Nolan Alexander (Host): This is Community Connect: presented by Tampa General hospital. I'm Nolan Alexander. Joining me is Dr. Ryan Wagoner, Chair of the Department of Psychiatry and Behavioral Neurosciences and Medical Director of the Behavioral Health Institute at Tampa General Hospital.

 Dr. Wagoner, welcome. Thanks for joining us today.

Dr. Ryan Wagoner: Thank you for having me.

Host: Today, we're talking about mental health and recognizing when to seek assistance. So, let's get on the same page. How is a psychiatric condition defined?

Dr. Ryan Wagoner: A psychiatric condition is defined as some sort of health condition that affects a person's thinking, their mood, their behavior. And it typically causes significant distress or impairment. You know, this is really a way to differentiate it from, say, for example, just a psychiatric symptom, right? We could all have symptoms of things, but an actual condition or a disorder is when enough symptoms impact the way that a person is able to function in their daily life.

Host: Is normal stress and feeling down a psychiatric condition?

Dr. Ryan Wagoner: Normal stress and feeling down are not by themselves psychiatric conditions. We have to remember that we're human beings, and we have different emotions, we have different responses to things. And depending on the situation, you can feel down or you can feel anxious.

For example, if something terrible happens to a loved one, it's completely natural to feel down about that. If you're going to be doing something that's stressful to you, it is very human to feel anxious about that. What we're trying to make clear though, is that sometimes those symptoms persist. They go on for a longer period, or they might cause some pretty significant distress or impairment. It's when those things happen that we start to consider those to be psychiatric conditions or psychiatric disorders.

Host: What would you qualify as a longer time?

Dr. Ryan Wagoner: It depends on the illness. You know, a longer time could be defined as, you know, in depression, lasting two weeks or more, versus something like generalized anxiety disorder, we're often looking for a pattern that can last six months or more. And so, it's really what I like to think about, it's not the occasional from time to time symptom, but something that is just more persistent, that it lasts day in and day out and is noticeable over a chunk of time. But it's going to vary for each different condition.

Host: Another qualifier you mentioned is if it could lead to other things, what would that look like?

Dr. Ryan Wagoner: Well, when we look at different psychiatric conditions, other things that we had talked about before might be other symptoms that arise in addition to just the one that you describe as, say, depression. For example, in major depressive disorder, you might have a depressed mood, which is often what people are talking about. But other symptoms that can come along with that include changes in a person's appetite, their interest in doing things, problems with energy, problems with concentration, problems with sleep, and may actually even be bad enough that they're having thoughts about wishing that they were dead, or suicidal thoughts. So, you can see how what a person commonly thinks about is just one symptom. But when a person truly has a psychiatric condition, there are a variety of other symptoms that enter the picture as well.

Host: I feel like I may know the answer to this based on what you said, but do I automatically need medications if I'm feeling anxious or down?

Dr. Ryan Wagoner: People who are experiencing feeling anxious or down do not immediately need medication for the most part, nor may they ever need medication in many cases. That's one of the reasons why it's good to see a professional to go through and figure out is this something that is part of the regular human experience or has this been hijacked and now we're in the area where it is a health condition that needs to be treated.

Even if it is a health condition, that does need to be treated, medications aren't always the first step. I like to say that some of my most satisfying evaluations are when at the end of it, I can tell the person, you know, "I think we can find you some help, but we don't need to do medications at this point." It's only whenever medications are warranted to really treat the condition that we start to go down that path.

Host: So with that, if I do have a psychiatric condition, what are my treatment options?

Dr. Ryan Wagoner: The different treatment options that are available to people with psychiatric conditions are really based upon the symptoms that they're having, and what particular condition it is. So, for example, if somebody has something like major depressive disorder, particularly if it's of a mild or moderate severity, we might recommend that that person starts with psychotherapy. So, that might be seeing a therapist, going through an evidence-based treatment protocol where they're given homework to do, they're asked to try to use new skills within therapy in order to try to overcome stressors and those sorts of things.

So, we'll often see those within anxiety disorders as well as depressive disorders. Sometimes though, those are either not effective, they need a little extra boost, or the condition is already severe enough that we might prescribe medication, say for example, antidepressants, which we often use both within depression and anxiety disorders.

