Jamie Lewis (Host): Mental health concerns continue to rise across all age groups affecting millions of Americans each year. Here to discuss mental health awareness and practical strategies is Dr. Nick Phillips, a psychiatrist specializing in both adult and adolescent care at Tri-State Health.

This is Tri-State Health Talk, a production of Tri-State Health. I'm Jamie Lewis. Dr. Phillips, thanks so much for being here.

Dr. Nick Phillips: Yeah. Thank you for having me. I'm happy to be here.

Host: Well, maybe we could start with the facts about mental health. So, what do you see as some of the most important things about mental health that people may not know?

Dr. Nick Phillips: I think some of the most important things are just the idea that physical well-being is really what's going to best approximate our mental well-being a lot of times. So, we think so much about taking care of our body or exercise, things like that, eating right as it relates to our physical well-being. But a lot of times, we dissociate the mind from the body. And so, it's really crucial to get enough exercise. There's been studies over the last couple years showing that if you can get in 8,000 steps a day, just walking, your associated rate of depression is much lower. There's similar studies that have come out over the last few years for just lifting weights, which is like resistance training. So, I think all of those are really crucial to understand.

And then, kind of a broad answer, I think a lot of people don't appreciate or don't recognize some of the trends that we see, which is that we're having increased anxiety, increased depression. I think certainly when you talk to people, over the last few years, you can maybe feel that with the increased anxiety rates. And then, some other concerning trends, as it relates to, unfortunately, suicide rates in the country, but also some really encouraging trends as it relates to decreasing substance use and alcohol use amongst our teens. So, those are some of the initial things that come into mind.

Host: Well, and along those lines, you're mentioning trends among young people. I mean, we see it in the news, we hear it all the time, that anxiety and depression and other mental health challenges are rising among young people. Have you seen that trend borne out in your practice? And what do you observe?

Dr. Nick Phillips: That's definitely accurate. The population of people I see in my practice is not representative of the overall population because by the time they get to me, they've gone through a therapist and/or primary care provider, and the primary care providers in the community do a great job of managing mental health to where they've tried a lot of strategies of the things I mentioned already that are behavioral strategies and they've maybe tried one or two or more medications already.,

So, I do see that though-- certainly, I think, we don't like to talk about it-- but since 2020 after the pandemic, there's been almost a doubling in the rate of anxiety as far as if you survey people in the community and ask them how anxious they feel so that's about twice as high as it was if you would've gone back to 2019.

Host: Do you think that that's a question more of reporting or actually the trend is traveling upward for anxiety and depression?

Dr. Nick Phillips: Yeah. I think the trend is upward. I don't think it's overreporting. We see similar things in the questions when we ask high schoolers, their substance use rates or their depression anxiety. Have they felt depressed in the last month? Have they been suicidal in the last month, felt anxious, drank alcohol in the last month? Those kinds of questions that I think you get false positive, false negative answers there where people are overreporting or underreporting. But the trends show a pretty consistent picture recently with higher anxiety, and I think we have some theories behind that, maybe nothing concrete.

Host: You did talk about earlier overall physical health as being tied to brain health and mental health. But beyond medication, which we know can help, what practical strategies are people incorporating into their daily lives to improve mental well-being that you're seeing?

Dr. Nick Phillips: So, we mentioned exercise and you don't want to start off with goals that aren't attainable. I think that's one of the biggest things across the board for whatever kind of behavior change you're going to attempt to make or something new that you're going to implement in your life, is starting off with setting a reasonable goal. If you're joining a gym, I tell people, "Go to the gym for five minutes the first day, and then don't go for a couple days, and then try to get in there for another five or maybe even just 10 minutes the next time." You don't go with the idea, I'm going to go for an hour and work out really hard if I haven't worked out in several years. And so, you want to be successful with what you try to do, regardless of what that is, of changing your sleep, changing your eating habits, how much time you're spending with friends. So, those are some of the things I see that are really crucial, is we want to go for walks. We want to spend time doing the things we love to increase the joy in our life and engaging in social activities, which increases our sense of belonging. Both of those things, when they're not satisfactory in our lives, are associated with bad outcomes related to depression and other mental health problems.

