We discuss ways to identify and manage stress, anxiety and depression with Dr. Ayesha Mian.
Can you tell us a bit about your clinical practice?
I am an adult psychiatrist and specialize in Addiction Medicine. I have been in practice for over 6 years. My patients are usually in different phases of their mental illness and/ or addiction disease. I help people get off alcohol and other drugs in a hospital and clinic setting. I also work with people who might be in a state of mental decompensation or seeking assistance to improve their mental health and well-being. I work at Fairfax County Community Services Board, Virginia Hospital Center and my private practice in Arlington, VA.
What are some of the most common mental health issues you see in the community?
Some of the most common issues I deal with are depression, anxiety and alcohol dependence. We live in the day and age of high stress, unrealistic expectations, limited social supports, social media frenzy, breakdown of family structure and abundance of reliance on alcohol and drugs. All these factors contribute to depression and anxiety and these are some of the most common issues I see in the community.
What are some early signs of depression, anxiety?
There are several signs to watch out for with depression- problems with sleep, that is sleeping too much or too little; problems with appetite, that is eating too much or too little resulting in weight loss or weight gain; problems with energy, focus and concentration. People might begin to lose interest in the things they normally find pleasure in, they might begin to isolate and may not be as talkative, they may start to call-in sick at work. Some times if the depression has gone on too long, people might start to feel that life is not worth living. Anxiety may or may not present with depression. When people are anxious, often times they complain of physical symptoms- feeling palpitations or a racing heart, shortness or breath, feeling ‘keyed up’ all the time, worrying constantly about mundane things, feeling overwhelmed etc. There is usually a spectrum of severity with these illnesses. You may only feel some of these symptoms and you may only have them at low intensity and they may progressively get worse. It is important to seek help if you or your loved one might be experiencing such symptoms.
We live in a world filled with multiple stressors. How do you counsel patients about dealing with stress?
I tell people that it is normal to have some degree of ups and downs in your mood with the normal ups and downs of life. It is important to keep a healthy life style, which includes nutritious diet and exercise. 30-40 minutes of cardio 5 or more times a week improves anxiety and low grade depressive symptoms. Incorporating yoga, mindfulness and meditation helps decrease levels of stress as well. Other ways of building resilience include reliance on social relationships, positive thinking and self-care. Human beings are social creatures and we should cultivate relationships in our life, spend quality time with family and friends and rely on our networks in times of need. Oftentimes we don’t reach out for help when we should. The power of positive thinking and having hope in the future are also important as coping skills. Self-care – taking the time out to treat ourself, read a good book, travel, any thing that makes one feel good – are important tools to improve one’s mental health. Eliminating negativity from our lives, decreasing use of social media, putting down our phones and having more meaningful conversations and relationships with people one on one are all coping strategies we can incorporate in our day to day lives.
Have you found a role for “mindfulness” and meditation in reducing stress? Can you talk a bit about that?
Definitely. Mindfulness, in short, is practicing being present in the moment and learning to accept without judgment. There are known benefits of meditation and mindfulness on mental health. Research shows evidence that mindfulness changes the brain. Studies show that the part of the brain called the Anterior Cingulate Cortex, which is associated with self-regulation of impulsivity and aggressive behavior, has higher activity in people who meditate. Meditators and people who practice mindfulness have greater self control and are less impulsive.
In addition, people in stress whether it is psychological or physiological, tend to have higher levels of the stress hormone called cortisol. Studies show that people who practice mindfulness or meditation tend to have thicker gray matter in the region of the brain called the hippocampus, which is involved in memory and emotion. This is the same region of the brain that has a lot of cortisol receptors and is found to be damaged in people with PTSD or depression. So, we actually see physiological benefits on the brain with practice of mindfulness and meditation and I absolutely recommend this to my patients.
There is a stigma in our society not only about mental illness, but also about seeking out counseling for issues like stress, family problems, anxiety etc. Many people are afraid they will be labeled as having a “mental problem” and hence shy away from these resources, or have tried it once and felt a disconnect. What would you advise about the importance of professional counseling and therapy?
Over 18% of the people in the US suffer from some form of mental illness each year. This is not a small number of people. It is important to address mental illness because it can very commonly get to a point where the person becomes dysfunctional in their life and / or it severely negatively impacts their relationships. It can also lead to suicidal or homicidal thoughts, which is considered a medical emergency. We see and hear about people completing suicide because they couldn’t tolerate the suffering and pain of their illness. Therapy and medications do help. You might have to see a few different therapists before you find the right fit, and it is definitely worth the time it takes to find the right person for you. It is important to have a therapist who is neutral (not a friend or family) and would be able to help guide you to discover things about you that you might not be able to otherwise.
How do you approach medication initiation for patients suffering from depression or anxiety?
Depending on the severity and effect of depression or anxiety on a person’s level of functioning, I make a decision on whether a medication needs to be started or not. Some times, people come to me after being referred by their therapist or other doctors. I almost always recommend life style changes – including diet, exercise, limited caffeine intake, meditation, yoga, breathing exercises, therapy etc. Often times, by the time someone is referred to me, these recommendations alone are not enough and we may add a medication. But it really is a decision based on each person’s individual history. There is no one-size-fits-all. I have to assess each person’s medical history, family history, trauma history, genetic predispositions, psychological and social factors, etc. before I can make a recommendation regarding medications.
If I notice a friend or loved one having some serious mental health concerns – (e.g. extremely depressed, paranoid thoughts, irrational behavior) but they are unwilling to see a doctor, what resources are there to seek help?
I come across this a lot. Some times but not always, family and friends have leverage and can do an intervention to convince the person to see a doctor. One way to find a therapist is through your insurance company. Another option is http://www.psychologytoday.com where you can search for therapists in your zip code and your insurance carrier. Your primary care physician might also know a therapist or psychiatrist they work closely with. Also, all Virginia counties have Community Health Services Boards with emergency services for their county residents. It is hard to get someone to go to treatment against their will, but if someone is in danger of harming self or others, then call 911 or take the person to the nearest emergency room.
What do you think are the biggest barriers to seeking out mental health services – Stigma? Financial coverage? Education and awareness of resources?
All of the above. There is a long way to go in improving the challenge that we see with stigma associated with mental illness. We as health professionals have to continue to create awareness about mental illness as a way to counter the stigma. I also think people don’t know how to recognize mental illness and when they do want to seek help, they do not know where to go. Another barrier is the scarcity of mental health professionals which makes it hard to get an appointment with a psychiatrist in a reasonable amount of time. The hope is that access and availability improves over time and those who need mental health care receive it.