0:00
- I'm psychiatrist Dr. Eric Bender.
0:01
Let's answer your questions from the internet.
0:03
This is "Mental Health Support."
0:05
[lively music]
Break from Reality
0:10
@_pinkpenguin_ writes:
0:11
"Someone please educate me, what does psychotic mean?"
0:14
Psychotic means a break from reality.
0:15
You are experiencing things that other people might not be.
0:18
That can include auditory hallucinations,
0:20
hearing things other people might not be hearing,
0:22
visual hallucinations, although those are rare.
0:24
You might have delusions.
0:26
Fixed false beliefs you believe are true despite
0:28
other people showing you evidence that those aren't true.
0:31
Psychotic does not mean someone is going to commit crimes.
Depression and Sleep
0:34
@AndreaHPerezz: "How does depression make you exhausted,
0:37
but then sometimes I'm too sad to even sleep?"
0:40
When you're depressed, your circadian rhythms are off.
0:43
In fact, one of the first things we ask patients about
0:45
is sleep.
0:46
People don't realize it.
0:47
They have this picture that when you're depressed,
0:49
you might sleep more, but in fact, it's the opposite.
0:51
You wake up early, and people are like, "Why am I waking up
0:54
at five o'clock in the morning not even setting an alarm?"
0:56
It's because your sleep cycle's
0:58
been phase-shifted or phase-advanced.
1:01
You go to bed earlier and you wake up earlier.
1:03
We think this has to do with a lack of neurotransmitters
1:06
when you're depressed, so there's less serotonin,
1:08
norepinephrine, and there's less acetylcholine,
1:11
and for some reason this makes us wake up early.
1:13
@AtenSupreme: "Anyone else think stress is contagious?"
Is stress contagious?
1:16
I'll tell you, watching high school students in the Bay Area
1:19
go through the college application process,
1:20
I can absolutely tell you it is contagious.
1:22
There was a study that looked at an audience watching
1:25
a speech being given by someone who was very anxious.
1:27
Saliva samples were then gathered from the audience
1:29
as well as the presenter.
1:31
The saliva had increased cortisol levels,
1:33
which is that stress hormone,
1:34
not only in the presenter, but in the audience.
1:36
So stress is absolutely contagious.
1:38
@seyi_baby is asking:
Hypnotherapy
1:40
"Can depression be hypnotized out of you?"
1:42
No. Hypnotherapy is very effective for some things.
1:45
It can help people with smoking cessation.
1:47
It can help people decrease their temper.
1:49
It sometimes hypnotherapy can also be used
1:51
to treat sleep disorders and insomnia.
1:53
It cannot change the level of neurotransmitters
1:55
in your brain that are correlated with depression.
1:57
Some people are more hypnotizable than others.
1:59
When you look at this eye-roll chart,
2:01
it gives you a sense of a gradient.
2:03
How hypnotizable somebody might be.
2:05
You ask them to look up into their head.
2:07
When they're looking straight ahead, that's a zero.
2:10
Then one, slightly, you start to see a little bit of white,
2:13
then you start to see more white.
2:15
The scale goes all the way down to four,
2:16
being you see mostly white, almost exorcist style.
2:19
There is a correlation between those that show
2:20
a lot of white when they roll their eyes
2:22
and being able to be hypnotized easily.
2:24
DJLeapCard asks: "What's the difference
Psychology vs Psychiatry
2:26
between a psychologist and a psychiatrist
2:28
and which one do I need to see?"
2:30
Well, a psychiatrist has gone to medical school
2:32
so they can prescribe medications.
2:34
If you're feeling overwhelmed and need to talk to somebody,
2:37
a therapist would be fine.
2:38
That could be a psychologist or a psychiatrist.
2:40
If there's suspicion that medication is needed,
2:42
then a psychiatrist is the one you'd want to see.
How to not cry
2:45
@bellemaps wants to know:
2:46
"Question for psychiatrist/counselors: How do you not cry?"
2:49
Well, @bellemaps, to be honest,
2:51
sometimes I do get tearful with patients.
2:53
We are human after all,
2:54
even though some people don't think we are.
2:56
@MEZZ4NINN33: "Do personality disorders work on a spectrum?
Mild Narcissism
3:02
Like, can you have mild disorder of narcissism?"
