I'm psychiatrist Dr. Eric Bender.

Let's answer your questions from the internet.

This is Mental Health Support.

[lively music]

@_pinkpenguin_ writes:

Someone please educate me, what does psychotic mean?

Psychotic means a break from reality.

You are experiencing things that other people might not be.

That can include auditory hallucinations,

hearing things other people might not be hearing,

visual hallucinations, although those are rare.

You might have delusions.

Fixed false beliefs you believe are true despite

other people showing you evidence that those aren't true.

Psychotic does not mean someone is going to commit crimes.

@AndreaHPerezz: How does depression make you exhausted,

but then sometimes I'm too sad to even sleep?

When you're depressed, your circadian rhythms are off.

In fact, one of the first things we ask patients about

is sleep.

People don't realize it.

They have this picture that when you're depressed,

you might sleep more, but in fact, it's the opposite.

You wake up early, and people are like, Why am I waking up

at five o'clock in the morning not even setting an alarm?

It's because your sleep cycle's

been phase-shifted or phase-advanced.

You go to bed earlier and you wake up earlier.

We think this has to do with a lack of neurotransmitters

when you're depressed, so there's less serotonin,

norepinephrine, and there's less acetylcholine,

and for some reason this makes us wake up early.

@AtenSupreme: Anyone else think stress is contagious?

I'll tell you, watching high school students in the Bay Area

go through the college application process,

I can absolutely tell you it is contagious.

There was a study that looked at an audience watching

a speech being given by someone who was very anxious.

Saliva samples were then gathered from the audience

as well as the presenter.

The saliva had increased cortisol levels,

which is that stress hormone,

not only in the presenter, but in the audience.

So stress is absolutely contagious.

@seyi_baby is asking:

Can depression be hypnotized out of you?

No. Hypnotherapy is very effective for some things.

It can help people with smoking cessation.

It can help people decrease their temper.

It sometimes hypnotherapy can also be used

to treat sleep disorders and insomnia.

It cannot change the level of neurotransmitters

in your brain that are correlated with depression.

Some people are more hypnotizable than others.

When you look at this eye-roll chart,

it gives you a sense of a gradient.

How hypnotizable somebody might be.

You ask them to look up into their head.

When they're looking straight ahead, that's a zero.

Then one, slightly, you start to see a little bit of white,

then you start to see more white.

The scale goes all the way down to four,

being you see mostly white, almost exorcist style.

There is a correlation between those that show

a lot of white when they roll their eyes

and being able to be hypnotized easily.

DJLeapCard asks: What's the difference

between a psychologist and a psychiatrist

and which one do I need to see?

Well, a psychiatrist has gone to medical school

so they can prescribe medications.

If you're feeling overwhelmed and need to talk to somebody,

a therapist would be fine.

That could be a psychologist or a psychiatrist.

If there's suspicion that medication is needed,

then a psychiatrist is the one you'd want to see.

@bellemaps wants to know:

Question for psychiatrist/counselors: How do you not cry?

Well, @bellemaps, to be honest,

sometimes I do get tearful with patients.

We are human after all,

even though some people don't think we are.

@MEZZ4NINN33: Do personality disorders work on a spectrum?

Like, can you have mild disorder of narcissism?

Absolutely there's a spectrum here.

You can absolutely have narcissistic traits.

When it's unhealthy is when you start

to think only of yourself.

Fantasies and obsessions over unlimited power or beauty,

and then the full-blown disorder,

you could go as far as to be a malignant narcissist.

You have a lack of empathy

and don't really care about other people.

This is where we find psychopaths.

@resilience_doc:

How do you think the brain-gut connection works?

Preclinical data, meaning data and research from animals,

not people, shows that there's a relationship

between the brain, the gut, and the microbiota

or the bacteria that populate your gut.

What we found was that in some stress-induced rodents,

they ended up having short-chain fatty acids,

and what we find is there's actually less serotonin

produced in the stress-induced rodents' guts.

