Mental Health VS Physical Health – How Are They Related FT. @DoctorMike

Welcome, Dr. Mike to the Psych2Go YouTube channel Thank you, so, much for having me, Hello Monica! Hello to all. The Psych2Goers I 39. M excited to chat. Mental health. This is something I chat with not only. With my patients, but with my friends all the time, ’cause it’s a topic, I get so passionate about Yeah. We love you. We love how you make medical education so interesting and accessible As a family medicine provider. Most people think that we manage only physical complaints, but the reality is not only do we manage a lot of mental health issues and well-being, but we also see the mental health issues start popping up as physical health complaints initially And then only upon further investigation figuring Out that there’s way more, that needs to be discussed before we started making a diagnosis Yeah. I think this leads to the question of the relationship between mental and physical health issues. A common question that we get from the community is: what is that direct relationship between mental and physical health Yeah, so it happens in multiple pathways. First, our bodies are interconnected through the neurological system, Any implication that plays a role in how your brain perceives the outside world is going to change. How your body reacts in the outside world A simple way of seeing this is, if you’re in a stressed out state high anxiety state, your blood pressure starts to go up and that’s a physical manifestation of something that’s happening on the Mental side of your body, Another way the body connects, is through a neuroendocrine pathway where the body starts signaling through different hormones. How your physical body should react again to your mental health state plays out in a lot of different roles when it comes to chronic stress states chronic anxiety or chronic depression states, because that’s, when you start seeing weight, gain, become an issue. Joint pain becomes an issue of lack of motivation And things that you might relate to being more physically health-bound, but are related more to the mental health side of things Right When you think of more common things, like diet and exercise, how can that play a role in all these neuroendocrine pathways and things that you just described So because the bodies so connected and is so reactive to each different aspect of life because the body’s all about maintaining homeostasis, which is sort of a balanced state within the body. So if you have a release of too much hormone, the body will then counteract its initial release and decrease the amount of hormone being produced And that sort of pathway that homeostasis pathway happens in many ways Whether we’re talking about blood pressure pulse even your Environment like if it’s too hot, you start sweating Or if you see a lion, you need to release a lot of adrenaline. That sort of homeostasis is all about balance and it’s best balanced when you’re experiencing both ends of the spectrum when your mental health is in a state where you’re only on one end of the spectrum, the negative end of the Spectrum, where you’re not feeling well or you, ‘re feeling down the body starts taking a toll on it, because the blood pressure starts to suffer The foods that you’re eating, start to become foods that spike your insulin, causing you to crash. More often, throughout the day have lower energy levels, And all of that is going to impact your motivation levels once your motivation levels start dropping it’s harder to go to the gym and it’s harder to create social connections And Loneliness takes a huge toll on us, both physically and mentally, So it’s really like this cascading pathway, where it may start with not feeling great and feeling down, then it goes to not eating healthy foods and eating a lot of junk foods that make you Crash and not have motivation, Then to putting on weight to having joint pains to having a less social connection, And that could further put you back into that cycle of not feeling great of having anxious thoughts, depressive thoughts And that’s. What a doctor should focus on when they’re, seeing you in the office or a hospital setting Because when we look at patients and we look at the issues that they bring forth to us, it’s about understanding them as a whole person. It’s very easy to just look at the end of that spectrum and say: Oh well, you don’t have many social connections. Let’s find you a social group to join, Or You’re, not eating healthy foods. Here:’s a list of healthy foods. I am technically providing you a solution, but it’s, not the solution to the actual problem. ’cause the problem started much earlier in that pathway And that’s. What a good doctor does that? What a good clinician does is try to figure out where that pathway starts. So we address that goal earlier on, so that pathway, does,  n’t even get a chance to form And to me that’s, the beauty of medicine, That’s, where, like I get to play detective to figure out why it’s happening. Yes, we’re talking about mental health, causing these physical manifestations, but that’s not always the case. Sometimes it is a physical issue that’s causing the patient’s symptoms, So that sort of touch-and-go balance, understanding the person in front of you gaining trust with them That’s the beauty of medicine, That’s. Why do I enjoy being in a room with a patient? I think it’s sort of similar to that bicycle-social approach to medicine and contrasting it to more disease models of medicine, And I think medicine as a whole is going more toward the bicycle-social approach, which is wonderful. We have to treat people’s patients as a whole rather than just isolated parts Yeah, and that’s. Why? Earlier in my career, when I was a resident, I started seeing a lot of physical complaints come in, and being an osteopathic physician. I was doing some manipulation. I was getting them. Physical therapy perhaps medications on board where they needed to or injections, And then I realized I feel like I’m missing part of the spectrum here because I’m doing what the textbooks told me to do. You know if a patient comes in with disease X, the treatment for disease X is Y, And