Stress, Anxiety, and Panic …Oh May!

 May 2024 Issue
by Dr. Gabriella Farkas

 

May is Mental Health Awareness Month. Since its inception in 1949, Mental Health Awareness Month has been a cornerstone of addressing the challenges faced by millions of Americans living with mental health conditions. This national movement is dedicated to eradicating stigma, extending support, fostering public education, and advocating for policies that prioritize the well-being of individuals and families affected by mental illness. As we all know, mental health conditions are at an all-time high, especially in young adults. Mental stress and anxiety are reducing quality of life, coping skills, social skills and general happiness in millions of people across the United States, and the world. We caught up with psychiatrist Dr. Gabriella Farkas to learn more about the latest concerns in mental health and what we can do about them.

Dr. Farkas, what do you see as one of the
biggest challenges facing mental health today?

I think it boils down to 3 things: access, demand, and quality of care. The issue of access arises from a national shortage of providers. Demand had increased before the pandemic but skyrocketed post-pandemic. Quality of care reflects the differences in (level of) training of different providers. I see a lot of misdiagnosis and overprescribing. The Hippocratic Oath says “First, do no harm.”

What are the three most common mental
health issues/symptoms you see in patients?

Stress and anxiety disorders are number one. This includes generalized anxiety disorder characterized by worry, insomnia, fatigue, feeling keyed up and irritable, or obsessive-compulsive disorders, phobias, posttraumatic stress disorder. Adjustment disorder happens in response to an obvious stressor or negative life event. The second category is variations of depression and mood disorders such as bipolar disorder. Then there is attention deficit—hyperactivity disorder that a lot of people started exhibiting after their job went virtual. The structure and setting that offices used to provide are not there any longer, and many people struggle to recreate these factors for themselves, resulting in productivity concerns. Unfortunately, personality disorders and substance abuse are high on the list, as well.

Please explain the difference between a counselor,
a psychologist, and a psychiatrist. How does someone
experiencing symptoms know who to see when?

A counselor is a talk therapist you can go see once a week to talk about various issues or just to get to know yourself, and how you can operate in the world better. This is a trained professional who not only listens but also equips you with guidance and healthy coping skills. A psychologist is a master or doctorate level professional who also offers therapy, but there are specializations, such as clinical psychologist, school psychologist, etc. A psychiatrist is a physician who prescribes psychiatric medications. Visits with this type of professional are usually once weekly or biweekly at the beginning of treatment. Once the right medication and the effective dose is established, these visits can be staggered to every two to four months.

When considering medications,
psychiatrists consider three factors:
1) Symptom severity (How bad are the symptoms?)
2) Subjective distress (How much do the symptoms bother you?)
3) Functional impairment (How much do the symptoms interfere with your functioning at home, at work, in relationships, in life in general?).

Many people fear mental health medications, thinking they will get addicted to them or that they will change their personality. How far have medicines for mental health issues come, and what are the advantages in taking meds to get better?

These are common misconceptions, and neither of them are true. Today’s medications tend to be very safe, even for long term use. If you feel like your personality is different, you are likely experiencing a side effect that your prescriber can address. The overwhelming majority of the medications we use are not habit forming, and if you are about to start one that is, any decent prescriber will counsel you on what you are getting into. Even when potentially habit-forming medications (such as benzodiazepines, certain sleep medications or stimulants) are needed, it is not impossible to get off these, with expert guidance. On the flip side, it is very important not to stay on meds just “out of a habit.” I look at it from an evidence-based perspective: what are we treating; what treats that. Any medication you take should have a clear benefit to you, otherwise it is not worth taking it.

As a society, are we at epidemic levels of
anxiety disorder, panic attacks and severe stress?
What is contributing to this problem?

Our lives have gotten so complicated. There are so many things that can prevent us from feeling calm and content—work issues, relationship issues, parenting difficulties, taking care of loved ones, aging parents, financial concerns, you name it. Not to mention the environmental factors, our lifestyles, etc.

Are you familiar with the Maslow’s Hierarchy of Needs? Most important is biological needs (food, water, rest) to be met. The second level is security and safety. Third is love and belonging. Fourth is self-esteem, then last but not least, self-actualization. If any of these are missing, there will be mental health issues.

Sometimes people feel anxious even when not triggered.
Why does the body (or mind) do this? Why do I feel this way?

Whether something happens in reality or in imagination, our bodies’ reactions are the same. Think of when you are watching a thriller and your palms get sweaty, or your heart rate starts to increase. Essentially, the mind is constantly looking for threats because that has been essential for survival over the evolution of mankind. However, in this day and age when our survival is usually not at risk, the mind tends to do a disservice to us by diligently monitoring for threats, such as rejection, criticism, failure, humiliation. So, we can overreact to things. Most people know about the “fight or flight” stress reaction. Two more recently described types of stress responses are freeze or fawn.

It’s easy to get caught up in our heads, however, one can consciously counter that by regular exercise, yoga, a beach walk, or anything that gets us “out of our head.” Never forget to try to see the beauty and blessings around you. Sometimes there comes a point when someone may not be able to do that anymore. If someone has ever gone through an extremely stressful or traumatic situation, that unfortunately, unless treated, can cause years of an overactive stress response and anxiety.

Since 2011, the suicide rate has increased by 16%, with 2022 showing the highest number of suicides on record (KFF.org).

This question has two parts:
1. If I feel suicidal what should I do?
2. Are there signs I should look for in a loved one
that could help them avoid taking his/her life?

Suicide is sort of tunnel vision under the circumstances or the effect of a mental health condition where the individual is unable to picture a better future for themselves. There is also an inability to bear feelings. We prefer escaping feelings on a societal level. This is why some unhealthy coping skills (such as excessive drinking or being a workaholic, etc.) are more “acceptable,” causing people to not seek help unless their condition gets critical. Anyone who has thoughts of not wanting to live, or wanting to hurt themselves, (especially if coupled with a plan and intent to carry it out), should seek help urgently.
In terms of helping a loved one, let’s pay attention to each other. Any significant change in behavior, engagement, function, sleep, eating, or normal habits can be a red flag. Really listen and be prepared to have conversations, even uncomfortable or difficult ones, if needed. These things are not as painful as we think, and in fact, can deepen relationships and make them more meaningful. Teenagers are particularly vulnerable, so paying attention to what they are up to is crucial.

There is a new emergency suicide hotline—988.
What are your thoughts on this service?

I am medical director for a national company. We have over a million customers, and we rely on, among other resources, the 988 number for crisis management. While building out our emergency workflow, I called the number to test it. Besides finding it slightly cumbersome to navigate to a live person to talk to, it is an excellent resource that is very much needed.

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After earning an MD/PhD dual degree, Dr. Gabriella Farkas completed her psychiatryresidency at the Northwell Health System in New York. Since graduating in 2017, she has practiced outpatient, inpatient, and emergency psychiatry, besides starting a telepsychiatry (video) group practice. Dr. Farkas leads a national mental health service in the private sector for asynchronous (texting) psychiatry. “I enjoy innovation in this very disruptable space.” She is a proud half-marathon runner and loves the beach. For more information: www.drgabbyfarkas.com