Scott Webb (Host): It might be surprising to learn, but many family medicine providers like my guest today, have the training and experience necessary to help patients with mental health issues. And I'm joined today by Dr. Kimberland Anderson. She's a Board Certified Family Medicine Provider with the Franciscan Physician Network. And she's here today to tell us about the common mental health issues that she treats and how she and other providers are working to remove the stigma from seeking mental health treatment. This is the Franciscan Health Doc Pod. I'm Scott Webb.

Dr. Anderson, thanks so much for joining me today. Let's discuss why a patient's family provider is a good place to start for mental health issues. You know, are family physicians prepared to help patients? Is there any specific training involved in recognizing the symptoms?

Dr. Kimberland Anderson: Yes. So starting with the family physician is a good place to start because we do get sufficient training in medical school and certainly within our practices. We are seeing on a daily basis, people who are struggling, whether it be with depression or anxiety or other things. So certainly it's a good place to start. Certainly we rule out things medically, to make sure there aren't other processes going on, causing symptoms. But many times it is due to stress or anxiety or depression, and we can get started with a treatment regimen with our patients.

Host: Yeah, that's good to hear because you know, for most of us, our sort of entry point into the medical and mental health system usually is our primary care physician, you know, our regular doc, whether that's a family physician or whomever. So good to know that most of them are going to be prepared to help us. And I, you know, most of us suffer with things. You know, I'm 54 and my back hurts and my knees hurt, and we suffer, quality of life types of things. And mental health would be on that list as well for some folks. How does mental health affect most people, you know typically in terms of their quality of life?

Dr. Kimberland Anderson: Mental health does affect quality of life. Certainly can give people a poorer quality of life by affecting various things, whether it's relationships with the individuals we work with, friends, family members. It can manifest physically where, you know, some individuals may have headaches, some may have pain, difficulty sleeping, difficulty focusing or concentrating. So it certainly can have a whole host of symptoms that can affect your quality of life on a daily basis.

Host: Yeah. So let's talk about some of the symptoms, maybe the sort of classic symptoms, if you will, of both depression, maybe anxiety as well.

Dr. Kimberland Anderson: Yes, absolutely. So typically with depression, and I'll just kind of give the most common things. So some of the more common things are a, a feeling of sadness or feeling down, sometimes somewhat hopeless. And then there could be certainly trouble sleeping, particularly falling asleep. Appetite can certainly be affected. Many people have a decreased appetite. Doesn't mean that, you know, having an increase in appetite does not happen. It certainly does, but more often than not, I see a decreased appetite. In addition to maybe not being as social with individuals. So certainly, those are some things that can be seen in depression.

Whereas anxiety, a lot of times, what we will typically see is heightened responses. Maybe worrying a lot about different things. Frequently waking up during night and there's nothing else going on that would be causing that. And some people have chest pain, heart racing where it almost feels like they're having a heart attack. So, there could be a whole scope of things that, you know, patients are experiencing that will bring them in.

Host: Yeah. And I know that physical health can affect our mental health, but does it work the other way as well Doctor? Can our mental health affect our physical health?

Dr. Kimberland Anderson: Absolutely. Absolutely. And this is an area where I think we are still learning things. When we talk about whatever we're experiencing mental health wise, you know, there's so much being thrown at all of us day in and day out. There's so many things outside of our control. So an increased level of stress. Or that feeling of, you know, sadness or being anxious, certainly can manifest in physical symptoms. And a lot of times we do the workup because we want to make sure that the heart is okay or the headaches, there's nothing else going on causing those. And many times when that workup is negative, we do find that, okay, this is linked to depression or anxiety or an increase in your stress level or lack of sleep.

Host: Yeah, there's no doubt. You know, it kind of works both ways. Mental can affect physical. Physical can affect mental. We're all one unit, you know, so to speak. Are there some chronic medical conditions that can lead to depression, and if so, why does that happen?

Dr. Kimberland Anderson: There are some chronic conditions that can lead to depression in particular. I mean, you know, we can discuss things like hormonal changes that many women go through. Things like menopause, can do that. But also chronic kidney disease or diabetes where chemically things are off and that can trigger feelings of depression or anxiety as well. Heart disease that should also be in the list. But all of those conditions certainly can cause, you know, more symptoms of depression and anxiety. Absolutely.

Host: Yeah. You can see how some of these physical things weighing on us, wearing us down, you know, would affect our mental health, whether it's through depression or anxiety, or possibly both. Are there some basic screenings that you can do for mental health awareness?

Dr. Kimberland Anderson: Yes, there are. So there are basic screenings that can be done. And I do screenings in the office when I see patients. So if someone comes in for a routine physical or whatever they are presenting to the doctor's office for, everyone gets screened for depression. And so it's called a PHQ 9.

 That is a questionnaire, that gives some idea of where things may fall as far as depression goes, and based off of how the questions are answered, gives me an idea of if depression may be present or not, or if that's something that I need to go into further. From an anxiety standpoint, there's something called a GAD7. That is also a questionnaire geared more toward anxiety.

And so that's a good initial start that we will do to further assess where someone may be. And then, you know, there are things that may be a little bit more complex. And that's part of the discussion that a patient would have with their physician.

Host: Yeah. And I think I know the answer to this, but I'm assuming Doctor, there are some higher risk populations, right? That there are some folks and some populations that are just at higher risk for poor mental health. And maybe you can explain why.

