Search for tag: "mental illness"

Interviewer: When it comes to your mental health, how do you identify when you are actually in a crisis and when you might need some emergent or immediate help?

To help us answer this question, we're joined by Natalie McClintock. She's a licensed clinical social worker for the Huntsman Mental Health Institute, formerly known as the University Neuropsychiatric Institute.

Now, Natalie, when it comes to our mental health, we've all had bad days, we've all dealt with anxiety, some people have dealt with depression, but when does it become a crisis? When does it become something more serious that someone should really seek some professional help for?

Natalie: When we're looking at hospitalization, we're looking at someone who is in acute crisis. So one of our jobs as someone in admissions at a hospital is to meet with patients that are currently suicidal, have an active plan, and intent.

Now, that plan and that intent and that level of suicidality can differ from person from person, but that is not the patient's role to determine. That's why we have licensed professionals who are willing to meet with them and talk with them and connect them with the appropriate resources.

Interviewer: I guess one of the questions I have then is if it is not up to, say, a patient or an individual who's dealing with an acute crisis like this, what signs should they look for to identify that they should probably reach out to someone?

Natalie: When we're talking about suicidal patients, please reach out if you are having thoughts of actively wanting to harm yourself. If you are looking for a gun or looking for medications to overdose on, that is a good sign that you may need some help.

Outreach for hospitalization if you're starting to develop a plan, if you are starting to think, "I'm thinking maybe I'll go and drive somewhere and just see what happens." The plan doesn't have to be concrete. If you're just starting to think of what that plan would be, a good indication that you need some help.

The other thing is to look at your level of intent. Now, the important thing to remember with intent is studies show that intent can happen within 10 minutes of the actual suicide attempt. So if you're starting to think of a plan, or just thinking that you are wanting to die, you may not feel like you would ever do that, but again, that intent can happen within 10 minutes. So it's very quick.

Interviewer: Wow. So this is kind of an emergent situation, something that you should probably get immediate help.

Natalie: Yes. Just like if you were bleeding, or in a car accident, or having stomach pain, mental health is just as important to seek help for.

Interviewer: Yeah, it's potentially as life-threatening.

Natalie: It is. And not getting the help that you need and deserve is definitely life-threatening. Outside of suicidal ideation, if you are significantly depressed, and you're not going to work, you're not taking care of your activities of daily living such as showering, taking care of your family, eating, sleeping, you're scared to go outside, those are also some signs that you may need some hospitalization and further help.

Interviewer: So it's not just suicidal thoughts. It's also if your life is being severely impacted, and if you're on the road to a depressive episode, etc. Those are also reasons to reach out.

Natalie: Absolutely.

Interviewer: Before you're in crisis.

Natalie: I would argue that what we call a significant decline in functioning is a crisis. It is threatening your day-to-day life. You're no longer able to function, and that's a crisis.

Interviewer: What about, say, family members or friends or loved ones who may be concerned about someone else? What should someone in that situation where they have someone in their life that they care about who seems to be showing some of these signs, what should they do? What should they be on the lookout for?

Natalie: They need to outreach as well. A lot of patients and individuals, they have a lot of good insight in when they need help and when they are in crisis, especially if you deal with depression and suicidal thoughts consistently. These patients have good insight. Some patients don't, and they need the help of their family and the community to help advocate for them.

So absolutely, family members can call to the hospital, to other crisis services that we can talk about a little bit later, to help connect their family members and their friends and loved ones to those services.

Again, you're going to be looking for the same thing. Are they starting to withdraw more? Are they starting to give away possessions? Are they starting to talk about no longer wanting to be around? Those are important signs. Again, same with the decline in functioning. Again, are they withdrawing? Are they not taking care of themselves?

One patient population that it is difficult in that they don't have a lot of insight based off of the illness are patients that are suffering from psychosis, whether they have schizophrenia or even bipolar with a manic component. Those patients need more advocacy from their family and the community because there's not a lot of insight.

So are they spending a lot of money? Are they impulsively putting themselves in danger? Extreme examples are walking on the side of the road in the winter with no shoes. Or are they leaving their stove on? Things of that nature are things to watch out for with these patients. Again with the mania, are they spending a lot of money? Are they becoming sexually promiscuous? Are they quitting their job?

Interviewer: I guess as kind of a layperson, one of the things that I'm always worried about, if I see in my friends, in my family, some of these . . . maybe not the more severe signs, but just depression. I always worry about asking, right? Am I going to make the situation worse by being like, "Oh, are you feeling depressed?" or, "Oh, have you had suicidal thoughts?" I always worry that me asking is somehow going to make it worse. Is that true?

Natalie: The important thing is to make sure that they're safe. Asking if someone is suicidal or becoming suicidal does not put that idea in their head. They're already getting to that point. The important thing is to help connect them to a hospital or to a mental health professional that can get them the help that they need.

Interviewer: So I'm safe to ask those types of questions. It's not like I'm making the situation worse.

Natalie: No. Now, some patients may become defensive and deny. But if you have significant concern for their safety, again, outreach to the appropriate authorities and the mental health professionals to get them the help, and we can help get them into the hospital and get them connected to the appropriate resources.