3:05
Absolutely there's a spectrum here.
3:06
You can absolutely have narcissistic traits.
3:09
When it's unhealthy is when you start
3:10
to think only of yourself.
3:12
Fantasies and obsessions over unlimited power or beauty,
3:16
and then the full-blown disorder,
3:18
you could go as far as to be a malignant narcissist.
3:20
You have a lack of empathy
3:21
and don't really care about other people.
3:23
This is where we find psychopaths.
3:25
@resilience_doc:
Brain-Gut Connection
3:26
"How do you think the brain-gut connection works?"
3:28
Preclinical data, meaning data and research from animals,
3:31
not people, shows that there's a relationship
3:33
between the brain, the gut, and the microbiota
3:35
or the bacteria that populate your gut.
3:38
What we found was that in some stress-induced rodents,
3:41
they ended up having short-chain fatty acids,
3:44
and what we find is there's actually less serotonin
3:46
produced in the stress-induced rodents' guts.
3:49
Now, that's not the same serotonin that's in your brain.
3:51
Yes, it's the same structure, but that serotonin in your gut
3:55
doesn't cross the blood brain barrier.
3:57
However, what we find is that the inflammation
4:00
that is caused during the stress causes the vagus nerve,
4:03
which is involved in depression
4:05
to not fire the way it's supposed to.
4:07
And so as a result, this inflammation
4:09
might have something to do with a depressive state.
4:12
It suggests that with a healthy gut
4:13
and healthy microbiome, we can actually have improved mood.
4:17
Okay, next question.
Start of Psychiatry
4:18
@deriz_no_bot wants to know: "When did psychiatry start?"
4:21
Well, formal psychiatry
4:22
can be traced back to the 19th century.
4:24
We used to have a group of doctors called alienists
4:27
and their job was to understand and treat
4:29
and be with people who had an alienation from the rest
4:33
of society that was due to mental health issues.
4:36
In 1895, Freud wrote "Studies in Hysteria."
4:39
Some consider that the birth of psychoanalysis.
4:42
"Why does no one talk about how depression
Memory Loss
4:44
and anxiety can cause major memory loss?"
4:46
Depression really can make us have memory issues.
4:49
What we think that has to do with is a lack of glutamate.
4:51
Glutamate is the excitatory neurotransmitter,
4:54
and when there's less of that,
4:56
we find that people don't lay down memory.
4:58
Processing speed of somebody with a depressed mind
4:59
can be 40% below what it is when they're not depressed.
5:03
There's something called pseudo dementia, in fact.
5:05
This false appearance of dementia,
5:07
but it could in fact be a depression.
Intrusive Thoughts
5:09
@meggie_meg26: "You ever had a random-ass thought
5:12
that just won't leave your head?
5:13
I'm going through it right now."
5:14
First off, every human being has a random-ass thought.
5:17
If we don't want them, they're called intrusive and then
5:20
they can become obsessive if you can't let go of it,
5:22
and that's when it can start
5:23
to go into the obsessive compulsive disorder range.
5:26
So the obsessive thought pathway starts
5:28
with the connection between the orbital frontal cortex
5:31
and goes back to these areas here called the basal ganglia.
5:35
When that pathway is activated, there's a worry,
5:38
but then the inhibitory pathway goes back
5:40
to the orbital frontal cortex and actually shuts it down.
5:43
It inhibits it.
5:44
In someone with an obsessive thought disorder
5:47
where they keep worrying about the same thing.
5:48
There's over-activation of that direct pathway back
5:51
and under-activation of the inhibitory pathway.
5:54
It's like there's no breaks to stop this worry,
5:57
so we have this cycle that goes on and on and on and on.
5:59
Cognitive behavioral therapy or CBT is used
6:01
to help somebody with these kind of obsessions.
6:03
You can also do something
6:04
called exposure and response therapy.
6:07
That's where you make a hierarchy of fears.
6:09
Let's say somebody's fearful of spiders.
6:11
First rung on that hierarchy of fears might be,
6:13
all right, let's talk about spiders.
6:15
The next thing might be going to the tarantula exhibit.
6:17
Then the last thing might be petting spiders
6:19
and lighting them crawl all over you.
6:20
Ohnotthatmimi is asking:
ADHD
6:22
"Why does TikTok keep telling me I have ADHD?"
