Sleep Disorders: The Things That Keep us Awake Pt.1

Sleep disorders are more common than people think and most people experience one or more sleep disorders at least once in their lives. There are over 70 known sleep disorders that are recognized though some say there could be more than 100. Sleep disorders are especially common in children, though they commonly self-resolve with age, and adults over 65. Often, sleep disorders are broken down into six main types: circadian rhythm sleep-wake disorders, insomnia, hypersomnia disorders, parasomnias, sleep-related breathing disorders, and sleep-related movement disorders. In this post, we’ll be discussing circadian rhythm sleep-wake disorders, insomnia, and hypersomnia disorders.

Sleep-Wake Disorders

Circadian rhythm sleep-wake disorders are characterized by some kind of interruption in the natural circadian sleep cycle. For example, we see this often with people who do shift work or have unpredictable work hours, and we often see this affecting people who have traveled from one time zone to another (jet lag). Less common forms of this sleep disorder are delayed sleep-wake disorder or advanced sleep-wake disorder. For those experiencing this disorder due to shift work, unfortunately the only way to really treat this is to have a more predictable work schedule. Having a regular sleep-wake cycle is the best way to deal with this type of sleep disorder, however that is not always an option for everyone.

Insomnia

Insomnia is the most well known sleep disorder with most people experiencing at least one episode of insomnia during their lifetime. It can be short term or it can be chronic. Chronic insomnia is diagnosed after a period of three months, with at least three instances of insomnia a week. It can involve delayed sleep onset (30 minutes or more to fall asleep), poor sleep maintenance (waking and being unable to fall back asleep after 30 minutes or more), or a combination of both. It can be very disruptive to a person’s life, involving the following symptoms or outcomes:

Irritability
Daytime sleepiness
Brain fog
Attention issues
More likelihood of mistakes while at work or driving
Can interfere with work or relationships

Insomnia can be related to many things and have many root causes. For example, it could be related to mood disorders, other mental health disorders, chronic illness, stress, or some medications. Alcohol, caffeine, or nicotine use (or other drug use), especially in the evening, can also contribute to insomnia.

However, insomnia is also very treatable! Lifestyle changes are usually the first recommendation, such as avoiding caffeine in the evening or avoiding naps. However, CBT-I is also an effective treatment for insomnia. CBT-I is cognitive behavioral therapy for insomnia and can help treat insomnia for those who have suffered with very long term chronic insomnia.

Hypersomnia

In contrast, hypersomnia sleep disorders involve excessive sleepiness. The most well-known form of hypersomnia is narcolepsy, but there are other disorders in this category, such as Kleine-Levin syndrome and insufficient sleep syndrome. The important thing to note is that those with hypersomnia do not necessarily sleep more than the average population when it comes to total hours of sleep. However, the sleep they do get is rarely refreshing, causing intense fatigue.

Narcolepsy is a neurological disorder that disrupts the sleep-wake cycle. It is characterized by extreme bouts of sleepiness. For some people, it can also involve sudden muscle weakness, especially during times of intense emotion (even when laughing!) known as cataplexy. Cataplexy can be dangerous because it can happen while driving or working, which can open up the possibility for serious injury.

While someone with narcolepsy may feel refreshed immediately after sleeping or taking a nap, the individual will soon become fatigued again and not feel rested. Other common symptoms of narcolepsy are sleep hallucinations, sleep paralysis, and issues with memory.

Thankfully, narcolepsy is treatable. Available treatments for narcolepsy include:

Stimulants – This is the first line of treatment for most people
SSRIs
Sodium oxybate (a medication for daytime sleepiness and cataplexy)
Maintaining a consistent sleep-wake schedule
Scheduling short, 20-minute naps through the day
Regular exercise
Avoid alcohol, tobacco, and other drugs, especially in the evenings

Narcolepsy does not seem to have a hereditary component. Another recommendation for those who have narcolepsy is to seek accommodations at work or school. Narcolepsy is recognized by the ADA and a documented case of narcolepsy as diagnosed by a doctor must be accommodated in work or school settings within reason. Always discuss with a doctor what the options for these accommodations would be.

While these disorders are something most people experience, if they ever become a problem for you or someone you know, seek out help from a doctor or other professional (such as a therapist familiar with CBT-I in an insomnia case, for example) in order to treat them. Sleep disorders are often very treatable and many of the more disruptive symptoms can be dealt with under proper care.

Resources

https://www.ncbi.nlm.nih.gov/books/NBK560720

https://www.nccih.nih.gov/health/sleep-disorders-what-you-need-to-know

https://www.psychiatry.org/patients-families/sleep-disorders/what-are-sleep-disorders

https://sleepeducation.org/sleep-disorders

August 23, 2024August 19, 2024

Taking Care of Your Mental Health

Our past few posts have been about various mental health topics, from compassion fatigue to major depressive disorder and more. While those were all more specialized posts, there is also a need to consider why it’s important to focus on overall mental health. Not everyone has a diagnosable mental health disorder but everyone should be taking steps to care for their mental health in order to have the best quality of life.

Of course, there are things you can do to take care of yourself when you’re experiencing extra stress or something distressing. Going to therapy, joining support groups, and reaching out to other sources of support, like a spiritual or religious leader, are all great options for everyone, along with medication when needed. But what about dealing with everyday stressors or concerns, like a bad few days at work or a fight with a loved one?