Interviewer: So why don't we talk about that a little bit more? We've discussed what signs to look for in yourself, what signs to look for in others, the importance of getting help. I think for a lot of people, myself included, if I were having these thoughts, I don't even know what the first step is. Do I call 911? Do I call my doctor, my priest? What is the kind of procedure or step-by-step? If you find yourself or a loved one in crisis, what do you do first?

Natalie: Here, locally, in Utah, we have the Community Crisis Intervention and Support Services. This service includes a crisis line and a warm line. And those are clinical professionals and peer support specialists who can help walk through any questions that you may have, whether it's individually outreaching or outreaching on behalf of a family member or loved one. They are trained to answer any questions that you may have about mental health, about people in crisis, and what the next steps should be. It is a free service.

The other service that they offer is the Mobile Crisis Outreach Team. That is a social worker and a peer-support specialist. And I think I should make it clear that a peer-support specialist is someone who has gone through mental health, either gone through, or continuing to go through it and seeking treatment. They go out to the community to where the patient is and meets with them in their own environment.

And that can be a great resource, especially since going into a hospital can be scary. And they can help walk through what that process would look like. So that's a great resource to be aware of.

The SafeUT app is also a great resource. Individuals who may be in the younger demographic, teenagers, young adults, calling may not be what they feel comfortable with. They feel more comfortable texting, and so that SafeUT app is a chat line. It's a text line that you can outreach to someone. It's manned 24/7, and it can also be anonymous. So that is also a great resource for you to outreach for yourself or for someone else.

Nationally, there's also a 988. So how it currently stands is there's a National Suicide Hotline that anyone can call nationwide and it will connect you to a certified mental health provider in your state. And so the crisis line here at Huntsman Mental Health Institute, we are the answering service for that.

Interviewer: Wow. So anyone, anywhere, if they're having these types of thoughts, if they find themselves in any crisis state, they can call 988 and it will connect them to their local resources?

Natalie: Yes. And it's a number that you can easily remember just like 911.

Interviewer: What is the number that people can reach out to locally in Utah to make sure that they can get either through to the crisis line or the warm line?

Natalie: 801-587-3000 and that will connect them to the warm line, the crisis line, and MCOT. The app for SafeUT is just SafeUT.

Interviewer: On any app store?

Natalie: On any app store.

Interviewer: Fantastic. So again, mental health is as important as physical health. And if you're in any sort of emergency, you should get some professional help. Natalie, thank you so much for joining us, and thank you so much for caring about mental health.

Natalie: Thank you for having me.

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Mitch: Have you been feeling a little off lately or maybe sad for a prolonged amount of time without any obvious cause? I know I feel that sometimes. Could it be depression? And if it is, what are we as guys supposed to do about it?

Depression is one of the most common mental disorders in the U.S. impacting as many as six million men a year. And yet, according to research, men may be more likely to suffer from the severe consequences of depression, like substance abuse and suicide.

This is "Who Cares About Men's Health," where we aim to give you some information, inspiration, and a different interpretation of your health. And today we'll see if we can't shed some light on depression.

I'm Producer Mitch, and I bring a little more than the microphones. And as always, we have Scot, manager of The Scope Radio, and he always brings a healthy dose of BS. Hey, Scot.

Scot: That's right. I'm ready with a healthy dose of healthy BS. I don't know what happened there. My mouth stopped working. All right. Why don't you introduce Troy?

Mitch: And the man who brings the MD, Dr. Troy Madsen.

Troy: Mitch, I'm super excited to talk about depression.

Mitch: I know, right? The most exciting topic. And joining us today is Dr. Scott Langenecker, the clinical neuropsychologist and professor of psychiatry at University of Utah Health.

Dr. Langenecker: Hi.

Mitch: Now, before we get to the professional, I think one of the things that we should probably talk about first is kind of the layperson's understanding of depression, because I think we toss that term around a lot. It's like, "Oh, I'm feeling a little depressed." That seems to come up a lot and I'm not always 100% sure if that's true depression. Scot, when you hear depression, what does it mean to you?

Scot: That's a great question because it comes back to this whole notion of what does it even mean to be happy? I tend to think that my people, if you will, tend to be maybe just a little on the depressed side. Maybe we don't relish in life as much as other people. Maybe we're not as effervescent.

But what is it really? I don't know. Is it a feeling of you just can't go on? Is it a feeling of you can't breathe, like you're dragging your feet in concrete just trying to get things done? Is that depression? So yeah, I'll be curious to find out.

Mitch: Yeah. And what about you, Troy? I wonder if in your practice at the ER and stuff like that, you must have at least a little bit of an understanding of it.

Troy: We do see a lot of patients who come in who are depressed. And certainly, I think all of us have fluctuations in mood and outlook. I think depression in my experience, it's more when it's . . . You get to a point where it's just like this haze, this fog that you're in, and it affects your ability to do your work. It certainly affects your outlook, affects your relationships.

So I see it as certainly a step beyond just a lot of, I think, the fluctuations we might feel in our mood over the course of a day or a week or whatever that might be.

Scot: Or just a little sadness or feeling the blues or something like that.