I would prescribe Y, and then the patients would maybe get better or not get better at all, And then I would feel frustrated that I’m not helping this Person, even though I’m following what the textbook told me to do, And that’s when I began to realize that the whole mantra of medicine being an art as much as it is a science is so true, But it’s not because the Treatments are all that different and some people may have a different choice of treatment, but it’s because of the diagnosis being so subjective, Because patients view the world through their lens. And then you have to view the patient through your lens And that’s the art, because only through properly understanding the patient and what symptoms experiencing and why they’re experiencing them. Can you make the right diagnosis and then come to the correct treatment? The treatment is the science, but the diagnosis is where the art form kicks in Right, Yeah, with diagnoses sometimes being subjective. There are often a lot of co-morbidities, right? So I’m wondering how can, for example, depression affect the body differently compared to I don’t know anxiety or even different subtypes of depression. That’s an important point you raised because depression has different subtypes A lot of times. My patients, who do suffer from generalized anxiety disorder, end up having symptoms of depression And again it’s very easy to start saying: Oh, they’re feeling down. They lost motivation in things they once enjoyed. They’re not sleeping well and they with major depressive disorder. The reality is they’re suffering from generalized anxiety, disorder from constant nervousness, constant, catastrophic thinking, and even jitteriness from this hyperarousal state. That needs to be addressed And then the depressive symptoms start to wane. So it’s understand what is the source of the symptoms Before jumping to following a checklist. Oh, the patient has X Y Z and that’s exactly the diagnosis. No, what caused those things to happen? Is it from that true depressive state, Or is there something else going on, And why is that important? A therapy tends to change depending on which diagnosis, your patient falls into B medications change. There are certain medications that we use for both depression and anxiety that can be sort of an upper for a patient. So if you have a patient who’s struggling to get out of bed struggling to be motivated, maybe we use a medication that will give them a little boost of energy and make them feel a little bit more motivated to do things And, on the other hand, even in a similar class of medications, there are ones that make them a little bit calmer, a little bit more relaxed And for patients who have high anxiety states, maybe that’s the optimal play. And while we know that these options exist, we also know that they act differently on different patients because the psychiatric world of medicine is not the most well understood, part of medicine, the Biggest class of medications. We probably use in mental health are called SSRIs medications we have theories as to why they work, and none of them are quite fully proven yet, the reality is that we see the evidence that they work. We see that they’re. Well tolerated in patients with certain side effects depending on which medication you choose and you try and choose the best one for your patient. But the reality is we don’t fully understand them yet, And I think that’s the world that I’m excited about because I think there is a lot of future in pharmacology and understanding of how the body works Because that whole idea Of homeostasis is what makes it all tricky You give a patient one medication. Are they getting better’cause? You’re increasing neurotransmitters, Or are you treating them because their neurotransmitters are going up and then their body through homeostasis is down-regulating the receptors that those neurotransmitters bind to So by flooding the neurotransmitters that are not what’s helping them? It’s. The body’s reaction to that flooding decreases sort of reactivity to those neurotransmitters. Maybe that’s why they’re helping And that’s what I’m so excited about to figure out the future and how that applies to each patient, Because no one patient is the same as the other And that’s why? We start with small dosages. We work our way up. We have a lot of education before we start medications, So that’s. Why? When I’m in my practice – and I see a 15-minute appointment for a patient who’s worried about their depressive or anxiety symptoms and they’ve never been seen before There’s no way, I can spend 15 minutes. I’m going to be late. I’m going to spend 45 minutes with that patient to understand what they’re going through. What their troubles are, and what have they tried? What do they want to try Lay out all the options. Talk about the dangers of the medications like not abruptly discontinuing and stopping medicines, because that can cause a lot of problems, and having an open line of dialogue. ’cause that’s the only way to go when it comes to mental health Right and with starting so many, perhaps different treatment options. How do you know which one’s causing the effect Hard to disentangle? I think I guess the way that I do it is. First, I have a patient who’s coming in with depressive or anxiety, symptoms, figuring out the severity and length of time of how long that they’ve been feeling. These symptoms are the first thing that we have to establish Then we figure out what the patient is open to or wants to do, Because some patients may just want to have that one visit to make sure their blood pressure is okay share. What is going on in their lives and that’s it? Some patients want to be more aggressive and want to take medications. Some people rush to medications, and maybe that’s not the best route for them. Based on our conversation, I try and decide if is this going to be a patient that wants treatment A then do they want treatment in the form of cognitive, behavioral therapy medications, Or both, Or maybe just learn about those options and then do some bibliotherapy? Where I give them some books to read or pamphlets to read on the subject And then we have a follow-up appointment then