Now, that's not the same serotonin that's in your brain.

Yes, it's the same structure, but that serotonin in your gut

doesn't cross the blood brain barrier.

However, what we find is that the inflammation

that is caused during the stress causes the vagus nerve,

which is involved in depression

to not fire the way it's supposed to.

And so as a result, this inflammation

might have something to do with a depressive state.

It suggests that with a healthy gut

and healthy microbiome, we can actually have improved mood.

Okay, next question.

@deriz_no_bot wants to know: When did psychiatry start?

Well, formal psychiatry

can be traced back to the 19th century.

We used to have a group of doctors called alienists

and their job was to understand and treat

and be with people who had an alienation from the rest

of society that was due to mental health issues.

In 1895, Freud wrote Studies in Hysteria.

Some consider that the birth of psychoanalysis.

Why does no one talk about how depression

and anxiety can cause major memory loss?

Depression really can make us have memory issues.

What we think that has to do with is a lack of glutamate.

Glutamate is the excitatory neurotransmitter,

and when there's less of that,

we find that people don't lay down memory.

Processing speed of somebody with a depressed mind

can be 40% below what it is when they're not depressed.

There's something called pseudo dementia, in fact.

This false appearance of dementia,

but it could in fact be a depression.

@meggie_meg26: You ever had a random-ass thought

that just won't leave your head?

I'm going through it right now.

First off, every human being has a random-ass thought.

If we don't want them, they're called intrusive and then

they can become obsessive if you can't let go of it,

and that's when it can start

to go into the obsessive compulsive disorder range.

So the obsessive thought pathway starts

with the connection between the orbital frontal cortex

and goes back to these areas here called the basal ganglia.

When that pathway is activated, there's a worry,

but then the inhibitory pathway goes back

to the orbital frontal cortex and actually shuts it down.

It inhibits it.

In someone with an obsessive thought disorder

where they keep worrying about the same thing.

There's over-activation of that direct pathway back

and under-activation of the inhibitory pathway.

It's like there's no breaks to stop this worry,

so we have this cycle that goes on and on and on and on.

Cognitive behavioral therapy or CBT is used

to help somebody with these kind of obsessions.

You can also do something

called exposure and response therapy.

That's where you make a hierarchy of fears.

Let's say somebody's fearful of spiders.

First rung on that hierarchy of fears might be,

all right, let's talk about spiders.

The next thing might be going to the tarantula exhibit.

Then the last thing might be petting spiders

and lighting them crawl all over you.

Ohnotthatmimi is asking:

Why does TikTok keep telling me I have ADHD?

TikTok's gonna tell you a lot of things.

Please do not look at TikTok

as your sole source of information for mental health.

A study looking at 500 videos on TikTok with the hashtags

mental health tips and mental health advice

showed that about 84% were misleading,

about 31% had inaccurate information,

and 14% had information that was damaging.

Only 9% of the people doing the videos

even had relevant qualifications to do the videos.

As a society right now, our brains are being trained

to be stimulated for only a few seconds

and to go to the next thing and to go to the next thing

and to go to the next thing.

I think people find they have a hard time focusing.

It's not ADHD, maybe it's being on TikTok too long.

@Mendee: I wish there was more information available

on how shrooms can help

manage PTSD, anxiety, and depression.

The information's here and more is coming.

There is a lot of promise that shrooms or mushrooms

can actually help with PTSD or with depression.

What we're talking about when we talk about shrooms

is really psilocybin, a chemical that binds

to the serotonin receptor, particularly in the thalamus,

so that we have these hallucinations.

But what's interesting is it's not the hallucinatory

experience that necessarily is the treatment.

There's a case report of a man

who did have a psilocybin-guided treatment.

He didn't have the psychedelic experience

and was actually kind of disappointed he didn't,

but 40% of his depressive symptoms went away

based on his reports and the structured evalsuations

that he was given.

