lot of it is curable and treatable. And it’s fun to give people hope.

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