End the Stigma, Mental Health IS Important!
By: Vikil Girdhar, MD
April showers bring May flowers, and May brings Mental Health Month. So, what exactly is mental health and why is it important? Does mental health influence a person’s physical health and well-being? How are mental health illnesses diagnosed and what are the treatment options? We are going to answer all these questions, along with explaining a few common mental illnesses and their warning signs.
To begin, we need to understand what mental health is, along with what it is not…
The concept of mental health includes emotional, psychological and social well-being, and affects how we think, feel and act. Mental health is important at every stage of life, from childhood and adolescence through adulthood (What is Mental Health?). Not only that, but it plays a very important role in our daily interactions with others, our ability to cope with bad news or stress and helps us remain positive even when dealing with a negative situation. Mental health is often labeled as a sense of abnormality or instability in a person’s brain, and it is crucial to understand that mental illness is just as important as physical illness. Research has shown that mental well-being has a direct impact on physical well-being, with chronic medical conditions being better controlled if mental health is stable. Almost everyone has pet peeves, something that irritates them or causes a reaction in a way that is outside the norm. Those are normal and aren’t what we are talking about here. What we are discussing is if a specific mental illness is serious enough that it starts to interfere with a person’s daily functioning, it’s a sign that treatment is needed.
What brings on mental illness? There are definite causes of mental illness and there are several factors that may play a part in its development. Genetics, family history or a history of sexual, physical, or emotional abuse are just some examples. Other causes also include biology, such as an abnormal balance of brain chemicals, or major stressors like death, divorce or changing jobs (Mental Illness Basics). It should be made clear that mental health doesn’t necessarily limit itself to depression and anxiety, however it can (and often includes) substance abuse via drugs and alcohol, post-traumatic stress disorder (PTSD), bipolar disorder or personality disorders. Grieving and bereavement may also progress to major depression. Mental health also includes psychotic disorders such as schizophrenia or post-partum psychosis.
What are the basics behind the physical causes of mental illness in the first place? Let’s use an example. Diabetes is linked with insulin resistance or a lack of insulin production in the body. So in short, having a physical problem with insulin in the body causes a form of diabetes. Mental illness is caused by changes in brain chemistry. There are four important chemicals in the brain; serotonin, dopamine, glutamate and norepinephrine (How Brain Chemicals Influence Mood and Health). Serotonin has a crucial role in sleep, depression and essential body functions, such as appetite, mood and arousal. Dopamine is responsible for functions like behavior, emotion, cognition (understanding and awareness) and communicates with the front part of the brain (pleasure and reward). Glutamate controls early brain development, cognition, learning and memory. Norepinephrine is involved in the body’s stress response in a fight-or-flight situation. The best way to describe mental illness is due to an imbalance of these chemicals, the brain processes and responds to its surroundings differently. Lower levels of serotonin and norepinephrine are connected with increased symptoms of depression and anxiety, whereas lower dopamine levels are associated with shortfalls in concentration as seen in ADHD (attention deficit hyperactivity disorder). An increased amount of dopamine is linked with psychosis and disorders such as schizophrenia, so medical treatment is guided towards finding the perfect balance of these brain chemicals in hopes of achieving mental stability.
Now that we understand what mental illness is along with a few of the background causes, let’s go over how it’s diagnosed, a few types of illnesses and common symptoms.
The basic way to diagnose mental illness is by clinical history and physical examination. Oftentimes, people are hesitant to get help and treatment because there is a negative attitude surrounding mental health. They may feel it shows a sense of weakness and that they are unable to handle their feelings. This stigma is why it’s crucial to screen for depression when patients come in for medical appointments. Often, a family member or spouse may accompany the patient and bring up a possible underlying condition in the patient. A noticeable change from the patient’s baseline, a recent life stressor (such as loss of job or family member), behavioral changes such as increased forgetfulness or diminished memory (especially in the elderly) or a decreased sense of self-care (poor grooming) are signs that a patient should be evaluated for underlying depression. A proper diagnosis is crucial to guiding therapy.
Common symptoms that may point to a diagnosis of depression are; sleep disturbance (difficulty falling asleep, staying asleep or sleeping too much), a loss of interest in pleasurable activities, a sense of guilt, loss of energy and motivation, lack of concentration, appetite changes, psychomotor slowing (movements, dexterity, strength, speed, etc.), agitation and most importantly suicidal/homicidal thoughts. It is crucial during an appointment to get a detailed history to ensure the patient’s well-being and the well-being of those around them. A prior suicide attempt or current plan is usually considered a psychiatric emergency and requires hospitalization, along with close monitoring of the patient.