There's something about having a guided treatment,

something about having somebody there with you

can be really helpful and really powerful.

It shows us that there's really a value

to being interconnected with each other.

@hexbags: Am I having a panic attack?

Heart attack? Heartburn? Weird chest pain? What is it?

Cry emoji, cry emoji.

A panic attack is abrupt. It comes out of nowhere.

You can have chest tightness, difficulty breathing.

It can feel like your throat's constricting.

You might have sweaty hands or sweat all over

and maybe some pain, so it feels like

you're gonna have a heart attack.

That anxiety peaks after a certain number of minutes

and then it comes down but you're so worked up

and so worried that absolutely you feel panicked.

There's also something called an anxiety attack.

Maybe you're giving a presentation, maybe you have

to take a test and you get more and more anxious

and you feel like you can't go on.

That's an anxiety attack.

@TUNEOFYOURDEATH wants to know:

Help. I'm having an anxiety attack

in the middle of class, sad face.

What do I do? Help.

You can do a grounding technique.

Remind yourself where you are and what you're doing.

I'm here. I'm sitting in the room.

There are people around me.

Some people go by the rule of 3, 3, 3.

See three things, hear three things,

and move three parts of your body.

A common thing people say is just breathe.

That is not helpful.

I never find that helpful to say, just breath.

A good breathing technique is actually inhaling

through your nose and exhaling for twice as long.

So you can inhale for, say, a count of three [inhales]

and exhale for a count of six. [exhales]

It's the exhale that's actually relaxing.

@angeldisrupted: I'll be honest,

I don't know the difference between serotonin or dopamine

or oxytocin or endorphins,

and at this point I'm too afraid to ask.

Endorphins are hormones.

Endorphin comes from the name endogenous meaning

it's made inside us, and morphine, which is a painkiller

and the endorphins imitate what morphine does.

That runner's high comes from endorphins.

Serotonin and dopamine are neurotransmitters.

They transmit messages in the brain.

Serotonin has to do with mood and anxiety,

and dopamine has to do with joy, pleasure,

and sometimes even motivation or attention.

Serotonin is implicated in depression and anxiety

when it's low, and dopamine can also be low

in depression and in ADHD.

Oxytocin is that loving or bonding hormone.

In women, when they breastfeed, that actually helps form

a loving relationship with the child.

@anxietyaloner says: Has anyone tried fish oil

or omega-3 supplements for mental health?

It's meant to be good for anxiety and depression.

Did you notice any difference?

Omega-3 fatty acids increase blood flow in the brain.

Now this doesn't necessarily correlate

to improvements in mood,

but some people do report improvements in mood

and that omega-3s can actually help with depression.

Even with ADHD, there's a population that will respond

to that and they'll be able to concentrate more.

You can take one gram or up to two grams,

but studies show that going up

to four grams doesn't really do anything.

One gram is the equivalent of having salmon meals

maybe three times a week.

You could get fish burps though. Just be aware of that.

@rydertrilla writes:

I would love to know what trigger schizophrenia.

Like, actually study that shit.

We do know that now there are

over 200 genes responsible for schizophrenia,

and what happens is if you have enough errors

in those 200 genes, you might develop schizophrenia.

Even in schizophrenia, it's something we know

has strong genetic component to it,

there are environmental factors,

and we know this from studies of twins.

If one twin develops schizophrenia,

there is a one in two chance the other will,

but it's not a hundred percent,

suggesting there's something in the environment.

What might unlock that could be substance use,

it could be trauma.

We're still trying to figure out

the connections between these.

What is the environmental factor exactly?

What genes are turned on exactly?

Here's another one. How does stress work?

How do you destroy the freeze response?

When we face stress,

there's a section in the brain called the amygdala.

It's a nuclei, a collection of cells.

That senses a threat and sends a message

to the hypothalamus.

The hypothalamus then gets our body ready

to make adrenaline or cortisol,

which allows us to have that fight or flight response.