Dr. Kimberland Anderson: Yes, absolutely. So there are populations of individuals who are at higher risk for mental health. Certainly if mental health conditions already exist in the family. Just like we look at family history for many other processes, mental health is also included in that assessment. So if we have parents or siblings, certainly first degree relatives who have some mental health. Certainly that individual is typically at an increased risk. It does not mean that someone has that, but it's something that we would keep an eye on. In addition to individuals who have chronic medical conditions, they can be at an increased risk as well as, you know, if someone is already suffering from a more difficult quality of life. If you're having financial strains, if you're having marital issues or relationship issues, your struggles at work. Any of those things, certainly can put someone at an increased risk of having depression anxiety.

Host: Yeah. And Doctor, it seems that maybe one of the silver linings of COVID is we've been talking more about mental health and some of the previous stigma related to mental health and having these conversations as sort of diminished somewhat, but, I'm assuming that many family physicians, including yourself, really are pushing for the elimination of all stigma, right, that accompanies poor mental health disparities, high risk populations, and so on. So maybe you can address that a little bit, the stigma and what you're trying to do about it.

Dr. Kimberland Anderson: Yes, absolutely. So yes, we are trying to eliminate any remaining negative stigmas when it comes to mental health. It is an essential part of all of us, and I truly believe that each and every one of us will go through things in life and you know, we are getting there. We're getting there to the point where we are seeing some progress in how open society is becoming when it comes to mental health.

We still have some ways to go, but we're trying to increase awareness by bringing things up on a regular basis when we are here in the office. Certainly with a lot of the medical societies, whether it's the American Academy of Family Physicians or various organizations that are linked to all of the physicians increasing that awareness throughout the community. And so, that certainly is an area where we're trying to do more work to eliminate any negative stigmas. Prior to COVID, we were doing more community fairs and things of that nature. So I would like to see, you know, that return. I feel like that also helped. So certainly that community outreach is absolutely key.

Host: Yeah, so important. And what are some of the newer treatment strategies that you all are employing to increase the number of patients who, you know, get the appropriate treatment actually, you know, either come in or possibly through, uh, telehealth, which I know became really big during COVID. What are you doing to try to just make sure that folks get the treatment they need?

Dr. Kimberland Anderson: In order to, you know, really make sure that people are getting what they need, the first thing that we try to do is make sure someone's comfortable. And so in, in discussing whatever concerns that they may have and then figuring out what's the best approach here for the needs of that person. That may be therapy, which has quite a few modalities now than had existed previously where they can help someone with maybe post-traumatic stress disorder or depression or anxiety. They have different techniques to help our patients, in addition to medications, sometimes they're needed.

That's a discussion to have, to make sure we are trying to minimize any unwanted side effects and maximize the desired treatment level that we have. And then the follow up is very important. And so it is a busy world and telemedicine and telehealth has truly helped us with that. So I, I see patients who, they're at work on a break and we're having a visit, checking in and seeing how they're doing. And just being able to have better access for the patients I think definitely helps with the treatment and having better outcomes.

Host: Yeah, definitely. I, I remember the first, uh, telehealth visit I did with my doctor, and I was just sitting in my kitchen and she could see me and I could see her, and I was like, this is weird, but I kind of like it. It it works. Yeah. I think we've all, you know, again, silver linings right of the crisis we all faced with COVID is that we've learned how to use telehealth and telemedicine especially for follow-ups, just the like, Hey, how's it going? You started taking those pills. How are you feeling? You know, we don't necessarily have to be in the office for those things. So, good to hear and so glad to have your time today. Doctor, as we wrap up, what are some of the options available? We talked about depression and anxiety, so what are some of the treatment options?

Dr. Kimberland Anderson: The treatment options do vary. Certainly there's individual therapy or counseling, group counseling. There are medications and medications now certainly provide a scope for treatment. So there are some medications that purely treat anxiety. And I know I've had patients in the past who maybe did not have depression and just had some anxiety. And so an antidepressant was not the best course of treatment for them. And so having medications now that won't cause any sort of dependency or abuse or anything like that, but will treat the anxiety is very important. Also, you know, having medications that are antidepressants for individuals who have depression. But having that discussion on these medications don't cause weight gain. These medications don't cause. And so going through that scope, that's certainly an area where having that discussion with the doctor is key and then, you know, we also will refer to the therapist if that is indicated as well.

So there is a whole scope of treatment available depending on what each person needs. And, you know, I would just encourage if anyone thinks that maybe they have some things that, you know, could be better, I would encourage them to see their physician and start the conversation. Yeah.

Host: Yeah, that's great advice. Because we got rolling here today was about like, you know, you can talk to your regular doctor, your family doctor, they have experience, they have training, and if they can't help or they feel that you're, whatever issues you're confronting are a little bit above them or outside of their area of expertise, they'll refer, as you say. But, we have to look out for ourselves, our family members, loved ones, see our doctors, trust their expertise, take our meds, you know, all that good medical stuff. Yeah. So, Doctor, it's been so good to speak with you today. Really educational. I love your compassionate approach. And you know, we hope that folks, when they click play, we hope they appreciate your advice as much as I did, and maybe we'll talk again in the future. Thanks so much.

Dr. Kimberland Anderson: Thank you so much, Scott. Have a good day.

Host: And for more information, visit franciscanhealth.org and search behavioral and mental health.

 And if you found this podcast helpful, please share it on your social channels. And be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.