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Helen Dandurand (Host): Welcome back to the Well Within Reach podcast, brought to you by Riverside Healthcare. I'm your host, Helen Dandurand. And joining me today is Miranda Sirvinskas, a Riverside Internal Medicine nurse practitioner who's here to talk about mental health support through your primary care provider. Welcome.

Miranda Sirvinskas: Thank you.

Host: Yes. So, you've been on the podcast before, but just if anyone hasn't listened to that episode, could you give us a little bit about your background?

Miranda Sirvinskas: Yeah. I have been at Riverside for a little over two years now. I've been working in healthcare for 10 years. I was a registered nurse in the ICU for seven of those. And then, I worked at an urgent care for a year before coming here.

Host: Great. Well, you got a lot of experience. So, let's get into this topic. I know a lot of people don't really realize that mental health can be a part of your primary care experience. So, can you tell us a little bit about how mental health fits into that and what you do as a primary care provider?

Miranda Sirvinskas: Yeah. So, every patient that we see, we always screen for depression with every visit. So, it starts there. Most of the time I'm the first provider that a patient will see regarding their mental health issues, whether it be anxiety, depression, attention disorders, et cetera. So, it's very important, for me to be able to talk to my patients and get more information about them and their mental health issues in order to treat them appropriately.

Host: You listed a couple of different mental health issues that people might have. So, what are some of the most common concerns though if there are more that patients will bring up here in a primary care setting?

Miranda Sirvinskas: Yeah, I would say the most common, like I said, anxiety and depression, things kind of start there. They may not know exactly what's going on. They might describe some of the physical symptoms that they're having that correlate with anxiety or depression that raise some red flags for me. Some cases are more severe than others. I do have a handful of patients who come in with issues concentrating, ADHD, ADD complaints as well.

Host: Yeah. So for someone who's never talked to a provider about their mental health, what does that first conversation usually look like?

Miranda Sirvinskas: First conversation can be a little scary for some patients, and sometimes it's a very touchy subject, which can lead to some strong emotions during the visit. During the rooming process, the tech asks questions from the Patient Health Questionnaire or the PHQ-2, which is a screening questionnaire for depression. We ask every patient. Regardless of what they're coming in for that day, they get asked it. The questions are, for example, "In the last two weeks, have you had little interest or pleasure in doing things? And in the past two weeks, have you been feeling down, depressed, or hopeless?" If they answer yes to either or both of those questions, we move on to further questions in the PHQ-9. And then, during the visit, I review the questions with the patient, go over their score.

We also use the GAD-7, which screens for general anxiety. So, we use both those tools and it can help the patient and myself come to a better conclusion about what's going on. I like to ask what symptoms they're having, how they're feeling, and any life stressors that might be affecting those issues.

I also let my patients make the decision in their care as best as I can, whether it's therapy, going to psychiatry or medications. And I do my best to help make them aware of the different options that they have.

Host: That's great. You mentioned at the beginning of that it can be a conversation that, you know, leads to some anxiety, and a lot of people worry about this appointment that they might be rushed or they might be judged. So, how do you go about creating a safe space that's comfortable for your patients to open up in?

Miranda Sirvinskas: Yeah. So like I said, I think many patients are fearful in some way to bring up those issues. They might feel ashamed or disappointed in themselves. And I try to explain to everyone that they're not alone in this and it's necessary to talk about it and ask for help when it's needed.

I make sure I look at the patient and listen to understand how they're feeling and what the best course of action might be for them. I never rush the appointment regardless of how long it takes. I ask the patients to be as honest and open as they can be so I can help them appropriately. And I've had several patients tell me that I'm easy to talk to or that they feel much better at the end of their visit. So, that alone makes me feel like, I'm doing something right and creating the safe space for my patients.

Host: That's great. I think one of the hugest components that you touched on is just not feeling the rushedness, you know, saying like, "We can talk about this as long as we need to." So, that's really great. We're going to take a quick break to talk about primary care at Riverside.

