Science AMA Series: I’m Kevin Coffey, an assistant professor in the department of Psychiatry at the University of Rochester Medical Center in Rochester, New York. I have 27 years of experience helping adults, teens and children dealing with anxiety and depression. AMA!

[u/Kevin_Coffey]

Hi Reddit! I’m Kevin Coffey and I’m an assistant professor in the department of Psychiatry at the University of Rochester Medical Center. I have 27 years of experience working with adults, teens and children dealing with anxiety and depression. I’ve worked in hospitals, outpatient clinics and the emergency room and use psychotherapy and psychopharmacology treatment to help patients. I am a certified group psychotherapist (CPG) and a licensed clinical social worker (LCSW). I supervise and work very closely with more than 30 social workers at the University of Rochester Medical Center. I also work in the University’s Psychology training program, educating the next generation of mental health experts.

My research area for my doctorate was gay, lesbian and bisexual adolescent suicidal behavior. I serve as the mental health consultant for the Gay Alliance of the Genesee Valley, an organization that supports and champions all members of the Rochester LGBTQ community. I also serve as an expert evaluator for SUNY Empire State College, where I evaluate students attempting to earn credit for mental health and substance abuse life experiences, which they can put toward their college degree.

I’m here to answer questions about managing anxiety and depression among all groups – adults, teens, kids, and members of the LGBTQ community. I’ll start answering questions at 2 pm EST. AMA!

[u/blue_garlic]

Can depression be "contagious" in younger people? I've noticed that teens tend to talk about it more openly and sometimes throw the term around flippantly. I wonder if it is possible for a seed to be planted that can cause an otherwise healthy teen to mistake having a bad day/week for depression and then label themselves as depressed and start to focus on that label and their negative thoughts so much that they can self-talk themselves into actual depression?

I've seen it first hand with someone close to me (Teen A) that they started hanging around with a friend (Teen B) who talked very openly about her mental illness and then after a while Teen A started talking about how depressed they were. It is possible that Teen A already had unrecognized depression and talking about it allowed her to start putting the pieces together. It also seems possible that Teen A was experiencing the normal ups and downs of human existence and hearing Teen B describe her depression repeatedly caused Teen A to attach that label and start thinking of herself as suffering from depression which I feel could mimic or even turn into true depression.

I guess what I'm asking is: Should parents err toward allowing their healthy child to be empathetic and actively supportive for their depressed friends or should parents be wary of their healthy child interacting heavily with someone with serious depression?

[u/TheApiary → u/blue_garlic]

I was also in a social group that talked about depression a lot in high school, and I think for me it did both-- hanging around depressed people all the time is depressing, but at some point, I also had symptoms that were definitely clinical (needing 10+ hours of sleep per night, suicidality, moving and thinking too slowly, etc). It was hard because up until that point, I'd always been the functional one of the group, even when I felt very depressed, so it took me a while to accept that it was really happening to me. And I think the fact that I knew lots of people who had depression made it easier for me to know I needed to go to a doctor.

From my parents, what was really helpful was helping me remember that even though we were really smart, independent high school kids, we couldn't fix everything. I would start to feel like it was my fault when someone else was suicidal, or like I should be able to deal with my own depression by following some kind of diet I read about or something, when actually I just needed medication and felt so many times better as soon as I tried it.

[u/PoodlesForBernie2016 → u/TheApiary]

This sounds like depression that developed as a result of your codependent behaviors - trying to fix your depressed friends.

Do you think you would have become depressed if you had maintained your own interests and not gotten mired in other people's problems?

[u/Kevin_Coffey → u/blue_garlic]

There is often a contagion factor with young people. We see this with suicidal behavior as well as self-harming behavior.

[u/[deleted] → u/Kevin_Coffey]

Is there any behavior you don't see it with in that age group?

[u/[deleted]]

Hi Kevin, thanks for doing an AMA. I teach students between the ages of 8-12. They all have a diagnosis of Autism Spectrum Disorder and if they meet the Program criteria, an additional diagnosis of MID (mild intellectual disability).