Major depression is usually diagnosed if five of the symptoms listed above continue for at least two weeks. Treatment usually is started with a selective serotonin reuptake inhibitor (SSRI), which increases levels of serotonin in the brain to help relieve symptoms. The response to medication typically takes four to six weeks for full effect, but patients may report a response in as early as three to four weeks.
Bereavement or grieving is a natural response to an acute stressor, such as a death in the family. There will be symptoms of sadness, lack of appetite, low energy, low motivation and sleep changes reported by the patient. While these are typically seen and normal as part of grievance and bereavement (and may continue for up to six to twelve months), these symptoms are typically self-resolving. However, if a patient reports thoughts of suicide, or feelings of hopelessness with statements such as “I wish it was me that had died…” it is a red flag and often something that requires additional evaluation for depression and the potential of self-harm in the patient.
The diagnosis and treatment of bipolar disorder may become a bit tricky if some of the criteria are overlooked in the patient. Again, a detailed history and a series of questions can lead to the right diagnosis. There are two main types of bipolar disorder; bipolar I and bipolar II. Bipolar I is defined by manic episodes or symptoms that last at least seven days, usually followed by depression lasting at least two weeks. Bipolar II is a pattern of depressive episodes and hypomanic episodes that aren’t the extreme manic episodes that Bipolar I involve (Bipolar Disorder). Manic phases tend to include a heightened sense of well-being, “feeling on top of the world,” a decreased need for sleep, impulsive behavior that may include impulsive spending that disrupts financial affordability, erratic behavior or sexual promiscuity. The treatment here is not going to be complete with just an antidepressant. It would require an antidepressant plus a mood stabilizer. These mood stabilizers work on brain chemicals different than serotonin, dopamine and norepinephrine (as seen in antidepressants) to relieve the manic symptoms patients display in this phase.
Anxiety is very common in practice and can show in many ways. Many times, anxiety is situational and is self-resolved. It can be a response to a major life stressor, health concern or may even be chronic in nature (as seen in generalized anxiety disorder). The mainstay of successful management and treatment is to get to the underlying cause of the patient’s anxiety. By using the correct medications (that are not likely to cause dependency and addiction) and counseling, anxiety can be managed in the most effective and safest way possible.
Psychotic disorders are named as such because the symptoms involve an altered sense of reality. For example, delusions and hallucinations such as hearing voices, seeing objects or the smell of burning rubber, are common examples of hallucinations that patients with schizophrenia describe. Without proper medication treatment, these hallucinations may become so strong that patients may not be able to distinguish them from reality. This puts their well-being and the well-being of those around them at stake, with potentially dangerous consequences.
Treatment of mental illness is not complete without counseling and therapy, which when combined with medication, show the best outcomes and relief of symptoms. Self-help and support groups are helpful counseling tools, along with cognitive behavioral therapy (CBT), which alters behaviors by gradually tweaking the thought process. CBT allows patients to cope with stressors and their surroundings in a much more rational and practical way.
Since mental health and physical health are often treated as different matters, it is important to rule out any underlying medical cause that may be a possible mental health condition. For example, untreated hypothyroidism is linked with depression, as is Vitamin D deficiency. Symptoms of appetite change, fatigue and energy loss may be due to poor sleep and hygiene, nutrition deficits, underlying diabetes or untreated obstructive sleep apnea (OSA). Once these medical treatments are managed, a patient’s mental health may show signs of improvement.
One in five adults struggles with a mental health condition each year, and one in 17 live with a serious mental illness such as schizophrenia or bipolar disorder (Mental Health Conditions). More so, half of mental health conditions begin by age 14, and 75 percent of mental health conditions develop by age 24 (Mental Health Conditions). Early diagnosis and support are critical to recovery. If you feel you or a loved one could benefit from being evaluated for a possible mental illness, AxessPointe Community Health Centers, Inc. will be more than happy to help assess your needs. Please call 888-975-9188 to schedule an appointment with any of our providers today.
What is Mental Health? (2017). Retrieved from https://www.mentalhealth.gov/basics/what-is-mental-health
Mental Illness Basics. (n.d.) Retrieved from https://www.medicinenet.com/mental_illness/article.htm#what_causes_mental_illness
How Brain Chemicals Influence Mood and Health. (2016). Retrieved from https://share.upmc.com/2016/09/about-brain-chemicals/
Bipolar Disorder. (2016). Retrieved from https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml
Mental Health Conditions. (2018). Retrieved from https://www.nami.org/learn-more/mental-health-conditions