At Riverside, our primary care providers are right here in your community, offering personalized care for you and your family close to home, and connected to specialists and the services that you may need. Having a primary care provider means having someone who knows you, listens to you, and helps you stay well through every stage of life, from annual checkups and preventative screenings to managing everyday concerns when they pop up, because remarkable care should never be out of reach. Remarkable care right where you live.

To find a primary care provider who's right for you and your family, visit myrhc.net/acceptingnew.

And we are back. So, what kinds of support can primary care actually offer from screenings to treatment to referrals for mental health?

Miranda Sirvinskas: Sure. As I mentioned above, we use the screenings, the PHQ-2 and/or 9 and the GAD-7 screenings to screen for anxiety and depression. Sometimes we also use a screening for ADD or ADHD if appropriate. We can prescribe medications to treat anxiety and depression, such as common ones, SSRIs, SNRIs, MAOIs, et cetera. if we think a patient needs additional screenings for more complex psychiatric illnesses, we can refer to psychiatry or neuropsychiatry for a formal evaluation. I also refer to psychology if a patient prefers, psychotherapy or talk therapy instead of medications or along with the medications. I think both are helpful.

Host: Okay. So when you're going through that process, is there a specific way that you can decide if, okay, this is something that we are able to help with versus you'll benefit from seeing a specialist?

Miranda Sirvinskas: Yeah. A lot of times in talking with the patient and learning more about them, I'm usually able to decide whether or not the patient is stable enough for me to treat versus seeing a specialist. Depression, anxiety, mood disorders, and ADHD can typically be managed by primary care. There's many complex cases such as bipolar or schizophrenia, just to name a couple that will require a patient to see a specialist.

In addition, some patients may not be responding to medications as well as we had expected, and they will need to see a specialist as well.

Host: Awesome. So, mental health can affect a lot of different things in your body: sleep, energy, focus, your physical health. What are some signs that mental health might be impacting someone more than they realize?

Miranda Sirvinskas: Anxiety can manifest in physical symptoms, which patients might come in and explain, such as rapid heartbeat or palpitations, chest pain or pressure, shortness of breath, feeling like you can't breathe, headaches, shaking. Digestive issues are a big one, like nausea, diarrhea, constipation, stomach pain, fatigue or dizziness. And then, depression can cause an extreme lack of energy or motivation, chronic pain; trouble sleeping, either too much or too little; loss of appetite and weight loss or the opposite, increased cravings and weight gain; digestive issues, sexual dysfunction and risk for illnesses. And I think that a lot of people. You know, they see these symptoms and they don't realize that it's related to anxiety or depression, and they think something else is going on. So, it's important to address those symptoms during the appointment.

Host: That's great to know that it's kind of like full body-focused and that you'll kind of go through everything that it could be and kind of get to the bottom of that and figure it out. If someone listening is struggling, but they feel unsure about reaching out, they're not sure if that's the right step for them. What would you want them to know about starting with their primary care provider?

Miranda Sirvinskas: I would say your primary care provider is the best place to start as we are more accessible in terms of getting an appointment more quickly. We also know you as a whole person from prior visits. Even as a new patient, it's still a great place to start. I get a handful of new patients each month with the main concern of anxiety or depression, and they end up very happy that they came in.

Another thing that I did want to share is that patients should never feel alone and approximately 23% of adults in the United States experience mental health illness annually. And about one in five adults experience a diagnosable condition in any given year. And the lifetime prevalence is about 46% of Americans will meet the criteria for a mental health condition in their lifetime.

Host: Wow.

Miranda Sirvinskas: It's pretty heavy.

Host: Definitely. I mean, and I can speak from experience that that's something that in the last year I was able to talk with my PCP about anxiety, things like that, and get on the right track. And it has been life-changing. So, it's so great to have someone who will listen and help you to find the right path for you.

Miranda Sirvinskas: Absolutely.

Host: Yeah. Well, thank you so much for being here today.

Miranda Sirvinskas: Yeah, thank you for having me.

Host: Of course. And thank you listeners for tuning into the Well Within podcast. Be sure to like and subscribe to Well Within Reach on Apple, Spotify, or wherever you get your podcasts. To learn more about the services at Riverside Healthcare, go to riversidehealthcare.org.