Joey Wahler (Host): It's something that can benefit all of us, so we're discussing improving mental health. Our guest, Dr. Imran Shakir. He's a psychiatrist and Chief Medical Officer for Silver Oaks Behavioral Hospital.

Welcome to Silver Cross Hospital's iMatter Health podcast, where medical experts bring you the latest information on health topics that matter most to you and your family. Thanks for joining us. I'm Joey Wahler.

Hi there, Dr. Shakir. Thanks for being with us.

Imran Shakir, DO: Hi. Thanks so much for having me.

Host: Great to have you aboard. So first, do mental health struggles affect pretty much everyone? And I know this covers an awful lot of ground. But if so, generally speaking, how so?

Imran Shakir, DO: Yeah. I think it's something that touches everybody at some point in their lives. We're all very, you know, generally productive creatures. We put a lot on ourselves, expectations. We have a lot of responsibilities. And as we go through our day, oftentimes our mental health is something that routinely affects our function and our Well-being.

Host: So, what are the most common mental health issues people suffer from these days?

Imran Shakir, DO: So, you know, there's a difference between a mental health struggle and then what you might consider something more of a clinical concern. I think for the vast majority of Americans, anxiety is something that I think we all struggle with. Now, the difference between clinical anxiety and normal anxiety, it's a lot to do with our function and how our anxieties are affecting our function.

However, I can't imagine there's anyone that can say, "Hey, I don't have anxiety," or "I've never experienced that." So, I would imagine that the vast majority of us are dealing with this in a healthy way or, oftentimes, what's going on is we're not even conscious of it. We're not even paying attention to what's going on inside of us, which has its own issues associated with it.

Host: And oftentimes, am I right, anxiety goes hand in hand with depression, which on the surface might seem like a pair of things that wouldn't go together kind of like jumbo shrimp, right? But they do go together.

Imran Shakir, DO: Yeah, absolutely. You know, research is actually starting to paint anxiety and depression as illnesses on two ends of the same spectrum. Some of the things supporting that is, gosh, the comorbidity is probably 80%, 85%, meaning that if you present with anxiety, 80% of those individuals also have comorbid depression.

If you also go further than that, if you look at the approach to the management of anxiety and depression, it's very similar. A lot of the drugs that we use to manage anxiety are the same ones we use in the management of depression. Same goes for therapy.

Host: Interesting. So, that being said, doctor, when would you say someone should seek help when struggling with their mental health? What's the line?

Imran Shakir, DO: So yeah, the line is function. Function, function, function. And then, that is typically the line between a disorder, and not a disorder, meaning normal anxiety, right? We want to feel anxious. It's protective. If I'm anxious about a test I have to take tomorrow, it's probably going to motivate me to study. If I see a bear in the forest, It's going to make me anxious. I'm going to try to run and protect myself.

However, just like anything else in our body, just like our pancreas can stop working correctly, our lungs can stop working correctly, kidneys can stop working correctly, so can the centers in our brain responsible for regulating anxiety. And so, typically, the line is Is it starting to affect your function? And so, an example I routinely give to my patients is, "Hey, I know you're anxious, but is your anxiety the reason that you're taking off from work regularly? Is that why you're in trouble at work?" Or the child is refusing to go to school. "Hey, is it your anxiety? That's really getting in the way of you being able to attend school and not be truant."

You know, with depression, function, and perhaps it may not affect you as much from a professional standpoint, but certainly, in your family or your social functioning, "Hey, are you isolating? Are you not seeking social interaction? Are the things that you used to love now seeming like a waste of time?" And typically, again, we're not even conscious about these things. It's kind of an insidious onset. It's small changes over a long period of time. So, the patient or the person themselves may not even be aware of it, but those around them noticed these changes.

Host: And speaking, doctor, of our functionality being affected, just how is mental health connected to our physical health?

Imran Shakir, DO: Gosh, you know, I think I'd have a harder time arguing how they're not connected rather than connected. Again, you look at the research, right? So gosh, what's an easy way I can improve my mental health right now? Exercise. That's a physical activity, right? But when you look at what's happening when we're exercising, the very same endorphins and neurochemicals that we're trying to affect with therapy and medications are being released naturally when individuals are engaging in exercise in a regular manner. I would say that that alone is good evidence that our physical health is directly connected to our mental health.