Troy: Yeah. Exactly. And like you said, Mitch, you might be like, "I just feel depressed today." But yeah, I think it's certainly something beyond that kind of mood changes we might experience.

Mitch: Yeah. And personally, I actually got diagnosed with some depression this last year and have been taking a kind of professional approach to it. But I don't want to bury the lede. I don't want to steal anyone's thunder when talking about depression. So why don't we get to Scott?

Dr. Langenecker, what is depression? And I guess as a follow-up, what is causing that?

Dr. Langenecker: So I want to put it in two big categories to start out with. The first big category is that you all alluded to, that sort of feeling sad for more than just a day, maybe a couple of weeks. So that's one big bucket.

The other big bucket is, "Man, I used to really enjoy hiking or skiing or running or playing basketball, and now it's kind of like blah. It doesn't give me that jazz anymore." And it could be one of those things. It could be one of the other things.

There are another seven symptoms that can be part of it, but those are the two big ones that sort of tip people off. But if you're not looking forward to things coming up in the future, or you look at your schedule for the day and you're like, "This is objectively a good day and I still feel sad," that's probably a tip-off.

Scot: Is it really sadness, though? I mean, how do we even define what sadness is?

Dr. Langenecker: Well, that's a great question because I'm not sure men are allowed to feel sad.

Scot: Oh, okay.

Dr. Langenecker: Can I say that?

Mitch: Only anger.

Troy: Scot, you've never felt it, so you wouldn't know.

Scot: Right. The eternal optimist.

Dr. Langenecker: Sadness isn't a man thing.

Scot: I don't know. Yeah, I think about depression and I don't know that I think about sadness necessarily. Maybe something like overwhelmed with some emotion. Maybe it's overwhelmed with sadness.

Dr. Langenecker: Yeah. So let's talk about the male interpretation of sadness, which is, "I've got people counting on me and I can't cut it. I can't do what I'm supposed to do and I'm letting them down. I feel this pressure and I can't do what I'm supposed to do as a man, supporting my family, supporting my job at work." So it comes across as that. That's one way.

The other way is irritability and anger, which is like, "Ugh, that person just drives me crazy all the time." And maybe it's true. Maybe they are. Or maybe it's just that you're feeling a bit depressed and anything is going to set you off. Those are kind of the two big ones for men.

Troy: It's interesting that you frame it that way too, because I agree. I think a lot of times we think of sadness like just being really weepy and down in the dumps. But to think of it that way in terms of just feeling more irritable and angry and just a sense of inadequacy, that makes a whole lot more sense in terms of, I think, probably how that sadness manifests in us as men.

Dr. Langenecker: Yeah. I would add there's sort of this classic trope about the middle-age crisis for men and getting a new wife and getting a sports car and buying new golf equipment. There's a premise for that that's sort of rooted in depression, which is, "Man, the things that used to really interest me just don't anymore. I feel kind of flat. I feel not into it anymore." Every time you go into that sort of stereotypical midlife crisis mode for men, is that depression? No. But it is some clues, right?

Troy: And you also mentioned it's not just a day. It's not just one day, "I feel irritable today." Maybe I didn't sleep well last night. You're talking about something sustained over weeks to really diagnose depression.

Dr. Langenecker: Yeah. And I should add one more thing. I know you've all talked about the interface between the brain and the body. Sometimes depression comes out, not just in men, but in women too, it comes out in the body. So people are like, "Oh, my back is just driving me crazy. I can't get comfortable, I can't sleep," or, "Man, my knee is just bothering me lately." And it turns out that there's actually a reason for that.

So some of the neurochemical systems that interface between the body and the brain are sending some of those signals both directions. And so it comes out sometimes as pain.

Troy: Yeah, and I will absolutely second that. A very large percentage of people I see in the ER with chronic abdominal pain, back pain, even chest pain, they're clearly underlying emotional health issues, and a lot of that is depression.

So that's a good point of being aware of maybe some of the physical symptoms we're seeing. Certainly not to blow those off as just writing those off without getting those checked out, but it makes sense that a lot of that does relate to depression or mental health.

Mitch: Wow.

Dr. Langenecker: And if you take that analogy a bit further, and this goes back to my upbringing, when you had pain in the olden days, you would go see a chiropractor, like if you have back pain or leg pain or whatever. And what happens in a chiropractor's office? You get a kind, caring individual. They do some manual adjustments. They spend some time with you. It's a powerful human interaction, and it resets some of those neurochemical signals in addition to some of the psychological support that comes with it.

Mitch: So if it's causing trouble in your mood, your behavior, and also in your body, do we know what causes depression?

Dr. Langenecker: We have clues.

Mitch: But no answers. Just clues? Okay.

Dr. Langenecker: We have clues, but no answers. Yeah. So the easiest way to think about it is our brain is really, really sensitive to things that are dangerous to us. And we grew up evolutionarily in a place where it was really a bad idea to not be afraid of a tiger or of a rattlesnake. And it was really a bad idea to sort of go wandering out in the dark at night. And so our brain has adapted over time so that, for many reasons, we would sleep, but also so that we would have a healthy fear of things that could kill us.