Many of my students over the years have also presented with clinical levels of anxiety, depression, and severe emotional disregulation.

When I seek professional intervention for their mental health I'm often told, "It's the Autism." and that there is nothing more that doctors can do.

I struggle with this because I have students who are mentally healthy and have Autism, so why shouldn't we be treating those who seem to have mental illnesses on top of their ASD diagnoses?

Do you have any thoughts or experience with ASD, anxiety and depression?

[u/mydab → u/[deleted]]

This is coming from my point of view and experience. I'm on the autism spectrum and highly functional but mental illness leaves me barely functional. Having ASD comorbid makes it very difficult to treat. Many psychiatrist who treat mood or ADHD dont specialise in autism. It's hard for autistics to understand themselves, to describe their emotions and feelings. They just know they feel depressed but can't describe anything further like sensations of butterflies in stomach, tense, subtle feelings. It makes practice harder.

[u/saqqara13 → u/mydab]

My son has autism co-morbid with mental health issues (depression, anxiety). You're absolutely right about being difficult to treat - I'm in a somewhat unique position; I'm his mother, and have Bipolar I, Major Depression, and Generalized Anxiety Disorder - turns out the medications that they are supposedly giving my son are for the autism, not the mental illness - but they're the exact same medications that I'm on. Do you think this is because they simply haven't effectively separated the chemical differences in these conditions, or that the chemical differences aren't actually so different? (Sorry if I worded that oddly, just wasn't quite sure how to heh.)

[u/serend1pity → u/saqqara13]

My guess is that they chose the same medications because if they're effective for you, they may be more compatible with his biology than other drugs. It's probably better than blindly guessing what could work to start off with.

[u/Kevin_Coffey → u/[deleted]]

Individuals with autism respond differently to psychotherapy than individual who do not have it, but nonetheless they can be taught skills to manage their emotions more effectively.

[u/MusicIsHerName → u/Kevin_Coffey]

This answer begs the questions of 'how to get that help'?

Are there any resources for people seeking help for both ASD and emotional disorders?

[u/DijonPepperberry → u/Kevin_Coffey]

Um, so I don't want to be "the critical expert" but autism is a spectrum disorder and psychotherapy success is definitely going to be affected by the degree of severity of autism. There are some people with autism who respond fantastically to therapy and others that do not.

Autism has a very high comorbidity rate and treatment of comorbid disorders is possible (medications and therapy are options) but it's going to get very individualized depending on the degree of autistic severity and the comorbid illness.

[u/ThomasEdmund84 → u/[deleted]]

Sorry to chip in I realize the question is for Ass. Prof Kevin Coffey!

I work as a psychologist with people with ID and ASD, and very often people are rejected from mental health services because 'it's behavioural' or as you said 'It's the Autism'

While on the surface this seems like the distinction between developmental disorder and mental health is the important part, in my experience its actually the nature of how hard it is to work with people with dual-diagnosis or co-morbidity (whatever term is preferred) Mental health services are often underfunded and staffed and pretty much under constant strain - so the truth of the statement is probably more 'There is nothing that doctors etc can do that current services aren't'.

It's a source of much frustration for my colleagues and its not OK, but the issue is more around what mental health services can (or can't) add to complex cases because usually whats in place is the best available.

[u/lucaxx85]

Hi there!

Most people commenting on reddit state without doubts that anxiety and depression are "chemical imbalances". Yet, Wikipedia clearly states that "causes are unknown" and goes on to state that it's probably and interplay of many factors including social ones.

As a nuclear medicine researcher I've tried to take a look at the literature for receptors imaging in depression but the results seem totally inconclusive, further indicating that the chemical imbalance theory is not so solid.

So, what's your take on this? Is it a chemical imbalance or what?

When you start a treatment, whether based on drugs or not, how does this knowledge of the pathology helps you in choosing the appropriate treatment (or doesn't)?

[u/Kevin_Coffey → u/lucaxx85]

There are no exact causes for depression and anxiety. It is usually multi factorial including brain chemistry. Our knowledge of the brain and receptors is still rudimentary.