Going further than that, you know, there's a lot of research now connecting the so-called gut-brain connection, things that we hadn't even considered in the past. Looking at flora and how many kinds of organisms that we have in our gut and comparing populations and saying, "Well, this particular gut microbe is less than normal in people who have anxiety. And people with depression present with higher levels, in general, of another microbe." And then, that ties into our diet and healthy eating. Taking good care of your dietary health is also scientifically proven to affect our mental health. So, we see these signs and symptoms everywhere, that they're clearly very connected things in a very biological way.

Host: And continuing on that path, you mentioned diet, exercise. So, how big a factor in mental health is getting enough sleep?

Imran Shakir, DO: Yeah,. Gosh, sleep is so very important. one of the most common presenting symptoms is changes in sleep, changes in appetite, biological functions getting affected by mental illness. And once you start to really focus in on sleep and try to get that better, it should be probably the top three priorities for someone who's really starting to get into treatment is regulating sleep. It starts to pay dividends. Imagine, you know, I know when I don't sleep, well, the next day is just that much harder for me. I am perhaps more on edge. Thoughts come slower to me. Words come slower to me. Now, add on clinical depression or a generalized anxiety disorder, which is already affecting your function. It's certainly additive and probably in an exponential kind of way, meaning it's not the fact that you're not sleeping well multiplies, not adds, but multiplies your difficulty in function. So, taking care of your sleep, making sure you're sleeping, what's a normal amount for you or a healthy amount for you is just so very important. It's not something that can even be overlooked.

Host: As you all know, so many people struggle with sleep, getting enough, getting enough quality rest, et cetera. So, do you have a tip on what people can do to bring about a better night's rest?

Imran Shakir, DO: Such a varied kind of everyone's experience with sleep is different. What's normal for everybody, you know, is oftentimes not normal for the next person. There is such a thing as sleep efficiency. There's people out there that can function very highly on four hours of sleep. There are others who need a full eight to function highly. It tends to be a tailored kind of exploration, meaning, "Hey, how have you slept? When was the last time you slept well? And how are you sleeping at that time? You know, using that as a foundation to build healthy sleep habits.

There's a lot of treatments out there. There's a kind of therapy, cognitive behavioral therapy-I, that I is for insomnia. And believe it or not, it's been shown to be more effective for regulating sleep, sleep onset, sleep latency, all of those things than most sleep aids on the market. And so, what we get from that is how our state of mind and our purposeful conscious approach to sleep matters a lot, right? If I can go and talk to someone and learn how to sleep better, research supports that, gosh, this person is sleeping better and it's better than anything that's ever been offered by most sleep aids, what more proof do you need than that? That, "Hey. Our mindset matters a lot." And this is something that takes a purposeful approach. It takes engagement with treatment with a professional if you're struggling with sleep at that level. But the basic things are the basic things. Screen time, you have to limit your screen time. Our screens emit blue light. And blue light to our brain is blue sky. Blue skies, it biochemically reverses the melatonin release and the natural things our brain does to shut itself down. Making sure that we're not taking caffeine. Making sure that when we are in bed, we're using it just for sleep. We're not answering emails. We're not sending out texts. Because when we're doing work in bed, that sends a signal to our brain. We train ourselves to now turn the bed, not as a place of rest, but as an extension of your office. And over time, it becomes harder and harder for you to sleep.

Host: Couple of other things. We spoke of sleep. So, how about the importance of then waking up after sleep and starting our day on the right foot to improve mental health? What's one thought maybe people can keep in mind about starting the day right?

