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Scott Webb: In 2017, SAMHSA reported that 35% of adults 18 and older do not receive treatment for a major depressive episode. An estimated 17.3 million adults in the US have had at least one major depressive episode, this number represented 7.1% of all US adults. Let's find out how we can own our own mental health with Dr. Jasleen Chhatwal. She's the Chief Medical Officer and Director of the Mood Program at Sierra Tucson.

This is Let's Talk: Mind, Body, Spirit by Sierra Tucson. Sierra Tucson ranked number one best addiction treatment centers 2020 in Arizona by Newsweek I'm Scott Webb. Doctor, can you provide a quick overview of what constitutes a mood disorder and what anxiety issues are presenting right now?

Dr. Jasleen Chhatwal: Mood disorders is a pretty broad category. It essentially encompasses anything that affects how you're feeling in the moment. So you can be feeling sad and depressed, uh, which typically, you know, sadness and depression is different. Sadness is typically related to a situation. Depression can be more of an overarching team where for weeks at end a person can feel injuring themselves, not being able to feel joy, feeling that sadness, but present sort of throughout the day.

But then also mood disorders can constitute the opposite, which is partly another condition called bipolar disorder. It can constitute to some degree anxiety disorders as well because they make our mood anxious. And then also sometimes some specific types of trauma disorders can be thrown under the broader umbrella of mood disorder, because when we face really hard situations in our life, we do have an impact on our mood and how we present in the world and how we experience the world. And so all of these various different elements, which would be considered different, even diagnoses by clinicians and physicians such as myself, uh, can all fall under the broader umbrella of a mood disorder.

Scott Webb: What anxiety issues are presenting right now? Like what are you seeing?

Dr. Jasleen Chhatwal: Yeah, this has been quite a challenging year. Uh, and you know, taking that into context, there is a lot of different types of anxieties that people have. There's been the recent election and stress around that. There's worry about anxiety related to COVID, our health status, the ability to really live our lives like we've been used to.

So here at Sierra Tucson, we've been noticing a lot of individuals who previously knew that they had some struggle with anxiety, but noticing that it's starting to affect their day-to-day lives. So that can be a generalized anxiety picture, which is that people feel worried and, um, tend to ruminate on just about everything that comes up in the day. So things that previously seemed pretty doable may seem like they're very hard to get through now.

Uh, we're also seeing an increase in panic disorders or symptoms of panic where individuals can have just a very intense episode of anxiety, which lasts typically a few minutes to about 10 to 15 minutes and can make it so that, you know, you're in the middle of the market or you're in a grocery store and you have a panic attack and you might feel like you're about to have a heart attack and you might die. That's the type of intense feeling a panic attack and a panic disorder can bring. Um, so we're seeing those.

We're also noticing that people who previously had, uh, trauma-related symptoms. You know, they've been through the death of a loved one, or been through some traumatic abuse, um, and neglect-type situations earlier in their life and was coping with it well. So we're also seeing increased anxiety in those individuals where this additional trauma of 2020 has just added on more than that person can work through at this time.

Scott Webb: When we talk about diagnosis, how are individuals diagnosed? And are you seeing an increase as well in people struggling with mood issues?

Dr. Jasleen Chhatwal: Diagnoses usually come about in psychiatry or mental health, when something gets-- you know, any sort of symptom becomes to the level or rises to the level where it starts impacting your day-to-day life. So it could be like I was saying earlier that somebody deals with some low-grade anxiety that comes up in a situational way when they have exams or when they have a relational kind of stressor like an argument with their spouse. However, once it gets to the place that it starts impacting day-to-day life and it's not just a short-lived experience, that is when it can rise to the occasion of being called a disorder.

Um, and personally, sometimes I cringe at the word because it almost makes it seem like, "Oh, there's something wrong with you." And it really is for mental health conditions. Yes, there are genetic, you know, conditions that are passed on through our family. So if your mother is very anxious, you may have a higher risk of carrying forth that anxiety, both genetically also with the way that you're raised. But sometimes the disorder can make it seem like, "Oh, now this fits squarely in my lap. There's something wrong with me that I need to go get fixed."

And I always try to encourage people to look at it from a different perspective. It's to say, "Okay. Life has come to the point right now that things are a little too much. And maybe if I could take a step back and care for myself and get a different perspective and get some time to heal, then maybe I'll feel better."

And so it's almost like, you know, you got a sprain in your ankle and you stay off the ankle for a little bit, and there's a higher likelihood that you can heal from it. So similarly with mood and anxiety disorders, when something like that rares its head, it is important for us to say, "Okay, this is something that's going on. It's affecting my life. How do I take a step back? And can I take a step back in my life and spend a little bit more energy on healing and taking care of myself upfront so that it doesn't completely take me off my path?"

Scott Webb: Those are all such great points and so important for all of us to make time for ourselves and to be kind to ourselves. And to know that if ever there was a time that people may struggle, it would be 2020, that's to be sure. Does mood or anxiety disorder affect a particular segment of the population more than another?

Dr. Jasleen Chhatwal: That's an interesting question, because when we look at epidemiological studies, we do notice that both mood and anxiety disorders are actually fairly evenly distributed in a population. Uh, we noticed that periods of transition, so when you go from adolescence to adulthood, that youth age group can have a higher prevalence of anxiety and mood disorders. That is a time both biologically as well as psychologically a lot is happening in our lives. And so that's one time that we do see a big uptick in presentation of anxiety and mood conditions, um, and then we also see other transitions in life whenever people are making. So retirement age, which is kind of that perimenopausal or even slightly later, also has a combination of biologic factors that are changing and we're aging, and then there's the psychological factors of not really working anymore, having more time. So those are some times that we see spikes that come up.