Well, it turns out in the United States today, it's a pretty safe place. Part of the evolutionary makeup that we had, too, is that we had to form small groups to protect each other. And so social connectedness was a super huge important part of being healthy and staying alive.

And then the final thing is if we got sick, we needed a system to keep us separated from other people so that we wouldn't necessarily get them sick as well.

All of these things are great if you're running around in prehistoric times with sabretooth tigers and whatever, but it's not super helpful in our environment now. So we have these super-sensitive in-tune systems for detecting danger and stress and so on, and sometimes our system gets over reactive to these triggers in the world.

Sometimes, however, we have experiences which I would put in the broad category of not being fair. And if I had a nickel for every time I said to a patient, "Hey, what happened to you was not your fault, and it wasn't fair, and let's see what we can do about it," I would be a very wealthy man and I wouldn't be talking to you right now.

Mitch: So you're saying that everyone is maybe hardwired to have these kinds of responses? It's not like you are some sort of different. You're not some anomaly if you experience depression.

Dr. Langenecker: This is where I'm at today, after 25 years of studying this. I think that apart from maybe 3% or 4% of humans, we all have the capability of becoming depressed. And I think that's actually an inherent part of being human. I think it's a good part of being a human. And if you don't have those signals working when things go wrong, people probably won't like you very much.

Mitch: You're unlikeable if you can't get depressed? Is that what you're saying?

Dr. Langenecker: You're unlikeable if you don't care about things and don't care about other people. And it turns out if you take that capacity to care and you combine it with bad experiences, a lot of times that's going to end up being maybe not depression, but some sadness, a couple of days of sadness.

So you asked me the question, "What is the cause of depression?" And that's the segue. The segue is a couple of days of sad to more than a couple of days of sad. I use this term professionally. It's perseveration of negative mood. What the heck is that? It means that the negative mood doesn't leave, no matter how hard you try and shake it.

So it brings me back to Charlie Brown with the rain cloud over his head following him around. That is a beautiful example. And I know that Charles Schulz experienced depression because nobody else would draw that unless they experienced depression.

Mitch: And that's interesting that you said that because that was kind of my sign that something was up. In the past, I could maybe go for a jog after I learned to enjoy running, or I could watch a movie and I could pull myself out of a funk if I did these particular activities, eating food I enjoyed, etc. Suddenly, nothing seemed to pull me out of it. And it didn't matter how hard I worked or how many self-help programs I tried or how many books I read, I just could not get out of it. And that's when I knew I had to talk to someone. And eventually, I had to get some medication for it.

Dr. Langenecker: Yeah, that feedback system, right? We have a feedback system from our brain to our body. And you sort of think in depression, that system gets jammed up. It isn't working the way it's supposed to.

I don't know about any of you, I joined the conversation about running late, but I don't like to run. I hate running, but I love how running makes me feel. And if all of the sudden I didn't feel that way after running, it wouldn't take long for me to say, "You know what? I don't want to run anymore." And that's what depression does.

So we mentioned it before. Depression is this sneaky [beep] that takes away the joy from things and then convinces you that that's a good idea. Like, "Oh, no. I shouldn't seek out joy anymore. That's a great idea. I should just sit in my bed."

Troy: And how good are we at actually recognizing that in ourselves? How often do you find people like Mitch who recognize it, get help, versus how often is it others who are really pointing that out, saying, "Hey, you used to really enjoy this. You don't do it anymore. What's up?" I'm curious how that really works.

Dr. Langenecker: It's interesting. I don't mean this in a negative way, but we as humans have a lot going on, right? There's a lot of stuff going on in our heads, lots of stuff going on in our lives. And sometimes we just miss it. We miss it in ourselves. We miss it in other people. And that's not bad on anybody else. That's just the complexity of being a human being.

But sometimes it's absolutely the case that you miss it yourself. Absolutely the case that somebody else is like, "Hey, I notice that you're a bit off. What's going on?" And then of course as a man, our first response is, "Whoa. No, no, no. We're not going there."

Scot: "No, no. Everything's fine."

Dr. Langenecker: "I just rubbed some dirt on it. It's fine."

Mitch: Right. Can we say sneaky [beep], Scot, or is that what . . .

Scot: I don't know.

Mitch: All right.

Scot: Why sneaky [beep]? Why is depression a sneaky [beep]?

Mitch: That's what I was going to say.

Scot: What is the fact that has . . . What's the definition of [beep]?

Dr. Langenecker: Yeah. Unpleasant fellow. Let's use "the sneaky unpleasant fellow."

Scot: Oh, yeah.

Mitch: Okay. I love that.

Scot: I thought it meant something else, I guess. Okay.

Dr. Langenecker: So, in technical speak, we talk about cognitive distortions, like how depression changes the way you view the world. You view the world in more black and white terms, like, "Things are all good or they're all bad," or, "People are out to get me," or, "Things are never going to work out for me." And those cognitive distortions don't really work for a podcast or for actually talking to patients, like real humans. And so I've come to think of depression as this sneaky inner voice.