Are we gonna get ready to stand up to this threat

or are we gonna take off?

What can also happen is another response

called the freeze response.

The deer in the headlights response.

Your body's been flooded with cortisol to get you ready

to fight or flight, but if your body's not responding,

then you don't do anything.

Destroying the freeze response would probably involve some

cognitive behavioral therapy or other types of therapy

where you talk about what is it

that is keeping you frozen in place.

@LiftingHumanity:

Can depression be beaten or only managed?

Absolutely depression can be beaten.

I have seen people have depression

in what's called remission.

It's not coming back again.

What happens in depression is that we have lower levels

of serotonin, and when I talk about serotonin,

I mean between neurons in the synapse,

that connection between nerve cells.

There are medications called

selective serotonin re-uptake inhibitors,

big fancy name, SSRIs,

that target serotonin receptors and block them

and then the serotonin sticks around in that synapse,

and with that you get increased dendrites,

which are the branches of the nerve cells,

and with that, you get an elevation of your mood hopefully.

Medications in this category might include

fluoxetine or the brand name Prozac,

sertraline, which is Zoloft, escitalopram, which is Lexapro.

What we think these medications do is

increase the number of dendrites.

That's part of the reason it might take two to six weeks

for these medications to work.

You're increasing synaptic connections.

So medication is one way you can beat depression

and some studies show therapy and meds together

help more than just medication or therapy alone.

@golddust27 writes: I was telling my therapist

about 'Encanto,' how it was all about

generational trauma and she was like,

Uh, are you sure about that? A Disney movie?

Yes, I'm sure about that.

Encanto was absolutely about

what's called transgenerational trauma.

Abuela, the grandmother, lost her husband Pedro.

He was killed right in front of her.

What ends up happening is that that trauma

was so disruptive, she wants to keep her children close.

She wants them to not do anything

that will cause her any kind of worry or pain.

Everyone is trying to protect Abuela from experiencing

any kind of loss or sadness again.

And in the case of Bruno, who recognizes,

Wait, this doesn't feel right.

He's the one who's outcast because he's not part

of this group of people who are protecting Abuela.

She wants nothing to do with him. We don't talk about Bruno.

Well, you know, you should talk about Bruno

'cause Bruno's actually realizing something's wrong.

@luh_TRAY asks: Are mental health issues genetic?

There's a gene on my mom's side of the family

that has me questioning my reactions all the time.

Some mental health conditions do have

a very strong genetic component.

Things like bipolar disorder,

schizophrenia, autism, even ADHD.

In fact, in ADHD cases, sometimes 25 to 50% of the time,

a parent has ADHD.

But genetics are not the only part of the picture,

your environment plays a huge role in whether your genes

are expressed, so you could have a gene or several genes

that contribute to you showing a mental health issue,

and if they're not turned on,

then you're not gonna express that.

That's called epigenetics.

It means there's something else

that turns on this genetic code that unlocks it.

@metalgurugirl is asking: How many of us take

a form of antidepressant medication?

Well, the CDC data is actually from 2015 to 2018,

they said that during that timeframe,

about 13.2% of the population took an antidepressant.

However, that was before the pandemic.

The American Academy of Pediatrics said in their journal

that from 2020 on, there was a 64% increase in prescriptions

to children and teens alone in terms of antidepressants.

So it's certainly more than 13.2% of the population now.

@sourskittlezs asks: Does ketamine therapy work?

Asking for a friend?

Yes, there's a lot of data on ketamine working

for depression, however, it's really important then

to know that ketamine therapy is not recreational ketamine.

There's an amount that you take

either by an intravenous infusion

and there's also a spray, esketamine.

What ketamine does is it blocks the place where glutamate,

the excitatory neurotransmitter binds.

By blocking that, the glutamate can increase.

It allows us to actually feel better,

but it only lasts for two or three days.