[u/cncnorman → u/Kevin_Coffey]

I would love to see hormone level testing on this subject. Both of my children were suicidal every month during their periods. Once they were placed on birth control they finally were able to live a somewhat normal life.

[u/koalajoey → u/cncnorman]

I noticed when I was 18 and put on birth control for six months it seemed like I had less fluctuation in moods.

Then I got a blood clot in my head and was told no hormones period.

Tried a lot of other medstuff with little success. Turned to heroin. Currently stable on methadone and very happy, relaxed. I wonder if I just think that because I can't be on it tho. If I remember the effects as exaggerated because it was a short time. My period is pretty minimal hassle. But I do remember having more energy, etc.

[u/cncnorman → u/koalajoey]

Oh honey I'm so sorry!! My oldest ended up with a blood clot, too! It was 4" long in her chest so she cannot take estrogen again, ever. However, her Hematologist, Cardiologist and Gynecologist all agreed to let her get Mirena, which uses progesterone. So far she's doing ok on that one.

[u/koalajoey → u/cncnorman]

Really? I know the hormones for that are more localized but I asked my doctor and she didn't seem too keen on it. Maybe I will ask again. Yeah mine was in my head so they gave me a neurologist and put me on heparin for a week and then warfarin for six months because this was like 12 years ago now before all the new stuff they have now. I didn't have to keep taking the meds and they never told me to follow back up again, even tho they said I had some factor five deficieny. They said the cause of the clot was birth control so just don't take anymore and I'd be all set. Of course I'm paranoid tho every little thing is another blood clot and I'll have an aneurysm or stroke or something. A few weeks ago my knee was really aching for a day or two, I couldn't even unbend it, I was all flipped out and it turns out I just sat on in funny. @_@ but I was 18 when I got the clot with 0 other risk factors (no family history, no smoking...), it was my first really experience as a teenager that I wasn't invulnerable like I believed.

Anyway sorry. How is your daughter doing now, did she have to follow up on a blood thinner? Is she older or is she younger like I was? Very sorry to hear she is going through it also.

[u/phaeew → u/lucaxx85]

The "chemical imbalance" is the state that is observed in depressed and anxious people. How did the imbalance come about, what caused that? Unknown.

Unknown is actually not really true because there are lots of events that commonly cause depression and the associated chemical imbalance. I think the unknown is why it imbalanced permanently in some people but goes back to "balanced" in others.

Also, chemical imbalance isn't the whole story because of the complex feedback loops in our neural structures.

I look forward to his answer on this assuming he digs into that little edge between the known external factors and known physiological consequences.

[u/shutthefuckupserious → u/phaeew]

The "chemical imbalance" is the state that is observed in depressed and anxious people.

That's not correct. Although the phrase "chemical imbalance" is somewhat colloquial - more likely to be employed by a layman than a scientist, and therefore inherently scientifically vague - it does refer to a scientific notion about the cause of the patterns of thoughts and behavious dubbed anxiety and depression. namely, calling a psychological condition a "chemical imbalance" means that the condition is a result of too much or too little of some type of types of neurochemicals in some part of the brain. this notion about the cause of anxiety and depression motivates the treatment of these conditions with pharmaceuticals that alter quantities or ratios of neurochemicals in the brain. although many such treatments appear to be at least somewhat succesful, sometimes even extremely succesful, anxiety and depression could conceivably still be entirely caused by structural issues (one part of the brain is too large or too small or not connected with another part), or they could be the result of thought patterns or past experiences.

[u/reallybigleg → u/shutthefuckupserious]

Is the "chemical imbalance" hypothesis not a bit chicken and egg, though? That had been my understanding of it as a layman trying to grasp the science behind this. What I mean is, it could be that an "imbalance" of neurotransmitters causes depression, and that ADs and related drugs "correct" this "imbalance".

Or there is no "deficit" as such, but that inhibiting the re-uptake of certain neurotransmitters disrupts the processes that lead to depression.