Importance of Self-Care for Mental Health

Keeping ourselves healthy physically is something we hear about all the time. Eating well, moving often, and resting when needed are all pieces of that puzzle. Mental health is also part of that puzzle. Self-care is something we talked about more in-depth in the compassion fatigue and clinician mental health post, it’s also something the other posts have mentioned here and there.

It can be difficult to make time for things like self-care. Sometimes even 5 minutes can feel impossible to find. But any attempt to add any kind of self-care you can manage is important. The social media version of self-care makes us believe that we need to do something super involved, possibly expensive, and often time-consuming. We think of spa days, lengthy skin-care routines, going on vacations, or any other number of big things that we’re told to do to “take care of ourselves”. Of course, all of these things are nice, and taking vacations can be important, but self-care can be much more manageable and doable on an everyday basis. Self-care can look like face masks and skin care, or it can look like just having a cup of tea or coffee by yourself while you just take time to sit quietly and unwind.

Types of Self-Care

Self-care can also look like watching your favorite TV show or movie, reading a few pages in a book, eating a delicious meal, or even just lighting a candle or using a diffuser to set a calming atmosphere in your home. It can also include cleaning your home and making sure you have a safe, healthy space to live in. Self-care is incredibly customizable and can be done in so many little ways or big ways that can add to our quality of life and help support our overall mental health.

While there is often a push that self-care is something that we do alone, and that is absolutely a valid option, the importance of social support shouldn’t be overlooked. Reach out to friends, family, or even join community groups. Volunteering can also be something that can help support our mental health, as helping others can help us to feel good and give us meaning, two important components of mental health.

Half of mental health care is preventative care, much like with physical health. Being able to have these habits and routines in place can help us get through some of the more stressful moments in our lives before we reach a crisis point. It can also be added to a more traditional mental health treatment program, such as therapy or medication, to help increase the effectiveness of the treatment.

Reminders and Wrap-up

It also cannot be understated how much physical health can affect mental health. Exercising regularly, even if it’s just a short walk outside, can help with stress and other everyday mental health needs we all have. Eating balanced, nutritious meals along with our favorite, comfort foods is a great way to keep ourselves healthy both physically and mentally. Cutting out entire food groups or types is not recommended unless under the supervision of a medical doctor.

Taking a few extra minutes every day can go a long way to supporting your overall mental health. While there is no expectation that you could, or would want to, try everything listed in this post, we hope that it may have given you a starting point for how to add a little extra care for yourself everyday.

August 16, 2024August 19, 2024

Post-Traumatic Stress Disorder Can Affect Anyone

May was Mental Health Awareness Month and on our socials, we shared information about different mental health topics throughout last month. These blog posts are part of a series where we expand on those topics and offer more information.

Post-traumatic stress disorder, more commonly known as PTSD, is a mental health disorder that develops as a response to a traumatic event. Currently, we’re not sure what exactly causes PTSD, as most people who experience trauma do not develop PTSD. We do know that people who were assigned female at birth are much more likely to develop PTSD than those who were assigned male at birth. We also have current statistics for PTSD: 3.6% of the US adult population has PTSD with 37% of those with PTSD having severe symptoms. It usually develops within months of the traumatic event and symptoms can last months, years, or even be life-long. Treatment is critical for helping to manage these systems.

Traumatic events that have been linked to development of PTSD are: sexual assault, abuse, witnessing a death, combat/war, terrorist attacks, being in an accident, and even experiencing the trauma of a loved one second hand.

Often, the symptoms are broken down into four main categories: re-experiencing, avoidance, cognitive/mood, and arousal.

Re-experiencing:

Recurring, intrusive thoughts about the event
Flashbacks
Bad dreams
Intrusive memories

Avoidance:
- Avoiding the place where it happened
- Avoiding people who remind you of the event
- Avoiding objects or other things that remind you of the event
Cognitive/Mood:
- Memory problems related to the event
- Negative self-image or thoughts
- Guilt or shame
- Numbness or depression
- Anxiety
- Derealization
- Dissociation
Arousal:
- Hypervigilance
- Easily startled
- Difficulty concentrating
- Sleep disturbances
- Irritability

Children have also been diagnosed with PTSD and we often see them develop it in response to many of the same situations that adults do. However, they can show some different symptoms such as:

Regression (for example, a toilet-trained child suddenly wetting the bed)
Unusual and sudden clinginess (usually to a parent or another trusted adult)
Re-enacting the traumatic events through play

Early diagnosis and treatment is critical for the best possible outcome for an individual with PTSD. This can help with reducing the severity of symptoms or even eliminating some of them entirely. Treatment can help the individual get back to a healthy level of everyday functioning and help them manage symptoms such as nightmares, flashbacks, and many of the other distressing symptoms of PTSD.

Treatments generally include medications, such as SSRIs, and therapy. Therapy usually consists of some form of CBT (like exposure therapy and recognitive structuring) and EMDR. Learning self-management techniques is also critical to successful therapy, such as the ability to self-soothe and use mindfulness strategies.