6:24
TikTok's gonna tell you a lot of things.
6:26
Please do not look at TikTok
6:28
as your sole source of information for mental health.
6:30
A study looking at 500 videos on TikTok with the hashtags
6:32
"mental health tips" and "mental health advice"
6:35
showed that about 84% were misleading,
6:37
about 31% had inaccurate information,
6:40
and 14% had information that was damaging.
6:42
Only 9% of the people doing the videos
6:44
even had relevant qualifications to do the videos.
6:46
As a society right now, our brains are being trained
6:50
to be stimulated for only a few seconds
6:52
and to go to the next thing and to go to the next thing
6:54
and to go to the next thing.
6:55
I think people find they have a hard time focusing.
6:58
It's not ADHD, maybe it's being on TikTok too long.
7:01
@Mendee: "I wish there was more information available
Mushrooms
7:03
on how shrooms can help
7:04
manage PTSD, anxiety, and depression."
7:07
The information's here and more is coming.
7:09
There is a lot of promise that shrooms or mushrooms
7:11
can actually help with PTSD or with depression.
7:15
What we're talking about when we talk about shrooms
7:17
is really psilocybin, a chemical that binds
7:20
to the serotonin receptor, particularly in the thalamus,
7:23
so that we have these hallucinations.
7:25
But what's interesting is it's not the hallucinatory
7:28
experience that necessarily is the treatment.
7:31
There's a case report of a man
7:32
who did have a psilocybin-guided treatment.
7:35
He didn't have the psychedelic experience
7:37
and was actually kind of disappointed he didn't,
7:39
but 40% of his depressive symptoms went away
7:42
based on his reports and the structured evaluations
7:45
that he was given.
7:46
There's something about having a guided treatment,
7:48
something about having somebody there with you
7:50
can be really helpful and really powerful.
7:52
It shows us that there's really a value
7:54
to being interconnected with each other.
Panic Attacks
7:56
@hexbags: "Am I having a panic attack?
7:58
Heart attack? Heartburn? Weird chest pain? What is it?
8:02
Cry emoji, cry emoji."
8:04
A panic attack is abrupt. It comes out of nowhere.
8:07
You can have chest tightness, difficulty breathing.
8:09
It can feel like your throat's constricting.
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You might have sweaty hands or sweat all over
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and maybe some pain, so it feels like
8:16
you're gonna have a heart attack.
8:17
That anxiety peaks after a certain number of minutes
8:20
and then it comes down but you're so worked up
8:21
and so worried that absolutely you feel panicked.
8:24
There's also something called an anxiety attack.
8:26
Maybe you're giving a presentation, maybe you have
8:28
to take a test and you get more and more anxious
8:30
and you feel like you can't go on.
8:31
That's an anxiety attack.
8:32
@TUNEOFYOURDEATH wants to know:
Anxiety Attacks
8:34
"Help. I'm having an anxiety attack
8:36
in the middle of class, sad face.
8:37
What do I do? Help."
8:39
You can do a grounding technique.
8:41
Remind yourself where you are and what you're doing.
8:44
I'm here. I'm sitting in the room.
8:45
There are people around me.
8:47
Some people go by the rule of 3, 3, 3.
8:49
See three things, hear three things,
8:51
and move three parts of your body.
8:53
A common thing people say is "just breathe."
8:55
That is not helpful.
8:56
I never find that helpful to say, "just breath."
8:59
A good breathing technique is actually inhaling
9:01
through your nose and exhaling for twice as long.
9:04
So you can inhale for, say, a count of three [inhales]
9:07
and exhale for a count of six. [exhales]
9:12
It's the exhale that's actually relaxing.
9:15
@angeldisrupted: "I'll be honest,
Endorphins, Serotonin, Dopamine, Oxytocin
9:17
I don't know the difference between serotonin or dopamine
9:19
or oxytocin or endorphins,
9:21
and at this point I'm too afraid to ask."
9:23
Endorphins are hormones.
9:24
Endorphin comes from the name endogenous meaning
9:27
it's made inside us, and morphine, which is a painkiller
9:30
and the endorphins imitate what morphine does.
9:33
That runner's high comes from endorphins.
9:35
Serotonin and dopamine are neurotransmitters.
9:38
They transmit messages in the brain.