And then, if none of that's helping, we want to seek out counseling or talk to our primary care doctor if we haven't already. It can be hard to get into counseling. There are some online options that work for people too. There's a program out of Boise. We have some great counselors in the community. So, those are all options. And then, sometimes supplements are relevant or can be helpful depending on what's going on with the person.

Host: Well that was my next question actually, as I know that there's a growing interest in supplements for mental health. And so, I'm wondering how should people approach that option, and are there any supplements that have any kind of scientific stamp of approval?

Dr. Nick Phillips: So, I think you can't talk about supplements without bringing up the concept of a placebo effect. So, the idea that, you know, a doctor or your friend tells you, "Hey, if you take this, it really helped me out. If you take it, it's going to help you out," whether it's for sleep, for anxiety, for depression. And so when, we try to decide is something truly effective for this science and the reason related to that specific supplement, we always try to figure that out.

And so, when it comes to mental health, a lot of supplements and medications have a challenge of people have a big response to placebo when it comes to mental health. So for depression, the placebo response rate for a lot of trials can be between 20-35%. So, you'll have roughly maybe a quarter or a third of people that get a placebo pill rather than the active medication or supplement in a depression trial that then actually have a significant improvement in their symptoms. And so, that does present a challenge, not only for psychotropic medications that we prescribe, but also for supplements. The study sizes tend to be smaller, so you have a smaller sample size for a lot of the supplements in comparison to the randomized controlled trials for some of the prescribed medications for those conditions.

But there are some supplements that I see really be effective for people. Vitamin D supplemented can be helpful. The most common recommended dose for mild depression symptoms with that is 5,000 IU recently, so a study came out showing that versus a lower dose of 2000 IU that we would use previously for depression. There's a supplement called N-acetylcysteine that can be helpful for some obsessive-compulsive behaviors or skin picking. So, those are two of the supplements that I see that can have an effect size the magnitude of improvement in our target symptoms that at times can parallel a prescribed medication.

And then, we know the supplement industry is like a multi-billion dollar industry right now. And it floods social media and advertisement. And so, some of it can be overwhelming. And I think getting to the idea of are we taking a supplement to treat a deficiency in our body? Are we taking a supplement for trying to have superior performance in some aspect of our life? Like, we want to be super happy, or we want to be able to concentrate really, really well, or we want to live a long time like for longevity. So, that's the other thing to always think about with supplements and why am I taking it, and is that relevant to the supplement and what the evidence with the supplement shows.

So, a couple other things: magnesium, zinc, fish oil, those all have some evidence in small studies for treating mild depression symptoms. Of course, we use melatonin for sleep quite frequently, and that's a pretty well-studied supplement. There's some evidence for creatine, maybe treating mild depression or helping with mild depression, either in combination with an antidepressant or standing alone by itself. Again, a lot of these are smaller sample sizes when it comes to their benefits to mental health.

Host: Right. Good distinctions to be made there too. You mentioned social media. And I know when we're talking about young people, a lot of parents are concerned about their children's exposure to screens and social media. I am wondering what does the research tell us about their effects on mental health, especially for those who are in those tenuous formative adolescent years?

Dr. Nick Phillips: I think that's the million dollar question right now for our society as a whole. As we know, it's not just teens anymore, spending too much time on the various social media platforms, and I think we're seeing the effects of that related to that's probably one of the factors increasing anxiety levels or possibly exacerbating some of the increased concentration problems that we see a lot of teenagers and adults presenting with it.

And so, I think those are the biggest things. There's evidence that increased social media use is associated with increased anxiety or increased depression. We want to try to put off access to social media as long as we can. I know kind of one consensus approach is no social media until as close to 16 as you can get without losing your teenager. But probably at least 14, 16 is best. So, you go through those formative early adolescent years when you're so susceptible to the opinions of others and lacking in your self-confidence without accessing social media. Maybe putting off a smartphone until 14. So, these are kind of drastic sounding things. However, that's trending toward the recent recommendations.