PTSD can co-occur with other disorders like depression, OCD, panic disorder, and substance use disorder. Often, treating these disorders co-currently is the best way to see improvement, as PTSD improves with the treatment of OCD, for example, and OCD improves with the treatment of PTSD.

Want help with PTSD? Look at our list of clinicians and contact us to book an appointment.

Resources:

https://adaa.org/understanding-anxiety/posttraumatic-stress-disorder-ptsd

https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Posttraumatic-Stress-Disorder

https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd

https://www.nimh.nih.gov/health/publications/post-traumatic-stress-disorder-ptsd#part_6135

https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd

https://www.samhsa.gov/mental-health/post-traumatic-stress-disorder

August 9, 2024August 8, 2024

Summer Isn’t the Best Time For Everyone: Summer SAD

In our previous post, we discussed the mental health benefits of summer. While there are many benefits of summer for the majority of people, some people experience more mental health difficulties during summer. Most people have heard of SAD, seasonal affective disorder, and the assumption is that it always affects people during the winter. However, some people have SAD in the summer.

Seasonal affective disorder is more formally known as major depressive disorder with a seasonal pattern. This means that the symptoms of depression come at predictable times seasonally. For the majority of people with SAD, symptoms start in the fall, get more severe during winter, and then resolve by the beginning of spring. However, about 10% of those with SAD experience symptoms starting in late spring which get more severe during summer and then resolve by early fall.

Major Depression or SAD?

The existence of a predictable pattern is what makes it distinctly different from major depressive disorder (MDD). MDD often does not have a specific pattern of onset of symptoms. Not only must the symptoms be seasonal but this pattern needs to exist for a minimum of 2 years in order for someone to be diagnosed with SAD as opposed to MDD or another mood disorder.

SAD is well researched, but the majority of research is for the winter pattern. There is little research about summer pattern SAD, which means we don’t know nearly as much about it. What we do know, is that it shares many of the same symptoms of winter pattern SAD, with a few exceptions. Instead of eating more than usual (especially carbohydrates) as is common in winter pattern SAD, summer pattern usually comes with decreased appetite. This means that people often lose weight as opposed to gaining weight. Summer pattern SAD also comes with more irritability and insomnia, as opposed to hypersomnia (oversleeping) common in winter depression.

There are also some studies that suggest potential triggers for summer pattern SAD. One potential trigger is pollen. Summer depression seems to be more common in those who have seasonal allergies triggered by pollen, which is more common in the spring and summer. Another trigger could be the heat and especially high humidity. Summer pattern SAD seems to be more common in countries that experience high humidity, which suggests this link. There also could be a link between more sunlight and longer days. It’s possible that in those who experience summer SAD that they’re more sensitive to circadian rhythm changes due to the sun. This could be what causes the insomnia many people with summer pattern SAD experience.

Treatment Options

Unlike with winter SAD, we don’t really have specialized treatments for summer pattern SAD. We do know that SSRIs and SNRIs are effective treatments for summer SAD, especially when started 4-6 weeks before the usual onset of symptoms and then discontinued at the end of summer. There is a form of CBT that has been developed specifically for those with seasonal pattern depression called CBT-SAD and that has been effective for treating summer depression, as well. Other suggestions have been to stay out of the heat and sun as much as possible (no more than 30 minutes to an hour), being in air conditioned spaces if possible, and to keep one’s bedroom dark. Going to bed right after sunset and sleeping in a dark room can help offset some of the disturbances the longer days can cause to sleep patterns.

Another suggestion is to try and maintain a normal routine as much as possible. This helps with avoiding the isolation that can come from depression symptoms. Exercise and maintaining a nutritious diet can also help with relieving the severity of symptoms.

While we may not know as much about summer pattern depression as we do about winter, we do know that it exists. If you’re one of those people who experience seasonal depression in the summer, you’re not alone. And there are effective treatment options out there. Hopefully over time, more research will be done on this form of depression and we’ll know even more about it and how best to treat it.

Resources:

https://health.clevelandclinic.org/summer-depression

https://www.healthcentral.com/condition/depression/summer-seasonal-affective-disorder?legacy=psycom

https://www.healthline.com/health-news/seasonal-affective-disorder-can-affect-you-in-the-summer-too#Ways-to-combat-summer-SAD-symptoms

https://www.nimh.nih.gov/health/publications/seasonal-affective-disorder

Could Summer Depression Be Seasonal Affective Disorder?

https://www.smithsonianmag.com/science-nature/people-get-seasonal-depression-summer-too-180955673

https://www.verywellmind.com/summer-depression-symptoms-risk-factors-diagnosis-treatment-and-coping-4768191

August 2, 2024August 8, 2024

Benefits of Summer: Supporting Your Mental Health all Summer Long!

We’re in the middle of summer and for many people, it’s their favorite time of year. Of course, there’s a lot to love about summer. It can be a great time to really work on strengthening mental health, too! There are a lot of benefits to summer when it comes to mental health.

Everyone knows vitamin D is good for you. It’s why so many things are fortified with it. Just 20-30 minutes of sun exposure can help boost your natural vitamin D production. Not only is it good for your bones, but it can also help with energy levels.