9:40
Serotonin has to do with mood and anxiety,
9:42
and dopamine has to do with joy, pleasure,
9:45
and sometimes even motivation or attention.
9:47
Serotonin is implicated in depression and anxiety
9:50
when it's low, and dopamine can also be low
9:53
in depression and in ADHD.
9:55
Oxytocin is that loving or bonding hormone.
9:58
In women, when they breastfeed, that actually helps form
10:01
a loving relationship with the child.
10:03
@anxietyaloner says: "Has anyone tried fish oil
Omega 3
10:07
or omega-3 supplements for mental health?
10:09
It's meant to be good for anxiety and depression.
10:11
Did you notice any difference?"
10:12
Omega-3 fatty acids increase blood flow in the brain.
10:15
Now this doesn't necessarily correlate
10:16
to improvements in mood,
10:18
but some people do report improvements in mood
10:21
and that omega-3s can actually help with depression.
10:24
Even with ADHD, there's a population that will respond
10:27
to that and they'll be able to concentrate more.
10:29
You can take one gram or up to two grams,
10:31
but studies show that going up
10:33
to four grams doesn't really do anything.
10:34
One gram is the equivalent of having salmon meals
10:37
maybe three times a week.
10:38
You could get fish burps though. Just be aware of that.
10:41
@rydertrilla writes:
Schizophrenia
10:43
"I would love to know what trigger schizophrenia.
10:45
Like, actually study that shit."
10:46
We do know that now there are
10:47
over 200 genes responsible for schizophrenia,
10:50
and what happens is if you have enough errors
10:52
in those 200 genes, you might develop schizophrenia.
10:55
Even in schizophrenia, it's something we know
10:57
has strong genetic component to it,
10:59
there are environmental factors,
11:00
and we know this from studies of twins.
11:02
If one twin develops schizophrenia,
11:04
there is a one in two chance the other will,
11:06
but it's not a hundred percent,
11:07
suggesting there's something in the environment.
11:09
What might unlock that could be substance use,
11:12
it could be trauma.
11:13
We're still trying to figure out
11:14
the connections between these.
11:15
What is the environmental factor exactly?
11:18
What genes are turned on exactly?
11:19
Here's another one. "How does stress work?
Freeze Response
11:21
How do you destroy the freeze response?"
11:23
When we face stress,
11:24
there's a section in the brain called the amygdala.
11:27
It's a nuclei, a collection of cells.
11:29
That senses a threat and sends a message
11:31
to the hypothalamus.
11:33
The hypothalamus then gets our body ready
11:35
to make adrenaline or cortisol,
11:37
which allows us to have that fight or flight response.
11:39
Are we gonna get ready to stand up to this threat
11:41
or are we gonna take off?
11:42
What can also happen is another response
11:44
called the freeze response.
11:45
The "deer in the headlights" response.
11:47
Your body's been flooded with cortisol to get you ready
11:49
to fight or flight, but if your body's not responding,
11:52
then you don't do anything.
11:53
Destroying the freeze response would probably involve some
11:56
cognitive behavioral therapy or other types of therapy
11:59
where you talk about what is it
12:01
that is keeping you frozen in place.
12:03
@LiftingHumanity:
Beating Depression
12:04
"Can depression be beaten or only managed?"
12:06
Absolutely depression can be beaten.
12:08
I have seen people have depression
12:10
in what's called remission.
12:11
It's not coming back again.
12:12
What happens in depression is that we have lower levels
12:15
of serotonin, and when I talk about serotonin,
12:17
I mean between neurons in the synapse,
12:20
that connection between nerve cells.
12:22
There are medications called
12:23
selective serotonin re-uptake inhibitors,
12:25
big fancy name, SSRIs,
12:27
that target serotonin receptors and block them
12:30
and then the serotonin sticks around in that synapse,
12:33
and with that you get increased dendrites,
12:34
which are the branches of the nerve cells,
12:36
and with that, you get an elevation of your mood hopefully.
12:39
Medications in this category might include
12:41
fluoxetine or the brand name Prozac,
12:43
sertraline, which is Zoloft, escitalopram, which is Lexapro.
12:46
What we think these medications do is
12:48
increase the number of dendrites.
12:50
That's part of the reason it might take two to six weeks
12:52
for these medications to work.