The drug rapamycin is being looked at,

it's being given with ketamine, and what that does is

it's actually preventing glial cells in the brain,

which chew up neurons from chewing up neurons,

and the length of ketamine is lasting longer.

So there's promise here.

That's being investigated at Yale

and we need to still see more results and more data.

@RubyBegonia3 is curious: Is there a test for psychopathy?

Yes.

Robert Hare, a Canadian psychologist, came up with a scale

called the psychopathy checklist.

He wrote out a number of traits that you look at

to see how someone fits on a scale of psychopathy.

Those include personality traits

and those include criminal behaviors.

Some of the personality traits might be

pathologically lying, particularly about your own history,

or you might be glib, you might not share much

that's real with other people.

Someone goes through each of these 20 items

and scores it zero, one, or two.

Zero is not present, two is very much present.

Maximum score is 40.

If someone is 25, in some places, particularly for research,

they meet criteria for psychopath based on this checklist.

The closest diagnosis from DSM

is antisocial personality disorder.

That's where you break rules a lot,

but not everyone with antisocial personality disorder

is a psychopath.

However, typically, those with psychopathy are in fact

having criteria for antisocial personality disorder.

@malikkmars wants to know:

Can you develop a personality disorder?

I think I caught one from somebody.

You can catch lots of things from people,

but typically, a personality disorder isn't one.

Now, that's said, there are a couple cases

where people might show personality traits

when that is already in their family.

For instance, histrionic personality traits,

being very dramatic about things.

If someone in a family acts that way,

you might start to do that too.

There's something called folie à deux,

which is folly for two, and that's when

a mental health experience is transmitted to somebody else

and they have the same experience.

That often happens when you're living with someone

who's psychotic and maybe they have a break from reality.

In fact, the next Joker movie is called Folie à Deux,

referring to Harley Quinn

and the Joker in their relationship.

@real_jawbreaker wants to know: What does the DSM 5

say about me thinking everyone is constantly

talking shit about me behind my back?

Well, the DSM 5 might actually say

you are a paranoid person.

There is something called paranoid personality disorder

where the DSM lists out criteria saying

that you might have delusional beliefs.

The DSM 5 is

the Diagnostic and Statistical Manual of Mental Illness.

It's essentially the guidelines with all the criteria

that psychiatrists and psychologists use

to diagnose people with a mental illness.

Sometimes it's controversial.

In early DSM volumes, being gay was a disorder.

Clearly, that has changed over time.

A new version of the DSM can come out

once every 11 or 12 years or so, so I guess I'll have

a new one to look forward to in another five years or so.

@x_tadashi wants to know:

What does the ink blot test even prove?

The ink blot test, also called the Rorschach test,

was developed by Herman Rorschach.

He was a psychologist and a psychoanalyst.

And what happens when you're given a Rorschach test,

someone might hold up the card and say,

Tell me what you see.

Batman, some kind of animal, something sexual,

and then there's a scoring system.

You would look at what part of the picture

did someone focus on, and the idea is that it reveals

something about their unconscious.

Initially, Rorschach thought this

could be a way to diagnose schizophrenia.

We know that that's not the case.

The Rorschach test is still used in some ways

in psychotherapy, particularly with kids.

You get a sense into how they're thinking,

what their life is like, so there's a way

to glean something about somebody from this test.

It's just not gonna be a way to diagnose schizophrenia.

@sulmoney says: What do you think about

integrative psychiatry, which merges traditional medicine

with alternative therapies?

Can these things work together?

I have actually had patients given terminal diagnoses

of illnesses, they took on conventional treatment

and then brought in spiritual healers or guided meditation

and what was a terminal diagnosis

has turned into this person's tumors shrinking.

There was a study that looked at around 30,000 outcomes

and the outcomes with anxiety were that therapy

and medication together did better.

To me, that's an example of how you can combine treatments

and do a lot of good.

So those are all the questions for today.

Thanks for watching Mental Health Support.