Another benefit of summer is that being outside soaking up that vitamin D encourages us to get more physical activity in. The warmer weather helps, too! With the nice weather, it can be hard to not want to go outside for many people. There are a lot of fun things we can do outside to help get us moving. For example, a lot of people love to hike, play sports (like tennis or volleyball), go for walks, or ride their bikes. All of these things keep us moving which helps release endorphins. Endorphins naturally raise our mood and help to keep us feeling great throughout the day. Exercise or movement during the day also helps many people sleep better at night, allowing us to be well rested the next day. Of course, remember to use sunscreen and sun protection while outside!

It does have to be noted that summer can be a stressful time for some people. For children and teens, summer comes with a disruption of their routines. While there are many benefits of summer for these age groups, there can also be social isolation. It’s important to keep children and teens in a routine as similar to their school year one as possible. This is especially important for younger children. Keeping to a wake and sleep schedule can also help make the transition back to school less difficult!

Parents can also have a hard time! Being faced with more child care difficulties during summer can be stressful. School often functions as a safe place children can be while parents work. Without school, parents are now responsible for finding care for their children during the work hours. This can be especially difficult for parents on a tighter budget or who don’t have family or friends who can help out with childcare.

Not only that, but summer comes with an expectation to spend more money. There are vacations, events, and outdoor activities that take up so much of people’s days. These things very often cost money, and for some families, the investment could be substantial. This extra financial stress can make it difficult for parents who are trying to juggle everything.

So how can we capitalize on all the benefits of summer without the drawbacks? It can be easy to get overwhelmed by the potential problems that summer can bring, which can cause us to isolate and stay indoors. This makes it difficult to get the good out of summer!

One thing that’s especially important for adults is to not spend their paid (or even unpaid) vacation time catching up on chores or projects around the house. Allotting some time for these things can be important, of course, but also try and make sure to carve out some time to unwind and do something that isn’t productive or checking things off a list. This can be especially restorative, even if it’s just a day or two.

As mentioned earlier in the post, keeping children and teens to a routine is important. Not just sticking to their normal wake and sleep times, but making sure there is some structure to the day, too. Younger children will benefit from having set play times and socialization time. If it’s in the budget, arranging for summer camps or other day programs can help fill this need for children. Older teens could benefit from socialization times being set and even possibly summer jobs. This can be especially helpful for teens who need deadlines to help stick to a routine. With a summer job, this can help ease the tension between teens and parents over outings teens may want to attend that cost money, too.

Another one of the benefits of summer is that the days are longer! Of course this means more daylight time to be outside and do fun things. However, some people also use longer days to stay awake later. It’s important for adults, too, to stick to their normal sleep cycles. Try to go to bed as close to your normal sleep time as possible, even if that’s only shortly after sundown. Making sure you get enough sleep is incredibly important!

Sometimes it can seem like there’s a party or event every weekend. And this can come with pressure to attend. However, it’s important not to overbook yourself. You don’t have to say yes to every invitation, especially if you’re starting to feel stressed about it. Make sure to schedule out some time every week to relax without the pressure of an event or thing to go to.

One thing that can be especially difficult for people is the end of summer. August and September bring with them the realization that routines are going back to normal, the weather is going to cool, and the days will get shorter. This can be very difficult for people, especially if they traditionally experience depression with a seasonal pattern in winter (Seasonal Affective Disorder or SAD).

Something that can help is to plan fun things to do throughout the fall. It doesn’t have to be big or extravagant but having activities to look forward to during the fall can help ease some of the summer ending blues. Think about hiking or walking while the weather is dry, doing more indoor activities like attending museums, or planning fun stay-in nights for the family. Something as simple as a monthly movie and take out night can help ease some of the sadness that comes from losing summer.

There are many benefits of summer to consider at this half-way mark of the season. Here’s to supporting your mental health all year long, however!

Resources:

Strengthening Mental Health in Summer

https://www.child-focus.org/news/how-summer-can-affect-our-mental-health

Five Self-Care Tips to Maintain Mental Health During the Summer

https://www.flexpsychology.ca/think-flexibly-blog/sunlight-and-serotonin-the-mental-health-benefits-of-summer

15 Activities for Your Summer Self-Care Checklist

Mental Health Benefits of Summer

Supporting your child’s mental health during the summer

July 19, 2024August 8, 2024

When Worrying Takes Over: Generalized Anxiety Disorder

Our next post for Mental Health Awareness Month, which was in May, is going to focus on generalized anxiety disorder, or GAD. On our socials, we covered these topics during May and these blog posts are part of that series, expanding on those topics and giving more information. According to WHO, 4% of the global population experience an anxiety disorder. And NIMH reports that 20% of adults in the US have an anxiety disorder. There are many different kinds of anxiety disorders but GAD is the most common. However, there is concern that GAD is actually underdiagnosed because of societal stigma and lack of education about anxiety disorders. Due to the fact that many symptoms of generalized anxiety disorder feel primarily physical as opposed to purely psychological, many people mistake their symptoms for signs of a physical ailment.

It generally develops in adulthood, around age 30, but it is common across all age groups, including children. It’s diagnosed twice as often in women and people assigned female at birth, though at this time it’s unclear why. Some research suggests that societal factors could play a role in this.