12:54
You're increasing synaptic connections.
12:56
So medication is one way you can beat depression
12:58
and some studies show therapy and meds together
13:00
help more than just medication or therapy alone.
Generational Trauma
13:04
@golddust27 writes: "I was telling my therapist
13:06
about 'Encanto,' how it was all about
13:08
generational trauma and she was like,
13:09
"Uh, are you sure about that? A Disney movie?"
13:12
Yes, I'm sure about that.
13:13
"Encanto" was absolutely about
13:14
what's called transgenerational trauma.
13:16
Abuela, the grandmother, lost her husband Pedro.
13:19
He was killed right in front of her.
13:21
What ends up happening is that that trauma
13:23
was so disruptive, she wants to keep her children close.
13:25
She wants them to not do anything
13:28
that will cause her any kind of worry or pain.
13:30
Everyone is trying to protect Abuela from experiencing
13:33
any kind of loss or sadness again.
13:35
And in the case of Bruno, who recognizes,
13:37
"Wait, this doesn't feel right."
13:39
He's the one who's outcast because he's not part
13:41
of this group of people who are protecting Abuela.
13:44
She wants nothing to do with him. We don't talk about Bruno.
13:46
Well, you know, you should talk about Bruno
13:48
'cause Bruno's actually realizing something's wrong.
13:50
@luh_TRAY asks: "Are mental health issues genetic?
Genetics
13:53
There's a gene on my mom's side of the family
13:54
that has me questioning my reactions all the time."
13:57
Some mental health conditions do have
13:58
a very strong genetic component.
14:00
Things like bipolar disorder,
14:01
schizophrenia, autism, even ADHD.
14:05
In fact, in ADHD cases, sometimes 25 to 50% of the time,
14:09
a parent has ADHD.
14:11
But genetics are not the only part of the picture,
14:14
your environment plays a huge role in whether your genes
14:17
are expressed, so you could have a gene or several genes
14:21
that contribute to you showing a mental health issue,
14:24
and if they're not turned on,
14:26
then you're not gonna express that.
14:28
That's called epigenetics.
14:29
It means there's something else
14:30
that turns on this genetic code that unlocks it.
Antidepressants
14:34
@metalgurugirl is asking: "How many of us take
14:36
a form of antidepressant medication?"
14:38
Well, the CDC data is actually from 2015 to 2018,
14:41
they said that during that timeframe,
14:43
about 13.2% of the population took an antidepressant.
14:47
However, that was before the pandemic.
14:49
The American Academy of Pediatrics said in their journal
14:51
that from 2020 on, there was a 64% increase in prescriptions
14:55
to children and teens alone in terms of antidepressants.
14:58
So it's certainly more than 13.2% of the population now.
15:01
@sourskittlezs asks: "Does ketamine therapy work?
Ketamine Therapy
15:05
Asking for a friend?"
15:06
Yes, there's a lot of data on ketamine working
15:09
for depression, however, it's really important then
15:12
to know that ketamine therapy is not recreational ketamine.
15:16
There's an amount that you take
15:18
either by an intravenous infusion
15:20
and there's also a spray, esketamine.
15:23
What ketamine does is it blocks the place where glutamate,
15:26
the excitatory neurotransmitter binds.
15:27
By blocking that, the glutamate can increase.
15:31
It allows us to actually feel better,
15:33
but it only lasts for two or three days.
15:35
The drug rapamycin is being looked at,
15:37
it's being given with ketamine, and what that does is
15:40
it's actually preventing glial cells in the brain,
15:43
which chew up neurons from chewing up neurons,
15:45
and the length of ketamine is lasting longer.
15:47
So there's promise here.
15:49
That's being investigated at Yale
15:50
and we need to still see more results and more data.
Psychopathy Test
15:53
@RubyBegonia3 is curious: "Is there a test for psychopathy?"
15:56
Yes.
15:57
Robert Hare, a Canadian psychologist, came up with a scale
16:00
called the psychopathy checklist.
16:01
He wrote out a number of traits that you look at
16:04
to see how someone fits on a scale of psychopathy.
16:07
Those include personality traits
16:09
and those include criminal behaviors.
16:10
Some of the personality traits might be
16:12
pathologically lying, particularly about your own history,
16:15
or you might be glib, you might not share much
16:17
that's real with other people.
