Transcription:
Women's Mental Health Awareness

Melanie: Thanks for tuning into Back To Health, the podcast that brings you up-to-the-minute information on the latest trends and breakthroughs in health, wellness, and medical care. Today's special episode is part of our Women's Health Wednesday series, which features in-depth conversations with Weill Cornell Medicine's top physicians and issues surrounding women's health throughout their life course. Listen here for the information and insights that will help you make the most informed and best healthcare choices for you.

I'm Melanie Cole. And today, we are discussing mental health. Joining me is Dr. Alison Hermann. She's an assistant professor in Clinical Psychiatry at Weill Cornell Medicine and an assistant attending psychiatrist at New York Presbyterian Weill Cornell Medical Center. Dr. Hermann, it's a pleasure to have you join us today. And as a woman in my 50s, on the upper end of that, I feel it. I feel it with my friends. I feel it with my family. I'm seeing it. Have you seen this incredible uptick in mental health issues? Not only since COVID, but for the last few years, I've kind of been feeling this worldwide stress. What have you been seeing?

Dr Alison Hermann: Absolutely. And Melanie, you really aren't alone in that. I am seeing a huge rise in the amount of distress just in the general ether. One thing I would say around that is that it may be useful to separate out distress and uncomfortable feelings and anxiety from mental health problems, because, you know, one thing that a lot of people don't realize is that emotions give us important information. And there's a reason that we have them, even uncomfortable emotions or ones that are difficult to tolerate.

So, for example, we feel sadness when we have a loss and it's part of how we understand that we've had a loss. And we have fear when we're in danger and that's part of what protects us and keeps us safe. And so those emotions are important to have and to understand and to nurture. The problem is that, when they get out of control or when they are not well-matched to the situation we're trying to face, right? So when you have an anxiety disorder, you have fear, but there's not actually a danger. Or when you have depression, you have sadness that's much more pervasive or problematic than a well-circumscribed incident, right? So, that's when the mental health issues come in and that's when we want to kind of view it in a different way.

The last few years, there's a lot going on that's scary, right? So we've had a lot of political unrest and we've had a lot of conflict out in the ether. And certainly with the COVID pandemic, there is a real danger out there. The threat is real. And so feeling on edge or fearful or anxious is a reasonable and appropriate reaction to what's happening in the world. The challenge for us is that it's long-lasting and we have to figure out how to cope, keep ourselves regulated and get through that hard time.

Melanie: Wow. So I love that you described a difference between this anxiety that we're all feeling and really mental health issues. So do you feel as this is crossing over a little bit, right? I mean, yes, some of us are feeling anxious, but maybe we don't actually have a clinical depression or a mental health issue, anxiety disorder. Do you still feel that there's this stigma that people are reluctant? Especially women, Dr. Hermann, we are the caregivers of the world and we have to put our own masks on as it were before we can help our loved ones. Do you feel that sometimes we are willing to pass off our own issues in response to just saying, "No, I'm strong enough. I can live with this or this depression isn't going to get me."

Dr Alison Hermann: That's a really good point. The stigma around mental health is less and less every year from what I see. And a lot of that is just because people are more willing to talk about it and we see kind of the fuller range of mental health struggles that are out there. It's not just the most severe illnesses that we see, but when people talk about going to a therapist or getting treatment for a milder condition, then we can see that it's much more common than previously understood.

That being said, I think there is something else that you touched on in terms of, once we recognize as women that things are going well for us, how do we respond to that? One of the things that we face in that particular role, more often than not take a leadership role in our families, managing our family and a lot of women also work outside of the home. There's an opportunity cost, right? And it's often difficult to put our own needs higher in the priority list there compared to all the pressing needs of our families and our homes and our workplaces and our friends and our community obligations. It's tough to say, "No, actually I need to take care of myself and I need to take care of myself" to the exclusion maybe of some of these other things that I think and know are important.

Melanie: True, really. So then tell us some red flags, some signs that this is a true mental illness, that we are suffering from depression. And while you're telling us these things to look for in ourselves, please tell us, if someone sees it in us or we see it in someone else, what do we do?

Dr Alison Hermann: The first thing I would say is when the uncomfortable feelings, the fear, or worries or sadness or irritability are transient and in reaction to an identifiable event and you can manage them, you often can find stress management or behavioral techniques to respond to them, and that maybe all that's needed. And, when they start to affect your body and, by that, I mean, your eating and sleeping patterns, your level of energy, your ability to function physically, then that's one thing that you have to start paying attention to. When they affect your work performance or your ability to meet your regular obligations of life, that's something to pay attention to.

And when they are affecting your relationships, important relationships. So if these symptoms are contributing to more frequent arguments with your spouse or if you're finding that you're being harder on your kids than you think that the situation really should demand, then that's something to pay attention to.

One last thing I would add in there is if there's been a creeping up of unhealthy coping behaviors. And by that, I mean, maybe more alcohol or too much alcohol, maybe more smoking or engaging in shopping behaviors or spending too much money or ways of just trying to kind of manage your emotions. Overeating is another one that might not be the healthiest for you. If you're coping in those ways that aren't healthy, then it's time to think about what more you need to do to help manage the situation.

In terms of if you see these things in other people, people that you love and care about and want to figure out what to do about it, it can be a very delicate situation because they may not see in themselves what you're seeing in them. You know, one of the insidious things about mental illnesses is that it can creep up on you in ways that are hard to recognize at first.