Risk factors for developing generalized anxiety disorder include: experiencing child abuse or trauma, having a chronic illness, living with a lot of stress, and substance use (such as: alcohol, nicotine, caffeine, and recreational drugs). It often co-occurs with other mental health disorders, such as major depressive disorder, or MDD, which we described in a previous post.

Symptoms of Generalized Anxiety Disorder

There are many symptoms of GAD to look out for. If any of these symptoms interfere with your daily life or relationships, it could be time to seek out a diagnosis and treatment. Symptoms must be present for at least 6 months:

Worry excessively about everyday things
Have trouble controlling their worries or feelings of nervousness
Know that they worry much more than they should
Feel restless and have trouble relaxing
Have a hard time concentrating
Startle easily
Have trouble falling asleep or staying asleep
Tire easily or feel tired all the time
Have headaches, muscle aches, stomachaches, or unexplained pains
Have a hard time swallowing
Tremble or twitch
Feel irritable or “on edge”
Sweat a lot, feel lightheaded, or feel out of breath
Have to go to the bathroom frequently
Children and teens are more likely to worry about school performance and the health of loved ones

Treatment

Generalized anxiety disorder is very treatable, even in chronic cases. However, it is important to seek out treatment as soon as possible to ensure the best outcome. There are a variety of treatments including medications, therapy, and some complementary additions someone can use to help their GAD along with other treatments. Medications, such as SSRIs, SNRIs, and buspirone are commonly prescribed to help treat GAD. Benzodiazepines were once a common treatment but are no longer generally recommended due to concerns about dependency and limited long-term effectiveness. CBT and ACT are common forms of therapy used, often in conjunction with medication, to treat GAD.

There are also complementary changes someone can make that can be added to the above treatments. For example, some lifestyle changes like limiting caffeine and nicotine, can help reduce anxiety symptoms. Mindfulness like meditation and journaling are also often recommended. Getting enough sleep, exercise, and joining support groups for those also experiencing anxiety are commonly added as recommendations to traditional treatments.

With proper treatment, many people go on to be able to return to their normal routines and regain functioning and quality of life. The earlier the treatment, the more quickly someone can return to their lives and the more effective treatments are likely to be.

Resources:

https://my.clevelandclinic.org/health/diseases/23940-generalized-anxiety-disorder-gad

https://www.nimh.nih.gov/health/publications/generalized-anxiety-disorder-gad#part_6119

https://www.ncbi.nlm.nih.gov/books/NBK441870

https://www.who.int/news-room/fact-sheets/detail/anxiety-disorders

July 12, 2024August 8, 2024

All About MDD: Major Depression Disorder

May was Mental Health Awareness Month and in honor of that, we shared information on our socials during May about various mental health topics. This series of blog posts is an expansion on those social media posts. Our last post was about compassion fatigue and why self-care and mental health is so important as a clinician. This post is about major depression disorder, more commonly just referred to as depression.

MDD is one of the most common mental health disorders in the world and one of the leading causes of disability globally. 3.8% of the global population and 29% of Americans experience depression at least once in their lives. 18% of Americans are currently experiencing depression. This disorder has been most commonly associated in adults in the past but more recently has been acknowledged in children. Depression is also proportionally higher in the LGBTQIA+ population than the general population.

While women and people assigned female at birth are 50% more likely to be treated for depression than men and people assigned male at birth, it’s unclear if this is due to genetic differences (meaning that depression is more common in one group or the other biologically) or societal differences. Men and people assigned male at birth are less likely to seek treatment for mental health disorders, primarily due to societal stigma, which may be skewing data in this area.

There is some data that suggests that depression could be genetic, with people who have at least one biological relative with depression being at higher risk than those who don’t. Those who have experienced trauma or stress as children are also more likely to develop depression as adults. Substance use (alcohol, drugs) has also been linked to higher rates of depression. Some physical illnesses, such as diabetes, are also associated with higher risk for developing depression.

Symptoms of Depression

In order to be diagnosed with depression, an individual must have five or more of the following symptoms:

Sadness, hopelessness, emptiness
Fatigue
Feeling restless or lethargic
Sleep issues (sleeping too much or too little)
Appetite changes which can contribute to weight gain or loss
Anxiety or irritability
Difficulty concentrating
Feeling guilty, ashamed, or like a burden
Social isolation
Lack of pleasure in doing things (anhedonia)
Thoughts of dying or attempting suicide

Some people may only have five of the symptoms while others could have many more. The important part is that these symptoms must be present most days for at least two weeks for the person to qualify for a depression diagnosis. Other possibilities must also be ruled out, such as vitamin deficiencies or a physical illness.

Most people go to their primary physician first at the onset of symptoms, especially for sleep disturbances and fatigue. This could be because of lack of education about mental health disorders such as depression or because of the stigma that is attached to depression. Physicians can help but usually their understanding of psychiatric treatments are limited in comparison to psychiatrists.

The majority of people experience major depression disorder once with many experiencing recurring episodes of depression. The more episodes of major depression disorder someone experiences, the more likely it is that the depression will be more chronic in nature. With proper treatment, most people start to feel better within a few weeks to three months. For most, MDD can go into remission in about 6 to 9 months. Without treatment, however, symptoms can last months or years and could be more severe than for those who are getting medication and/or therapy for their depression. This is one of the many reasons early diagnosis and treatment are so important. It can help avoid someone’s life being so impacted by depression that they become disabled or attempt (/complete) suicide.