16:18
Someone goes through each of these 20 items
16:20
and scores it zero, one, or two.
16:22
Zero is not present, two is very much present.
16:24
Maximum score is 40.
16:26
If someone is 25, in some places, particularly for research,
16:30
they meet criteria for psychopath based on this checklist.
16:33
The closest diagnosis from DSM
16:35
is antisocial personality disorder.
16:37
That's where you break rules a lot,
16:39
but not everyone with antisocial personality disorder
16:41
is a psychopath.
16:42
However, typically, those with psychopathy are in fact
16:45
having criteria for antisocial personality disorder.
16:48
@malikkmars wants to know:
Personality Disorder
16:49
"Can you develop a personality disorder?
16:51
I think I caught one from somebody."
16:53
You can catch lots of things from people,
16:55
but typically, a personality disorder isn't one.
16:57
Now, that's said, there are a couple cases
16:59
where people might show personality traits
17:02
when that is already in their family.
17:04
For instance, histrionic personality traits,
17:06
being very dramatic about things.
17:08
If someone in a family acts that way,
17:10
you might start to do that too.
17:12
There's something called folie à deux,
17:14
which is folly for two, and that's when
17:16
a mental health experience is transmitted to somebody else
17:18
and they have the same experience.
17:20
That often happens when you're living with someone
17:21
who's psychotic and maybe they have a break from reality.
17:24
In fact, the next Joker movie is called "Folie à Deux,"
17:27
referring to Harley Quinn
17:29
and the Joker in their relationship.
DSM-5
17:31
@real_jawbreaker wants to know: "What does the DSM 5
17:33
say about me thinking everyone is constantly
17:35
talking shit about me behind my back?"
17:37
Well, the DSM 5 might actually say
17:39
you are a paranoid person.
17:41
There is something called paranoid personality disorder
17:44
where the DSM lists out criteria saying
17:47
that you might have delusional beliefs.
17:48
The DSM 5 is
17:49
the Diagnostic and Statistical Manual of Mental Illness.
17:53
It's essentially the guidelines with all the criteria
17:55
that psychiatrists and psychologists use
17:57
to diagnose people with a mental illness.
18:00
Sometimes it's controversial.
18:01
In early DSM volumes, being gay was a disorder.
18:05
Clearly, that has changed over time.
18:07
A new version of the DSM can come out
18:09
once every 11 or 12 years or so, so I guess I'll have
18:12
a new one to look forward to in another five years or so.
18:15
@x_tadashi wants to know:
Ink Blot Test
18:17
"What does the ink blot test even prove?"
18:19
The ink blot test, also called the Rorschach test,
18:21
was developed by Herman Rorschach.
18:23
He was a psychologist and a psychoanalyst.
18:25
And what happens when you're given a Rorschach test,
18:27
someone might hold up the card and say,
18:29
"Tell me what you see."
18:30
Batman, some kind of animal, something sexual,
18:34
and then there's a scoring system.
18:35
You would look at what part of the picture
18:37
did someone focus on, and the idea is that it reveals
18:39
something about their unconscious.
18:41
Initially, Rorschach thought this
18:43
could be a way to diagnose schizophrenia.
18:45
We know that that's not the case.
18:47
The Rorschach test is still used in some ways
18:50
in psychotherapy, particularly with kids.
18:53
You get a sense into how they're thinking,
18:54
what their life is like, so there's a way
18:57
to glean something about somebody from this test.
18:59
It's just not gonna be a way to diagnose schizophrenia.
19:02
@sulmoney says: "What do you think about
Integrative Psychiatry
19:04
integrative psychiatry, which merges traditional medicine
19:07
with alternative therapies?
19:08
Can these things work together?"
19:09
I have actually had patients given terminal diagnoses
19:12
of illnesses, they took on conventional treatment
19:16
and then brought in spiritual healers or guided meditation
19:21
and what was a terminal diagnosis
19:22
has turned into this person's tumors shrinking.
19:25
There was a study that looked at around 30,000 outcomes
19:29
and the outcomes with anxiety were that therapy
19:32
and medication together did better.
19:33
To me, that's an example of how you can combine treatments
19:36
and do a lot of good.
19:38
So those are all the questions for today.
19:40
Thanks for watching "Mental Health Support."

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