So you might remember back in the day, long ago in cartoons where they had the devil on your shoulder and the angel on your shoulder. This is kind of the devil on your shoulder saying, "Yeah, things are terrible. They're always going to be terrible. And that person is not going to help you, even if you ask them for help."

And so those cognitive thoughts are happening in the same exact system that does all of your problem-solving. And it doesn't take long to figure out, "Oh, so the same exact system that's doing the problem-solving is also distorting my perceptions of the world." That's the trap. That's the sneakiness of depression.

Scot: It's like a little saboteur.

Dr. Langenecker: It is absolutely a saboteur. And then to add insult to injury, in depression, I will feel ashamed that my brain is doing this to me on top of that.

Scot: Actually, it's like that game. What's that game, Mitch, that brought up the term sus? "It seems sus."

Mitch: Oh, "Among Us."

Scot: "Among Us." Yeah. It's like the little evil person in "Among Us" that pretends to be your friend, pretends to be looking out for you, but really behind the scenes, not doing cool things.

Dr. Langenecker: Yeah. So we come back to the question of "What is depression?" Depression is your own brain convincing you that things that are good for you aren't good for you.

Mitch: That resonates so much with me. I was actually talking to my therapist the other day. I've been in a bit of a depressive episode. And when I was chit-chatting, it was just like . . . He's like, "You know what you need to do to get better." And I'm like, "I know. I need to start eating better, I need to get out, I need to do the things that I enjoy more, remind myself I enjoy them. I need to be talking to people."

And he's like, "Even if you don't like doing it right now, that's just your depression telling you, 'No. Don't work out. No, don't go talk to these people because they hate you,' or whatever. Just power through it. Ignore them. It might be unpleasant, but you've got to start doing those types of things if you're going to get out of the depression cycle."

And I think that's kind of what I want to ask next. What do you do? How do you fight back against this saboteur of depression?

Dr. Langenecker: I'm glad you brought that up, Mitch, because there's another piece to this. So you take this maleness of "I don't need help," and then you take this sort of cultural belief that we're doing the Horatio Alger thing and just pulling ourselves up by our bootstraps. And then you take this idea of positive psychology, which is literally rub some dirt on it or rub the dirt off of it. I don't know what it might be. And for somebody who's experiencing depression, that's basically telling them, "You're an idiot. You can't figure it out. You should have figured it out a long time ago. Why are you such a moron?"

And I'm using really strong language here because that's the saboteur. The saboteur can take really well-meaning, "Hey, maybe you could try this," or often, "You should do this," and it comes across as, "I'm incompetent, and I'm making a big deal out of this, and I should just get over it."

So part of the work with a therapist, honestly and truly, is getting folks to realize that they deserve better and to believe that they deserve better and to do things in the world to actually experience the better. That's how we beat the saboteur.

Mitch: That's interesting, because on another episode we kind of talked a little bit about the first couple of mental health workers I worked with. I was suffering from depression and that was the very same thing I felt. When that first person was like, "Oh, yeah, have you tried gratitude journaling?" the first thing I thought was, "I've tried it. It's obviously not working for me, doc. You've got to help me here. I'm not going to open up the journal again. Things are obviously terrible."

And I think looking back on that, he was probably giving decent advice and good advice. I just was not in the mood to hear it.

Dr. Langenecker: And that's why I use the analogy of a journey with some really comfortable shoes because it's not just the what, it's the when. And there's a phenomenon in depression, the waxing and waiting of depression, where as a therapist, I wait for windows of opportunity. I don't force windows of opportunity. And that has taken years to hone that skill, because if I force it at the wrong time, I'm going to be breaching some of that trust that I worked so hard to build with my client.

Mitch: So to kind of wrap up this discussion on depression, Scott, it sounds like depression is when you are feeling out of sorts or sad for more than one day, things that you used to enjoy aren't giving you that spark of joy that they used to. At what point should someone . . . what is a sign, a red flag that they should probably go talk to someone or they should probably seek some sort of treatment in one way or another? And what can they expect on those first steps of their mental health journey?

Dr. Langenecker: So to come back to that point, having the sadness or lack of joy for . . . Technically, we use the term two weeks or more as sort of the breakpoint. That is not a magical number. That is just a number that we've come up with over time. It could be more than five days, it could be more than three weeks, but just sort of this idea that something is off.

And then if it starts to mess with your sense of who you are as a person and what you deserve in the world, that's the point at which you say, "You know what? I don't have to fight alone. There are really talented people who are out there ready to help me."

Mitch: I love it. And what can they kind of expect on their first couple of steps into getting help?

Dr. Langenecker: I think the main thing is don't rush it, like we were talking about before. Don't feel like you have to rush this thing. We get into this mindset of, "Oh, I can take my car in for a tune-up." A brain tune-up is much more complicated than a car tune-up. It might take a couple of months. It might take longer. Be comfortable with the idea that you are investing in you. You are investing in you deserving a better life.

Mitch: Scott, thank you so much for joining us, and thank you for caring about men's health.

Dr. Langenecker: Thank you.