An important thing to note is that depression and grief are not the same thing. Grief, which can come with sadness, is a natural response to loss. However, they can co-occur, which can prolong symptoms of grief and make them more severe. Accurate diagnosis is crucial in this area in order to make sure someone gets the proper treatment most likely to help them.

Treatment Options for Major Depression Disorder

Major depression disorder is very treatable in most people and there are a variety of of treatment approaches that are available:

Treatments include a variety of medications that can be tried (SSRIs, SNRIs, TCAs, MAOIs, etc)
Various forms of talk therapy are also available for treating MDD (CBT, family therapy, interpersonal therapy, etc)
For treatment resistant depression, brain stimulation therapies exist that can help severe MDD (ECT, rTMS, VNS)
Esketamine is a newer, FDA approved treatment for MDD that has not responded to other forms of treatment.
A combination approach is usually the most effective way of treating MDD (therapy plus medication, for example)

When trying medications it is important to remember that it can take at least 6-8 weeks to feel the full benefits of a medication. If side effects are intolerable, discuss with your doctor before discontinuing treatment.

Along with these traditional treatments, a variety of self-care activities can be done in conjunction (not instead of) to help alleviate symptoms more quickly or avoid a recurrence of a depressive episode:

Regular exercise
Eating nutritious and balanced meals
Mindfulness, such as journaling or meditation
Spending more time in nature
Remaining connected with your social circle and confiding in trusted people
Setting realistic goals
Break down tasks into smaller steps
Avoid using substances such as alcohol and drugs not prescribed to you

Self-care is incredibly important when treating depression, especially in those who have recurrent depressive episodes. While it can be difficult to get into a self-care routine while depressed, it can be crucial to helping shorten the depressive episode. It’s especially important for staving off future episodes.

Ending mental health stigma is an important step in ensuring that people are more likely to seek help for their depression sooner rather than later, which can help with achieving the ideal prognoses. The more we discuss mental health and educate others about it, the more likely people are to seek help in a timely manner and get back to being able to live their lives more fully again.

Resources:

https://www.hopkinsmedicine.org/health/conditions-and-diseases/major-depression

https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Depression

https://www.ncbi.nlm.nih.gov/books/NBK559078

https://www.nimh.nih.gov/health/topics/depression

https://www.psychiatry.org/patients-families/depression/what-is-depression

https://www.samhsa.gov/mental-health/depression

https://www.who.int/news-room/fact-sheets/detail/depression

July 5, 2024July 5, 2024

The Importance of Clinician Mental Health

An image with a teal background and white text. The text reads "Clinician Mental Health". There is a flower wreath and inside of it is a calandar, watch, and the sillhouette of a human head with a lightbulb growing out of it.

The topic of clinician mental health came to us when May was Mental Health Awareness Month and we shared information on our socials about various mental health topics. This is an expansion on those posts to give more information about things of note related to mental health.

Mental Health Awareness Month is usually focused on raising awareness of different mental health disorders, the type of help available, and trying to reduce the stigma attached to mental health disorders. While this is partially aimed at educating the general public it can also be a way of encouraging people to seek out the mental health care they need.

One important group we often fail to mention in these conversations is that of the helping professionals, or mental health practitioners. Those who work in the mental health field need to be just as aware of their mental health and needs as anyone else. This allows us to do our jobs for longer and do them better. It also lets us get the most out of our profession and everyday lives. Not taking care of our mental health can lead to things like burnout and compassion fatigue. Focusing on clinician mental health can help avoid both of these concerns.

Compassion Fatigue

Burnout and compassion fatigue can look very similar. Burnout usually comes from overwork and low job satisfaction while compassion fatigue is more associated with vicarious or secondary trauma. Compassion fatigue usually comes on suddenly while burnout occurs slowly over time. When thinking about the differences in their symptoms, burnout usually involves resentment towards the job or coworkers, and can feel like wanting or needing a new job or a different job. Compassion fatigue involves self-contempt, as opposed to contempt of others and it can feel like you’re not working hard enough or doing enough to help others. It can also leave you feeling like the therapeutic relationship is uneven, with you giving much more to your work and clients than you receive in job satisfaction.

Despite these differences, they do have some overlap of symptoms. Both involve feelings of job satisfaction, bringing “work home” (an inability to stop thinking about work during off-hours), mental and physical exhaustion, headaches, trouble sleeping, poor eating habits, depression, and anxiety.

Certain clinicians are more likely to develop compassion fatigue. If you work with victims of trauma often, if your caseload is made up primarily of severely depressed clients, or if you work heavily with grief and bereavement, you’re at higher risk of developing compassion fatigue.

The first step to avoiding burnout or compassion fatigue is to be aware of how you’re feeling. Being able to notice changes in how you approach work or others can be one of the early signs that you may need to take extra care of yourself or change how you approach your professional life. If you, or others around you, notice any of those symptoms becoming a problem for you, then it’s time to step back and evaluate your work load and your self-care routine. These are important aspects of promoting clinician mental health.

Self-Care

We all know that self-care is important for many of our clients. However, it’s just as important for those who work in the mental health field. This is critically important when it comes to being able to not just do our jobs, but to do them well.