But then also, you know, for women, when in their perinatal periods, when they're pregnant and right after they have kids, that can be another period that more of these conditions show up. But for the most part, all through adulthood and even through adolescence, you can get diagnosed with an anxiety or a mood disorder. Um, and so nobody's really quite immune or in the safe category from that, which is why what I was saying earlier about being mindful, checking in with ourselves, checking in with our loved ones, becomes really important.

Interestingly, for physical health, we do that a lot. You know, we can talk to each other every day, "Hey, are you going to the gym?" "Oh, I went for a run." "Oh, I like to swim." We think about that for physical health, but it's interesting that not everybody thinks that way for mental health. Like that seems to be a very new concept to say, "Okay, let's think about a mental health gym." "How is it that you're taking care of your mental health day to day?" What is the equivalent that you're doing for your mental wellbeing?

Scott Webb: And do you think the reason maybe that we just don't talk about mood and anxiety and those types of struggles and issues, do you think it's just that there's still a mental health stigma about that in this country?

Dr. Jasleen Chhatwal: Yeah, I think both here in the US and other places that I've worked, essentially globally, like the US is one of the countries where maybe it's a little bit more readily accessible to talk about mental health. So I do think it's not just our country that stands out if it is a global-type phenomena. And the way I think of it is, you know, physical health conditions are easy to see. You have a break in the bone, you have an abnormal lab value, like when you get a laboratory test. But for mental health, it is a more abstract concept for a lot of people. And we also know from other studies that even adults sometimes struggle with abstract thinking.

So to some degree it may be that, you know, we're not talking about this early on in life. There is the stigma associated. And then also it's asking for people to have some abstract thinking and taking somebody else's word for it. So if I have somebody sitting in the office with me and they say, "Hey, I'm feeling really depressed." There are some objective signs that I can also see, but I also have to take their word for it that they are feeling depressed and that, you know, it's sort of giving them grace and making sure that we honor their stories and how they're viewing their life. And sometimes socially, that can be hard because we're just kind of opinionated about other people.

Scott Webb: One of the things I want to ask you about is what are some of the new treatment methods and methodology that are available for improving our mood and reducing anxiety?

Dr. Jasleen Chhatwal: We have thankfully been working pretty diligently in the field of mental health, looking at alternate treatment modalities and such. And even though there is nothing that's say cutting edge or brand new or very different than before, we have over time expanded the overall number of modalities. Like over the last, um, couple of years we've been able to approve ketamine, which is used to be used as an anesthetic and then also kind of a party drug, but it's been studied in a different way and in a controlled manner to be used for depression. And that's got an FDA approval recently.

Uh, we're also looking at more creative and different ways of stimulating brain regions. So doing neurostimulation, such that we can activate areas of the brain that seem to, um, have slowed activity in depressed individuals. And then also start to try to modulate areas, um, in the more primitive emotion centers, which tend to be overactive in individuals with anxiety as well as a ruminative type of depression. So through transcranial magnetic stimulation, which is a form of neuromodulation, through some studies on bioneural feedback. Uh, so there are additive things that we're being able to do.

And then one of the things that I find really interesting is that we are being able to do even those smaller studies on looking at what large treatment looks like. So it could be doing some other things that are considered pretty broad-based popular knowledge, and then adding things that are considered integrative or previously would fall under the category of holistic medicine. So everybody's always heard about using light boxes using light therapy.

And so now we here in our work at Sierra Tucson in the Mood Disorders Program are trying to see how it would work when we have individuals not only using the medications, and then adding neurostimulation, but maybe also adding all these integrative modalities in more evidence-based ways. And so I think I'm fairly excited about our capability in helping individuals by using creative mixtures of treatment modalities.

Scott Webb: You know, doctor, it's so great having you on today. And as we get close to wrapping up here, what advice can you share with listeners about mood, anxiety, dealing with 2020, you know, the election, COVID, holidays, no pressure here, but what can you tell listeners? What advice can you give us?

Dr. Jasleen Chhatwal: I'd like to say to anybody who's listening today that trust yourself. You know yourself better than others around you may even know, and maybe even sometimes as professionals. It takes us a while to get to know people as well. That's why we spend a lot of time upfront trying to understand and see your perspective. But really trust yourself, then check in with yourself, like to do something that's a daily check-in be that in the form of journaling, be that, you know, now, there's this wonderful app that you can put information into and then really consider what your mental health workout looks like.

Um, and if you find yourself at the place where doing some of these things seem too much, then that really is the time that looking for a mental health professional to support you in your journey will be important. And there are other times, and for a lot of other individuals where maybe this will fall in the category of wellness and they feel like, "Oh, this is pretty doable, what she's saying." So I invite you to look at yourself and look at your health in a broader and more holistic way.

Scott Webb: That's great and a great way to finish. And I love your idea earlier about a mental health gym. Doctor, so great having you on, your expertise, your compassion, your excitement over new additive modalities. Thank you so much and you stay well.

Dr. Jasleen Chhatwal: Thank you, Scott. Thank you for having me and you have a wonderful day as well.

Scott Webb: Call (800) 842-4487 or go to SierraTucson.com for more information, Sierra Tucson, where change begins. And if you've found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is Let's Talk: Mind, Body, Spirit from Sierra Tucson.

I'm Scott Webb. Stay well.