Imran Shakir, DO: Mindfulness, you know, and it's such a powerful thing, and it's a really simple thing. The essence of mindfulness is insight. Insight looking inward, right? Looking inside ourselves. And it's really just a matter of starting your day, logging your emotions, how you're feeling that moment, kid of in a very conscious way. "Gosh, I woke up kind of anxious today. Where's that coming from? I'm feeling kind of down today. Why is that?" You know, so many times, we carry emotions with us and we're not even aware why we're carrying them. We go through half our day before we kind of say, "God, you know, today's just not a good day. I'm not feeling well." Really, if you explore that and you say, "Well, what do you mean I'm not feeling well?" "Well, I'm kind of feeling anxious today." "Why am I feeling anxious?" "Well, I had a negative interaction with someone that I really respect the other day." And just bringing that from the unconscious into the conscious mind, I can't tell you how powerful that is to process that anxiety and however we're feeling.

So, it's really as simple as waking up, doing an inventory of our emotions, processing those emotions, putting meaning to them, takes seconds. But it takes practice. And it takes a purposeful and calculated approach to this. This is something that is not going to come natural to anyone. But if we do it, I can't tell you any advice I can give to anybody that could potentially be more powerful than that.

Host: Interesting. So, I guess what you're saying there is we all have many of the same thoughts and feelings, but it's a matter of being more in tune with them and how they're affecting the way we go about our day, right?

Imran Shakir, DO: Absolutely. Yeah, you got it. And again, it sounds so simple. But when you start to practice it and you start to do it, it's almost like something falls into place. You know, it's like, "Gosh, this feels so natural." How come it's not a natural process that my brain just does? Again, it requires practice. It requires a concerted effort to do this. But again, when you do it, it'll help you not only in the morning, but goodness, in the rest of your day. And certainly, you know, it'll start to pay dividends in your relationships, in your productivity, and on and on and on.

Host: Absolutely. So in summary, doctor, as you know, mental health awareness in recent years is getting much more public attention on TV and radio, social media, for sure. How beneficial is that to you and yours and to the community at large to have this be something that's more on the forefront of people's minds and have it maybe create less of a stigma as well?

Imran Shakir, DO: That's exactly what I would say. That's what I appreciate most about this awareness, is breaking down these walls, and primarily stigma. You know, I have this conversation all the time with my patients. We always give our ourselves permission to be sick when it's a physical thing. We don't blame ourselves when we break our leg. We don't say, "God, I should be able to think my broken leg away and walk." It's like saying to someone with diabetes, "Well, doctor, I don't want to take medicine. I don't want to do treatment. I'm just going to control my sugar with my thoughts." It sounds absurd. But for whatever reason, when it comes to mental illness, we throw our hands up and we say, "I don't want to depend on your treatments to feel better. I don't want to engage in treatment because I should just not have to think this way. I should just be able to think this way or use my thoughts to no longer feel depressed." These are all chemical illnesses. This is biology. This is neurochemistry. It's just affecting different parts of our brain.

Now, breaking those walls down and reducing that stigma will hopefully turn into engagement, right? Meaning, trying to come to a point where people know when to reach out for help, that's what matters the most. Again, we're all supposed to feel anxious, it's a normal emotion. We're supposed to feel sad, that's a normal emotion. There's a difference between anxiety and generalized anxiety disorder and panic disorder. There's a difference between sadness or mourning and clinical depression or complicated grief.

Again, just to recap, that lies in how badly it's affecting our function. That is the litmus test. In mental health, I know everybody on this side of the table, all the psychiatrists, therapists, mental health workers, we've known we've had a crisis in this country long before it's become chic or in the media. And so, it's nice to see that mental health is kind of being elevated, and it's taken more seriously, and it's becoming kind of the bell of the ball. Because, goodness, if we compare the cost of mental illness to physical illness, oftentimes we find mental illness is costing our country a lot more than physical illness is.

And so, at the end of the day, what that says is a vast majority of our population is dealing with these things, struggling with illness, however not engaging with treatment, not taking that next step to get better.

Host: Absolutely. And folks, we trust you're now more familiar with improving mental health. Valuable information indeed. Dr. Imran Shakir, thanks so much again.

Imran Shakir, DO: My pleasure.

Host: And for more information, please visit silvercross.org/mentalhealth. Again, silvercross.org/mentalhealth. Now, if you found this podcast helpful, please do share it on your social media. I'm Joey Wahler. And thanks again for being part of Silver Cross Hospital's iMatter Health podcast.