There are a lot of different things you can do to take care of yourself both before and after developing compassion fatigue or burnout:

Consider getting therapy if this is heavily impacting your day to day; we all know how important therapy is for our clients and it can be just as important for us, too. This is especially true if you find yourself “bringing work home with you” a lot.
Take regular days off and vacations, if possible, in order to relax and decompress from your work. While work will still be there when you get back, this can be a good way to reset yourself and give yourself more mental resources in order to tackle your caseload efficiently.
Consider a smaller case load, if needed, or changing the types of clients you see. Sometimes it really is that we’ve reached a point where our caseload is hurting us more than we’re helping others.
Try bringing mindfulness into your every day, such as meditation or journaling. This can also be a great way to catch the signs of compassion fatigue before it starts to impact you.
Exercising regularly and making sure to eat a nutritious diet can also help as it’s easier to tackle the day when you’re taking care of yourself physically, too
Make sure to get enough sleep regularly.
Make time for things that bring you joy.
Spend some more time in nature.
Make sure to stay connected to your support system – compassion fatigue can sometimes make us want to isolate and this can make things worse.
Engage in hobbies you love or find a new one – games, books, movies, gardening, anything that brings you a sense of peace or you’ve been curious about trying.
Practice gratitude, both for the things around you and for yourself and what you bring to the world.

Prioritizing self-care can be hard, especially for the types of people who are so drawn to helping in the first place. It can be easy to feel guilty or compare ourselves to others, even more so if we have clients who are unable to engage in self-care themselves. It’s deeply important that we practice self-care, however, because this is how we can better take care of ourselves. And others, too. You need to take care of yourself before you can fully take care of others. Like we’re always told on planes, you need to put your oxygen mask on first before helping someone else put on theirs. It’s not selfish, it just ensures that we’re best able to provide that help to someone else.

Mental health care is incredibly important, not just for our clients, but for us, too. It’s especially important because we are tasked with listening to the worries of others. If we cannot keep ourselves healthy, it becomes much more difficult to do this day in and day out. Clinician mental health is something we should make sure we make time for and focus on.

Curious if you’re at risk for compassion fatigue? Take the Professional Quality of Life test developed to measure compassion fatigue AND compassion satisfaction.

Resources:

https://compassionfatigue.org/index.html

https://www.goodtherapy.org/blog/the-cost-of-caring-10-ways-to-prevent-compassion-fatigue-0209167

https://positivepsychology.com/self-care-therapists

https://www.samhsa.gov/blog/mental-health-awareness-month-time-self-care

June 28, 2024July 5, 2024

Men’s Mental Health

By: Kerry Moran

June is Men’s Mental Health Awareness Month and we decided to bring you a blog post about this. Here we detail some of the statistics, potential reasoning behind those statistics, and what can be done to help. Men’s mental health is an important topic in the mental health world and yet is severely misunderstood.

Many people in the United States are diagnosed with a mental illness every year. However, women are diagnosed almost twice as often as men with depression and other mental health disorders. It can be easy to look at that and think that women are just more prone to mental illness. Despite that, men make up almost 80% of all suicides each year, making them 4x as likely to complete suicide. Why is that, if they’re not being diagnosed at a higher rate than women?

There are many things to consider when it comes to this statistic. At least 1 in 10 men experience depression, but less than half seek treatment. This means that while women have higher rates of diagnosis, there are many men going undiagnosed every year. Men also make up 10% of bulimia and anorexia diagnoses and 35% of binge eating diagnoses each year. However, we also know that men are less likely to seek care, which means these figures could be higher.

A blue image with gold text that reads "Why do men fall through the cracks?" There is a silhouette of a man along with gold and blue details.

Why Does Men’s Mental Health Fall Through the Cracks?

So why do men so often fall through the cracks? Societal stigma against mental illness cannot be ignored. It’s what keeps so many people, regardless of gender, from seeking mental health care. Until this is something we eliminate as a society, there will always be people who go untreated for mental illness. We also have very strict societal ideas about what men should be and how they should act. This includes being non-emotional, that anger is an acceptable solution to many problems, that heavy drinking is normal. And, of course, that men shouldn’t cry. These factors not only contribute to why men don’t seek mental health care but also actively harm their mental health.

We don’t socialize men to be able to recognize their feelings or discuss them. This means they’re more likely to lack the verbiage to be able to clearly say that they need help. Sometimes, as a society, we can downplay when someone says they’re not feeling well if it doesn’t seem serious. It’s likely that because of the lack of socioemotional education for men that they have a hard time expressing just how seriously unwell they’re feeling. On the outside, it can look like they’re just having a bad day. However, inside, they could be very seriously depressed.

They’re also not socialized to have these types of conversations with each other. Often, we showcase that men should have relationships with other men based on shared hobbies. This makes it difficult to “ruin the fun” and bring up something difficult during what is supposed to be a low-key outing. They’re also not encouraged to ask other people, especially men, about how they’re feeling. This can lead to the false sense that men don’t suffer. Or, that they don’t recognize the suffering of others. Neither of these things are true.