There are other conditions though where we have to start with medications. For example, a psychotic disorder such as schizophrenia, where somebody might hear voices, see things that aren't there, become immensely paranoid about something. That type of condition often is not responsive to therapy, so that might be a situation where we jump immediately to medications in order to try to get that under control.

Host: Why would someone need to be admitted to a psychiatric hospital?

Dr. Ryan Wagoner: The primary reason that a person would be need to be admitted to a psychiatric hospital is because the condition is severe enough that we need to get immediate care, right? So, we think that it's a little bit different within psychiatry, but it's very similar to the rest of the medical community. You know, you can go to the outpatient whenever there's a condition that you don't immediately have to treat today, but you should go ahead and start on something so that it can eventually get treated.

But you might have to go to a hospital if it's something that needs to be taken care of right this moment or the type of medication that's going to be started has to be done in a hospital setting. It's very similar within psychiatry. A psychiatric hospitalization is for people who either wouldn't be safe if they were to remain at home or in the outpatient setting, they might not be able to take care of themselves, or they might be a danger to other people. that's one way that people get into a psychiatric hospital to go ahead and manage that quickly.

The other is if we want to adjust medications fairly rapidly, that might be another reason that somebody might choose the inpatient route, because then we can take care of that in a pretty quick way.

Host: And a big question here to wrap us up. Is mental illness curable?

Dr. Ryan Wagoner: I get asked pretty often if mental illness is curable, and the answer is it depends. Sort of like with health conditions, there are symptoms that we can treat and may never come back, which would often be associated with the term cure, right? So for example, if you were in a health clinic and you had some sort of bacterial infection, an antibiotic might be able to help with that.

On the psychiatric side of things, if a person had significant depressive symptoms or anxiety symptoms because of some specific stressor, like being at a job that they really hated, being in a relationship that wasn't working out, and that was eventually removed and the person was given the appropriate skills and treatment afterwards, then yeah, that may not come back, and we would consider that cured.

However, there are many psychiatric conditions, where we do manage them and a person may need to stay on medications long-term. I like to think of the comparison with certain health conditions like diabetes, right? Many people do have to continue to manage their diabetes long-term, and it's not something that they could just stop medications and it would go away.

On the psychiatric side of things, I think to myself, for example, someone who might have a psychotic disorder that developed whenever they were a teenager and they've had it for many, many, many years. That person likely does need some form of treatment in order to manage their condition. So, I wouldn't say that it's a cure. However, what I do want to note, because this is often the followup with it, is if you can't cure it, what can you do? And the answer is we can manage it quite well, right? Because if you've got the right medications on board and the symptoms are under good control, people can lead very fulfilling lives. They can continue with their daily activities. They can really get back to what they wanted to do before these conditions popped up. So to say that something is curable, it's a little hard to say. However, I would say that the vast majority of mental health conditions are manageable to a point where a person may need to stay on medications, but they may not even notice any symptoms.

Host: Dr. Wagoner, I feel like this has been an informative and a broad look at mental illness and mental health. Is there anything else that you'd like to add to this topic today?

Dr. Ryan Wagoner: I think the one thing I would like to add is that I think that people should feel comfortable talking about mental health. We've seen this become less and less stigmatized over the years, but there's still some room to go with it. But if you are somebody who is struggling with either depressive symptoms or anxiety, the thing that I tell folks is first just reach out for help and reach out to who you're comfortable with. If that is a trusted friend, if that's a member of the religious community, all of these are great options because really it's that comfort.

However, if you get to a point where people are saying, perhaps you need to see somebody professionally take advantage of that. Go and see someone. There's always this fear that if I go and I see a psychiatrist, or someone else in the mental health profession, they're immediately going to tell me there's something wrong with me and that I need medications and all of these sorts of things.

And often that is not true at all. We're not going to tell you there's something wrong with you. We're going to tell you that these are the symptoms and this is how we can manage them. And just because you go to see a psychiatrist, that doesn't automatically mean that you're going to be started on a medication.

Host: Dr. Wagoner, thank you so much for your time today. We're so much better for having this conversation with you. Thank you.

Dr. Ryan Wagoner: Thank you for having me.

Host: That has been Dr. Ryan Wagoner. And for more information, please visit health.usf.edu. If you enjoyed this episode, please be sure to like, subscribe, and follow Community Connect: presented by TGH on your favorite podcast platform. I'm Nolan Alexander. And this is Community Connect: presented by TGH. Thanks for listening.