And then, I think the other thing is the time of day that we're on our phone or on social media. So, a lot of us are aware of the idea that, "I shouldn't be on my phone or having screen time right before bed, that I could disrupt my sleep," even though most of us are probably doing that to an extent. There's also some more data recently about maybe not being on your phone immediately after you wake up. So, separate from purely just social media, but the idea that you pick your phone up, and it's a bright light and you're starting to, you know, scroll your emails from work or whatever, check what came in overnight. And in doing so, you're turning on your brain's fight or flight system first thing in the morning actually. because our brain really misperceives the bright light as a threat. And so, that can increase your cortisol levels early in the day and kind of exacerbate an anxious or poor attention span pattern for the rest of the day. So, those are the other things I'm talking to people about a lot lately, is the timing of when we're using our phone or accessing social media.

Host: Yeah, I think that's really important, vital to remember going forward. I for sure feel more harried, more hectic, more fragmented when I get on my phone first thing in the morning. So, yeah, I've just observed that in my own body. Well, you touched on sleep, the importance of sleep, which I think also gets underutilized as a tool for mental health; the importance of physical activity and, if you're starting it brand new, going slow and being gentle with yourself about it. But what about diet? What do you see as specific dietary factors that people should be aware of for mental health?

Dr. Nick Phillips: We started off talking about that of just what we're putting in our bodies can have a huge impact on what we're getting out in terms of how anxious we are. Are we depressed? How's our motivation? How's our focus? So, there's a big push nationally, I think, to try to avoid artificial sweeteners as much as possible. And you've seen the labeling where everybody knew what aspartame was, so they started taking that out of foods. And then, there's other artificial sweeteners they would use like acesulfame or sucralose, and people are starting to catch onto that as well. But in general, we want to minimize the use of any of those as much as possible. The sugar alcohols, like xylitol, erythritol are associated with bad cardiac outcomes. Others likely cause type two diabetes. The claim that there are zero calories is false. Old studies show maybe there's a 15-20% rate of metabolism of those, so it's not actually zero calories. And you're probably making your body less efficient at breaking down sugar from your other calorie sources throughout the day by consuming those.

And then, the other thing that I think is a really hot button issue is consuming seed oils, right? So, canola oil, vegetable oil, things like that. And maybe in small quantities, those are fine. There's two concepts there about why we think they might be bad for us. Number one is they are sprayed with pesticides while they're being grown in the fields. And since they're making the oil out of those plants, the pesticide can, in theory, soak into the oil itself. And then, we're consuming that.

And then, the other is the idea of what fat type we have. So, omega-3 and omega-6 fatty acids. So, things like salmon are really rich in omega-3 fatty acids and are very helpful for mood and our overall health, the health of our cardiovascular system. And so, the seed oils contained a lot of omega-6 fatty acids, and that throws off the balance of omega-6 to omega-3 fatty acids, which tends to push us in the direction of having more systemic inflammation. So, that might be contributing to fatigue, mildly depressed mood, joint pain, things like that, that so many Americans struggle with.

And so, I think those are some places to start, you know, not going to the point of you're likely never going to get seed oils entirely out of your life, but just being mindful of what we're consuming, if it's something we're going to snack on every single day.

Host: Well, to wrap things up, I'm curious, is there anything else that you want to leave the listening audience with about prioritizing mental health?

Dr. Nick Phillips: Some of the most important things are just doing the activities you like. Get outside, go outside first thing in the morning. If you can call a friend you haven't talked to in a while, avoid being on your phone right away. Try to get your 8,000 steps in once you've built slowly up to that, right? Or add in some weight training into your daily life. And if none of that's working or if you just want to do that and you can't get off go, you can't start that process, that's where therapy or possibly medicines if appropriate, if you're struggling with a depressive or anxiety disorder, that's where medicines can sometimes come in and be helpful to get us the initial amount of motivation to start making those behavior changes.

So, we have a great behavioral health team at Tri-State and are very well supported by the hospital as a whole. And people can reach out to us if all these other things aren't working for them or they just can't implement the changes that are needed to make a difference.

Host: Well, that's a great first line of prevention. Thank you so much for all of your expertise, all the information and insight.

Dr. Nick Phillips: Yeah. Thank you so much for having me. It's been a pleasure.

Host: That was Dr. Nick Phillips, psychiatrist at Tri-State Health. To learn more or to schedule an appointment, visit tsh.org and thank you for listening to Tri-State Health Talk.