It seems there has been a big increase in the number of children being diagnosed with sensory disorders. One reason may be that kids with sensory issues actually have other diagnoses, such as ADHD, anxiety, PTSD from abuse, and autism, just to name a few examples. Other times, some kids may just be sensitive to some things but not others and don't actually meet the full criteria. It has only recently been added to the psychiatry diagnosis textbook, the DSM-5.

Sensory processing disorders are basically where kids are sensitive to sounds, textures, or other stimuli to the point where it is beyond normal childhood behavior and causing a disruption in the child's life and also in the life of the family. Any of the five senses, taste, touch, smell, sight, and sound can be affected. Often children with sensory issues also have poor fine motor skills or have a hard time with social cues and interactions. They have a hard time regulating their emotions.

One study shows that sensory processing disorders affect 5% to 15% of school-aged children. Another study showed that there may be a biological cause with abnormalities in the white matter of a child's brain that could explain sensory issues.

Some children are hypersensitive to things and may think everything is too loud or too bright. They are the ones who are covering their ears often or have a low pain threshold or are super picky with eating certain textures. They have a hard time focusing and controlling their emotions, and they don't like to be touched. Other children are hyposensitive and they crave input, trying to get more sensory input. They're more likely to have a high pain threshold, put things in their mouths, hug too tightly, invade other people's personal space, or rock and sway.

One big issue is that there is still so much to be learned about sensory processing disorders. Your pediatrician can suspect your child has a sensory processing disorder but cannot actually make the diagnosis. Again, there are so many other brain issues that can present with similar symptoms so it takes a developmental or a behavioral specialist or even a neuropsychologist to get an official diagnosis. Your pediatrician will refer your child to someone who can help do a full and complete evaluation to get the correct diagnosis. The mainstay of treatment for sensory processing disorders is occupational therapy. Occupational therapists can help kids and parents learn ways to manage their sensory needs.

If you have concerns that your child may have a sensory issue, please talk to your child's pediatrician and ask them for a referral to a specialist who can get them the right diagnosis and treatment.

Dizziness, especially in teenagers, seems to be a common concern I'm seeing lately. Is this something really concerning or a symptom of other more common issues?

Lately, I'm having one or two teenage patients a week coming to see me with the chief concern of dizziness. It's usually girls, usually around 15, but sometimes boys too. A conversation about their symptoms often points me down one or two paths -- vasovagal syncope or anxiety.

Kids who have vasovagal syncope feel lightheaded when they stand up too quickly. Their blood pressure drops and down they go. The most common reason is they aren't hydrated and their blood pressure can't compensate fast enough for how quickly they stand up. This type of reaction also happens with fear and strong emotions, such as seeing needles.

Often, if kids stay hydrated, which means drinking enough water so that when they pee their pee looks like water, their symptoms improve.

Parents often ask me, "Well, how many glasses of water is enough?" But there's no simple answer other than to monitor their urine. Everybody is different with their water needs.

With anxiety, the dizzy feeling is more a nervous system response. Along with the dizziness, they will say that they're hyperventilating or their heart rate goes up or they're sweaty or they're shaky. That's a panic attack.

Unfortunately, the treatment for that kind of dizziness is a bit more complicated than just drinking water. Drinking water won't help anxiety. The first step for anxiety is learning some coping skills to help stop the panic attack. Have your child learn some deep-breathing exercises such as square breathing.

You may ask, "What is square breathing?" We'll have your child use their finger to draw a square in the air in front of them. Every time they draw a side of the square, they either take a deep breath in or they let their breath out.

There are several free apps to help with meditation also. The schools will often use Calm. We've used Relax Melodies at our house.

If that doesn't help, the next step is finding a therapist who can help your child manage their anxiety.

Finally, if your child is still having panic attacks despite therapy, your pediatrician can help you find a mental health provider who can work more closely with your child on their anxiety.

Many teen girls that I am seeing for dizziness also admit to cutting or other self-harm behaviors as a coping mechanism. So a mental health provider can also help with this.

Many parents often ask me to do blood work for anemia for their teen's dizziness. In boys, because they don't have periods, this is rarely the case. In girls, if their periods are really heavy or frequent, that could be the cause. But I do not find that they are anemic for the most part.

Abnormal thyroid labs can also cause dizziness and anxiety, even depression. More so in older teen girls than boys, but this too is usually not the case.

Parents often want me to check vitamin levels because their kids don't eat as healthy as they should. That's not something that a pediatrician will usually do. Unless the teen has a specific underlying medical condition, vitamin deficiencies are not very common. And if a parent is very worried about vitamin deficiencies, they can just have their teen take a daily multivitamin designed for teens. There are several on the market, and they come in tablets and gummies.

The bottom line is if your teen says they are dizzy, try hydration first. And talk to them. See if they're anxious about anything. If the problem persists, then it's time to bring them in to see their pediatrician.

Interviewer: Ten percent of people living in Utah are at a higher risk for seasonal affective disorder. We're talking today with Dr. Jason Hunziker. First of all, why are we, living in Utah, at a higher risk?

Dr. Hunziker: There are a lot of theories as to why people who live in the northern latitudes are at higher risk of this type of depression. One of those theories is the fact that there just is not as much daylight in the north as there is closer to the Equator. So the further we get away from the Equator, the shorter the days become, the darker it becomes, and so people get more depressed.