Mental health affects men in many different areas of their lives, which could then contribute to worsening mental health. For example, it can affect their work lives and make their jobs difficult or cause lower productivity or job satisfaction. It can result in problems in romantic or platonic relationships, which can contribute to loneliness in men. It can also affect their families who may experience the brunt of some of the symptoms that many men experience.

There is also the issue that men’s symptoms, especially for depression, most often present as physical. For example, they often report headaches, digestive issues, fatigue, or general aches and pains as opposed to low mood. This means they’re more likely to seek help for what they perceive as a physical ailment from a doctor than reach out to a mental health professional for depression. They also often have a difficult time distinguishing depression from stress, as they present very similarly in men, and often have similar causes (relationship problems, work issues, family dynamics, etc.).

We also see that men are more likely to self-medicate when they’re depressed or anxious. This means they turn to drugs and alcohol more often. Unfortunately, it is considered societally normal for men to use alcohol to deal with stress or difficulties, which can encourage this behavior but also means that depression is going unnoticed. We see it as a man just trying to unwind from a hard day as opposed to a man experiencing depression. Even worse, these methods of self-medicating often make the problem worse, causing a vicious cycle.

Not only this, but physicians and mental health care providers are also less likely to realize the severity of symptoms in men. This is partially due to how gender differences play into presentation of symptoms but also due to inherent bias that all of us carry with us in our everyday lives. There is an unspoken understanding that men just don’t experience depression as often and so when they seek help, they are more likely to be dismissed as the problem being less severe than it actually is. Often, men are blamed for their own symptoms by society, with a focus being on their attitudes about mental health and masculinity (which are all influenced by the cultures in which they live).

We do not focus on addressing these societal issues and instead focus on how those experiencing mental illness should do better. Especially paired with how their symptoms are often different, these men who do seek care often do not get the level of care they need. In fact, almost half of all men who died by suicide sought mental health care in the year before completing suicide. Clearly, there is something missing in how health care professionals, including mental health professionals, are being trained in this particular area.

Barriers for Men of Color

Men of color have even more barriers to mental health care than their white counterparts. Indigenous men have the highest rates of suicide of all demographics and are more likely to report feelings of hopelessness, for example. Racism and racial trauma adds an extra stressor to the lives of men of color that contributes to poor mental health. Racial biases still exist in the health field, which could also contribute to a reluctance on the part of men of color to reach out for help from a predominantly white pool of health professionals.

Not only that, but historically, white medical professionals have used Black individuals for experimentation, often against their will and without their knowledge, harming their health permanently or killing them. This has contributed to lack of trust in the medical field. We also have to consider the impact that lack of resources have on men of color’s ability to even seek care. Many men of color live in areas with low density of mental health practitioners, heavily limiting their access. Many also cannot afford mental health care, which further causes impediments in seeking help for mental illness.

How does depression often present in men? We associate depression with low mood and excessive sleeping or eating, feelings of hopelessness, or other things that we associate with people being “sad”. However, we have seen that men often exhibit other symptoms when depressed:

Escapist behavior: spending more time at work, spending more time on hobbies such as sports.
Physical symptoms: muscle aches or pain, fatigue, headaches, nausea and other GI complaints.
Self-medicating by heavy use of alcohol or drugs.
Abusive behavior such as violence, controlling behavior, or emotional manipulation.
Anger, irritability, or aggressiveness that seems to not line up with expectations for the situation.
Risky behavior: use of illicit drugs, reckless driving (such as speeding), many sexual encounters.
Noticeable changes in mood or appetite.
Difficulty concentrating.
Feeling restless or on edge and an inability to relax.

So what can we do? One of the things we have to work on as a society is how we approach mental health stigma. While many strides have been made in this area, not enough has been done to address the stigma specifically aimed at men. We also have to, as a society, work to address how we see masculinity and the way we expect men to behave.

Our current gender roles are actively contributing to men’s poor mental health and their deaths. While these are big tasks, smaller tasks we can do is work on how health professionals are trained. We need to make them more able to recognize symptoms of depression in men. And to be able to meet men where they are to work with them towards better mental health. We need more access to mental health care, especially for men of color. We also need to encourage people to check in on their male friends and be prepared to have difficult conversations.

There are two organizations that are working on addressing men’s mental health and how people can have these conversations with men in their lives. They are Man Therapy and Movember. Man Therapy approaches men’s mental health with humor in the hopes of destigmatizing access and encouraging men to reach out for help. They also offer resources to help men recognize their symptoms and to recognize if a friend could be struggling. Movember also works towards this and has resources to help men talk to other men about mental help, including ALEC and R U Okay? Movember is working on releasing an online education program called Men in Mind . This is for mental health professionals to help them be better equipped to help male clients.

Men’s mental health is something we need to talk more about. And we need to work towards the end of stigmatization and approaching men with a focus on their unique needs. Men are dying at incredible rates from preventable mental health consequences. There is more we could be doing as a society and mental health professionals to address this.

Resources:

https://www.aamc.org/news/men-and-mental-health-what-are-we-missing

https://adaa.org/find-help/by-demographics/mens-mental-health

https://online.hpu.edu/blog/the-importance-of-mens-mental-health-awareness

https://www.medicalnewstoday.com/articles/mens-mental-health-man-up-is-not-the-answer

https://mhanational.org/infographic-mental-health-men

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7444121