from there it’s a feeling-out process Unless it’s severe depression. My general policy is to get patients to do cognitive, and behavioral therapy. First, The conditions that I mentioned, and then, if that’s not working or we feel like, we could add some extra benefit. Then we get medications on board, But again it’s, patient-dependent. It’s what they want: it’s what they’re comfortable with Because everything has side effects. Everything has time commitments, prices, costs, and insurance, Our healthcare system, especially when it comes to the mental health side of things, is a disaster There.’s. No other word for it: It’s an absolute disaster. I have to tell my patients with major depressive disorder, which means that they have low motivation levels to tell them that they have to be motivated to call 20 different offices and see which one is gon na have availability, which one is gon na, be able to Take their insurance, which one has availability within the next six months, And it’s like a recipe for disaster, because that patient is already struggling to brush their teeth in the morning or take a shower. How can I expect them to make all these calls, that’s, where we have the introduction of interdisciplinary teams, where we have social workers and counselors on staff that could help patients with things like this, Give them some assistance in finding availability or perhaps Be an interim counselor while they are waiting for their appointments that are booked super far down the line. That has been probably the biggest change that I’ve noticed over the last five to 10 years in medicine of working as interdisciplinary teams, Whether it’s mental health-related or even something like dieticians or nutritionists. Because we need that We can’t handle everything. As primary care physicians, This is physically impossible, especially with the time constraints we have Yeah there are a lot of barriers. It seems Even trying to access mental health in the first place, Not even when you’re already in touch with the GP, And so I think it leaves a lot of people wondering whether their feelings of stress might just be the usual normal feeling of stress Or whether it could be something more that warrants a medical professional. So what are your thoughts on whether someone can tell if they should be reaching out to someone or if it’s short-term and manageable on their own? My first thought is: if you’re, considering it do it, Because the worst-case scenario is that you go, and you realize you’re glad you did it, but you don’t need it. That’s the worst-case scenario, And if that’s the worst-case scenario you might as well go and have the relationship with your GP that you’re sharing what’s going on in your life. But for me, it starts with exactly that, having a GP and having a primary doctor because if you have a primary doctor, you’re already seeing them regularly And you’re having what we call touchpoints in medicine, where you’re interacting with your patient. In those moments you can catch that the patient is feeling a little bit off. You can catch that something’s going on in their life that they may need some help, whether it’s counseling medication, or even physical, or health-related. So to me, if you have a primary care doctor and you’re considering that, Should I go, I’m kind of feeling off that’s it that’s, the sign you’re telling yourself the trigger, Go and allow someone with an objective perspective to take a look and see if you can benefit from some kind of help, And sometimes patients come in and they speak with me and I feel like they’re doing a great job. Coping where I say Look, I think you’re doing a great job. Why don’t you take a look, and read this book? I think it’s going to help you a lot There are some exercises and stuff to do in it. We can reconnect, in a period of two to four weeks, to see how you’re doing. If you’re not benefiting greatly from this, and you could use more, we can escalate treatment, But it’s really about that experimentation and figuring out what works best, because there’s, no one size, fits all answer There’s, no score where you’re like If I feel like a five out of 10. That means I need to go see a doctor. It just doesn’t exist, unfortunately, because mental health is a very subjective space and it’s a subjective space with a lot of outside influence. You could feel okay one day, but then your partner can be unfaithful to you the next day and your whole mental state can change And that’s understandable. So at what point does it become a disorder versus a normal human reaction to someone breaking your trust or having a death in the family and you’re grieving? There’s a lot of misunderstanding that comes with that. I have young patients who come to my office, believing that they are depressed because they read it online or they see their favorite social media star talk about it And when I start talking to them, they tell me that they had a death in the family. Recently, Like a week before two weeks ago, I asked them like, If a person was sitting next to you who recently lost a family member – and they were down about it, would you tell them that they’re depressed or there’s something wrong With them Say, No absolutely not, I asked them like. Why are you feeling that way about yourself And they sort of start to realize that Oh, this is normal. Part of life is being sad. Part of life is experiencing a whole range of emotions, And it’s really about that balance. When does that balance get thrown off Medically the definition of the balance being thrown off is that it starts impacting your work. It starts impacting your ability to have relationships. Family social, romantic And if those things are suffering that’s when it starts getting, labeled quote unquote, diagnosis or disorder, And doctors technically can put that as a code’cause. We love our codes in medicine and our nomenclature When in reality, that means nothing. The human in front of you is everything Monica Hey Psych2Goers. I hope you enjoyed this part one interview with Dr. Mike. If you want part two of this video don’t forget to share this video to create awareness on how physical health may impact one’s. Mental health,