So what I would say there is if you're going to confront a loved one about this is to start by just opening up the conversation with some questions. Make a time to sit down to really connect and say a real, "How are you? How do you feel like you've been doing throughout all of this? Are there things that you're struggling with or worried about?" And oftentimes, when they have the time to sit and reflect, some things come up that you can touch on. "Oh, I have noticed that your sleep isn't as good as it normally was" or "I noticed that there seems to be a lot more junk food around" or whatever it is that has concerned you or, "Yeah, you and I have been getting in more arguments recently, and that's not normal for us. I wonder what we can do about it. Would you be open to maybe having a consultation or trying out a therapist or something to see what we can do to help you feel better?"

Melanie: So tell us a little bit about treatment in just a brief minute, Dr. Hermann. Tell us a little bit about some of the treatment options that are out there. And while you're doing that, things we can do for ourselves. You mentioned alcohol or smoking more or shopping more, and I've seen these things in all of my friends. I mean really lately, but the difference being the actual mental health that may have existed before all this anxiety that we're all feeling, right? So what would you like us to be doing for ourselves as far as self-care, because that's so important, and mindfulness. But then speak a little bit about treatment options available, whether they be medication or cognitive behavioral therapy or what you want women to know about the help that is out there.

Dr Alison Hermann: I'll start with the regular stress management strategies first. What I tell my patients all the time is that there is not a pill I can give you that's a better stress manager than exercise. Exercise really needs to be prioritized in your life and it doesn't have to be anything crazy. You know, what I would want you to do is I want you to kind of do an assessment of the amount of physical movement you're doing in your day. The wearables can be really helpful for giving you some more accurate feedback on that. And just seeing if we can increase it a little bit, right? So can we take a longer walk? Can we take the stairs? Can we do a little bit more stretching? And even if it's 10 or 15 minutes more a few days a week than you're doing already, it's progress and you have to congratulate yourself and build on that.

The second thing I would say is good sleep hygiene. Sleep is so restorative and helps stabilize your mood and cuts the adrenaline that we're all experiencing. And so we could go into all sorts of techniques about what all that includes, but being a good steward of your sleep is very important.

And the last thing I would say, and I know this very difficult in the midst of physical distancing restrictions, but socialization is really, really important for stress management. So finding safe ways with the midst of the viral outbreak to connect with friends and family can really lower the amount of stress that you're experiencing and help you regulate yourself. So everybody should be working on all of those things all the time. It takes a lot of attention and maintenance work to keep on top of that.

The next level that I would go to are medication behavioral things that you can do. A lot of complementary and alternative medicine interventions are helpful here, like acupuncture or, if you can manage massages or mindfulness meditation practices, there's a lot of commercially available apps that are very good for that for helping build a practice. That is also very helpful and may come even before the mental health referral for a lot of folks and maybe a bit more available and easier to access.

The next level is psychotherapy. And this can be done with a psychiatrist, a psychologist, a social worker. There are master's level therapists out there. There's lots of different people who are trained to do good psychotherapy. And there's lots of different kinds of psychotherapy. I know you mentioned cognitive behavior therapy, which is one of our really all-star kinds of therapies, particularly for anxiety and depression. And what that involves is usually weekly meetings for around 45 minutes or so. And sometimes it's very open-ended you come in and you just kind of talk about whatever's on your mind. And sometimes it's very goal-oriented. So different diagnoses have different indications for the psychotherapy and also different people just have different preferences.

And finding a therapist, it's a little bit more challenging. It's more like baiting. You have to find someone that you have a good connection with. You need to agree on what you're working on and how you work on that. So what I would say in finding a therapist is that it's, you know, the first one might not be the right fit, maybe it is and that's great. But if it's not the right fit, don't presume that therapy is not for you. Keep looking and trying different therapists and seeing if you find that right fit.

The next level is medication and the medications can be prescribed by a psychiatrist or they could even be prescribed by an internal medicine doctor or a family medicine doctor. And those are usually when these other techniques don't work or the symptoms are just significant enough that it's hard to put those other practices in place. And again, I'm happy to go into the details around the medication if you're curious about them. But generally, they're very well-tolerated and have very few risks involved in taking them. They often don't get rid of the full syndrome, like they make it easier and more helpful to put these other things into your life that help you manage this situation. It can kind of turn down the volume of these symptoms or get you out of the pathological syndrome. But oftentimes there's still other work to do beyond the medication even if you go that route.

Melanie: Well, I'm glad that you brought that up because I know that hesitancy to go on medication is really pretty prevalent. People are a little bit nervous about whether it's going to zombie them out or take the joy out of their lives. So I'm glad that you mentioned that they're well-tolerated. I'd like you to wrap it up for us, Dr. Hermann, with your really best advice for mental illness awareness and those red flags you spoke about and how you're helping your patients remain calm, manage the emotional challenges of this pandemic, the emotional challenges of our lives and to recognize really when we need to ask for help, because sometimes we all do.

Dr Alison Hermann: That's right. We all need to ask for help at times. And I would also say, sometimes it's asking for help, sometimes it's asking for support and sometimes it's just kind of doing what you need to do to help yourself. It's a very vulnerable thing to reach out to a mental health clinician and take this step. Most people, once they do and have the experience with what it feels like wish they would've done it earlier.

So what I would say is if you start feeling like things aren't great and feeling like you want to make a change, reach out sooner. It can take a little bit to find the right person and the right situation. And you want to be proactive about that.

I really want women to know that these are very, very common struggles. There is help out there. The help works, the treatment works, so go ahead and take advantage of it.

Melanie: Really great information. Something we all need to hear right now, Dr. Hermann. Thank you so much for joining us today and really helping us to realize some of those red flags when it's severe enough that we need to seek help and that there is no stigma to getting help, because sometimes we just all need a little bit of an extra bit of support. Thank you again for joining us. And we're so glad you joined us for Women's Health Wednesday.

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