Interviewer: And so, then it's true that sunlight actually makes you happy.

Dr. Hunziker: That's correct. People who live closer to the Equator have less chance of this type of depression.

Interviewer: Are there other risks then, being in Utah, besides not enough sun?

Dr. Hunziker: There are, and people who are at risk that live in Utah are people who are young, they're a lot more at risk. Women tend to be at a higher risk than men, at an almost ten times more likely to get this type of depression than men.

The other thing that occurs in Utah, that doesn't occur in other places, is our inversion. So time away from the sun, even on a bright day, we don't get that because the inversion's there to block the sun. People who live around tall buildings that block the sun tend to get more depressed. If your job is indoors, in the basement with no windows, during the winter you're really at risk.

Interviewer: And especially since we have Daylight Savings here in America, you get out of work at 5:00 and it's already dark.

Dr. Hunziker: That's right.

Interviewer: And so you don't really ever . . .

Dr. Hunziker: That's right.

Interviewer: And then you wake up at, you know, 6:00, 7:00 and it's still dark, and so you never really see the sun.

Dr. Hunziker: That's correct, and it can't just be the light in your office that makes the difference, it has to be the same wavelength as the sun to make a difference, which is why people use light boxes because that does help with most people who have this type of seasonal disorder.

Interviewer: So knowing that people in Utah are at higher risk for depression, tell me from a doctor's perspective exactly how dangerous that is.

Dr. Hunziker: Yeah. So depression can be extremely dangerous, and suicides rates, particularly in Utah, are quite high. And if depression of any type goes unchecked, it can lead to people thinking about ending their life, which is extremely important. So any time you're experiencing a depressed mood, it should be evaluated, at least by your primary care doctor to see if something else needs to be done.

Interviewer: So with depression being so serious, does it often get confused for somebody just being moody, then, because people get moody and they get upset, but when does that become depression? When does it become dangerous?

Dr. Hunziker: The way you can tell is if this lasts every day for at least two weeks, where you're feeling so terrible that you don't want to get out of bed, where you feel like you have to sleep all of the time. You have absolutely no energy, or interest, or desire to do anything with anyone. You notice that you're eating a ton, particularly carbohydrates. With this population that gets seasonal affective disorder, carbohydrates tend to be the big thing that they do. And then, of course, if you start having any thoughts about hurting yourself at any time, that's when it really needs to be addressed.

So in summary, I think that for those of us living in Utah, we are at higher risk, so we need to pay attention to those signs of depression. Particularly women, particularly young people, particularly people who work in environments where they're not around sunlight need to pay attention to this. If you notice that you're having any changes in your mood, please seek help.

updated: December 16, 2022
originally published: December 16, 2015

Dr. Jones: About 10% of US adults experience mental illness such as depression or anxiety every year. How to overcome that stigma? This is Kyle Bradford Jones, family physician at University of Utah, coming up next on The Scope.

Announcer: Health information from expects, supported by research. From University of Utah Health, this is TheScopeRadio.com.

Dr. Jones: So lots of people, particularly adults in the US, suffer from depression or anxiety but have difficulty overcoming the stigma of having that. A lot of people think, "Hey, am I crazy if I'm depressed? I can buck up. I can do this on my own." The culture in the United States tends to revolve around being the cowboy, "I am independent. I can do this on my own. I do not need your help," but depression and anxiety is more than that. This is something that is a real illness that you cannot simply overcome on your own.

There are a couple of things to keep in mind. This is more than just being sad. That's kind of the first thought that most people have. Depression can be an emotion, it can be a symptom of something else, or it can be a diagnosis. The emotion is feeling sad. It is having a bad hair day. It's going through something tough. That's completely normal. It can also be a symptom of something else, such as thyroid disease or something like that.

But the diagnosis of depression, you feel a little bit more sad, you feel guilt, you have trouble concentrating, you have less energy. You no longer take pleasure in things that are normally fun and entertaining for you, and it leads to decreased function. And so having that thought of, "Hey, I can overcome this on my own," is actually going to be detrimental if you have the diagnosis of clinical depression.

So what things can you do? First of all, go see your physician. This is something I can start with your primary care physician. Talk to them about what you are experiencing. They can give you some guidance on how severe it is, if it is the diagnosis versus if it's an emotion, a symptom, they can offer some different things for you.

A lot of people think that therapy is just talking to someone and that's it. But that's not the purpose of it. So certainly that helps a little bit, but there are therapeutic methods that have been proven to give you better coping skills, to help you better deal with the things that you're experiencing.

Now, the best way to deal with depression is a combination of therapy and medication. A lot of people are worried, "Hey, if I go on medication, I'm going to be on this for the rest of my life. It shows that I am crazy and I'm going to feel like a zombie. It's going to completely take away my ability to feel." It's actually the opposite on all those accounts.

The vast majority of people who are on medication for depression or anxiety take it for about 6 to 12 months, and then they're okay without it after that. It's actually not something that's going to make you feel like a zombie and keep you from feeling. It actually quiets the depression and anxiety so that you can get back to your normal self, to your normal feelings, your normal activities. Less than 50% of adult men get treatment for their depression or anxiety. Obviously, that's a big deal.

Now, how do we get rid of this stigma? The first step is understanding it, understanding that this is a medical condition. It's caused by a decrease of chemicals in your brain. This is not a moral weakness. Oftentimes this can be brought on by a stressful life event and it can just be a short-term thing. Like we said, you don't need to have treatment long-term for most people. Also, understanding that as a society we just need to talk about it more. It's okay.

There are actually a significant amount of people that struggle with this from time to time and that's okay. Treatment helps because if you don't get it treated, it actually worsens your relationships, it worsens other health problems that you have and overall can simply make things worse. So seeking treatment and seeking the appropriate diagnosis can really make a big difference.

In summary, if you feel like you may be suffering from depression or anxiety, you are not crazy. Seek therapy. Go see your physician. Don't be afraid of it, because denying it only further ruins everything else going on in your life.

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Interviewer: People with eating disorders experience severe disturbance in their eating patterns. It's important to remember that eating disorders are mental illnesses and the physical effects are the symptoms. That's coming up next on The Scope.

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Interviewer: Three percent of Americans suffer from binge eating disorder. We're talking with Dr. Jason Hunziker, a psychiatrist at the University of Utah. Dr. Hunziker, what mental conditions can cause an eating disorder?

Dr. Jason Hunziker: There are lots of mental illnesses that are associated with eating disruption or eating disorder for different reasons. An example would be somebody with schizophrenia gets very paranoid often, so they won't eat their food because they're afraid it's been poisoned. We have other people who are so anxious about allergies in food that they just won't eat, so they have a specific phobia about certain foods. Some recent studies have shown that people with bipolar disorder and/or depression also struggle with eating disorder of a different type in which they binge eat.

Interviewer: First of all, what is binge eating?

Dr. Jason Hunziker: Binge eating is when you're going along fine and you eat normal foods, then you have an episode in which you just can't get enough food. You binge on whatever's in front of you. Most often it's not stuff that's good for you.

Interviewer: Always.

Dr. Jason Hunziker: You eat lots of it. Then, you eat to the point that you almost feel like you're going to burst. That leads to some people then going in and purging and getting rid of the food that they just ate.

Interviewer: So, it's different than, say, on a Saturday night I'm in front of a movie and I'm eating everything that's in my kitchen. That's different. It's those people that do that but then feel guilty, and then they throw up afterwards. Is that correct?

Dr. Jason Hunziker: That's correct. Usually, with binge eating there is a number of times you need to participate in that event before it even gets classified as a binge eating disorder. That has to be several times a week or month. Then, you qualify for a binge eating disorder.

Interviewer: What exactly causes someone mentally to think okay, I need to throw up? Because when I eat too much and I'm full I just wait for the food to settle down.

Dr. Jason Hunziker: Not everybody does throw up when they have the binge eating. What they'll do, though, is they use that food as some way to help comfort them for whatever's going on in their life. Often, as I said, it is associated with depression. When people are sad and they're down they...

Interviewer: They eat.

Dr. Jason Hunziker: ...feel like eating. And, the same with bipolar disorder - when you're sad and you're down, you eat. That somehow gives them some comfort, while at the same time it induces shame, and guilt, and other aspects of well, now I'm gaining weight, and now I'm not thin. It's a vicious cycle for them.

Interviewer: We obviously know that we classify binge eating as an eating disorder which is a mental illness. What other physical health conditions can it cause?

Dr. Jason Hunziker: It depends on how long this goes. Clearly, binge eating is going to increase your weight. As your weight increases we know that affects all aspects of your body including your lungs, and your heart, and then the cardiovascular system and other physiologic effects that it can bring on. Type-2 diabetes in this country now is really expanding because of the obesity problem, and this would be another way to contribute to that problem.

Interviewer: That's interesting. There are all these sorts of more severe diseases that can come from just binge eating.

Dr. Jason Hunziker: That's correct.

Interviewer: Obviously, you know that's going to happen. You want to treat it. Is it something that you physically and emotionally are maybe aware of, or do you need somebody to tell you I think there's a problem you need to go see a specialist?

Dr. Jason Hunziker: I think that some people are aware and some aren't. I think if it's associated with your mood disorder that would be a time to get into your doctor and get on some medication for your depression, which often will help take care of those binge eating episodes. Sometimes the medication itself will help take care of that compulsion or drive to eat which some people just have. They just feel compelled to do it and they can't feel good unless they do it. Then, they feel bad after they do it. It's a really vicious cycle. The medicine often will help with that.
There are good therapies that can help with eating disorder as well. It's really important to understand the underlying cause, and if it's caused by another illness to make sure that you treat that illness so that you can then treat the binge eating.

Interviewer: Any final thoughts on binge eating?

Dr. Jason Hunziker: I think that the important thing to do is for the patients and/or their families to recognize that the binge eating is a disruption to them, and that they get into talk to their doctor as soon as possible about what could be done to help them...

Interviewer: Because it can be treated.

Dr. Jason Hunziker: ...because it can be treated.

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