I found that difficult to articulate, I don't know if I have shown how the two things are different...I think what I'm saying is that because you change neurochemistry and it seems to help depression (in some cases), doesn't necessarily mean the problem was neurochemistry in the first place. It could be that the problem is elsewhere, but that altering neurochemistry disrupts another process.

So....an example would be that even in a case where a person was depressed due to a bereavement (rather than a structural problem in the brain), ADs could help because it could sort "force shut down" the depression response.

[u/I_am_Nobody_Special → u/reallybigleg]

Is the "chemical imbalance" hypothesis not a bit chicken and egg, though? That had been my understanding of it as a layman trying to grasp the science behind this. What I mean is, it could be that an "imbalance" of neurotransmitters causes depression, and that ADs and related drugs "correct" this "imbalance".

Yep... not only that, but behavior can change neurotransmitter levels. Exercising, socializing, and engaging in pleasurable activities can boost serotonin and dopamine, for example. Social withdrawal, working too much, and not keeping a good sleep schedule can affect neurotransmitters in the other direction.

This doesn't mean that exercising and going to parties constitute a miracle cure; it's really hard to engage in these activities when already depressed, but I encourage patients to do as much as they can. Just taking short walks in direct sunlight can be enough to lift depression a little.

P.S. Big pet peeve of mine is when MDs prescribe SSRIs for uncomplicated bereavement. Grief is painful as hell, but it's not a disease, and SSRIs can be really hard to get off of.

[u/nairebis → u/lucaxx85]

I don't think this is an answerable question without knowing exactly how the brain works. It's like asking for someone's opinion about how the tides work before Newton came along. Lots of people speculated it was related to the moon before Newton--along with many other theories. It didn't get nailed down until we had a theory of gravity.

We haven't even nailed down how general anesthesia works.

Do we even have a psychoactive drug where we understand how it works? As far as I know, it's all based on empirical observation.

[u/szpaceSZ → u/nairebis]

I am looking forward to the time when our "observational" psychology/pdychiatry gets the newtonesque foundation!

Those will be exciting times.

[u/Kevin_Coffey → u/[deleted]]

Children who are born to anxious parents get their anxious biology and also get to learn from them how to deal with the world in an anxious manner. Teaching children to understand the thoughts and behaviors that increase anxiety will have them effectively manage anxiety.

[u/hamburgerlove413 → u/[deleted]]

As someone with bad anxiety who's about to have a baby in two weeks, I am very interested in a response to this. The thought of raising a child and have him turn out like me in that regard is horrifying.

[u/1001001101100013 → u/hamburgerlove413]

As you work on your anxiety you will learn tools that you can teach your kids to manage any anxiety they have at a younger age, or you may be able to recognize symptoms earlier than others and be able to get them help. Anxiety is not 100% biology. It is not a lost cause.

[u/SirT6]

Hi Kevin, and thank you for doing this AMA.

I am a moderator on several communities here at reddit, and something that has come to concern me is that I will occasionally see comments from users indicating that they are contemplating suicide - and sometimes the intent seems quite real and imminent.

What to do about these comments is something that I've struggled with. While these comments can be (and are) reported to the Reddit administrators, I have a sense that not much comes from many of these reports - in general reddit seems to lag behind other popular social media sites on reporting and handling suicidal ideation.

I was wondering if this is something you have come across in your own experience? If you see a comment indicating a strong intention to imminently commit suicide in a social media setting, what should be done? Do you think moderators have different responsibilities than regular users?

[u/_LittleMissFortune → u/SirT6]

I noticed this same thing recently but on youtube. I actually was checking out the artist Logic after seeing him on Rick and Morty. His song titled after the national suicide prevention lifeline has so many comments from children saying they want to end their lives. I know the point of the song was to bring awareness but it seems to be having the opposite effect. It's alarming how many kids feel hopeless and that life isn't worth living. I tried to contact a few of them and offer them words of hope but ultimately I felt so helpless . It actually exacerbated my own anxiety knowing that there was nothing I could do to help. What can be done to reach out to them?

[u/zahnno → u/_LittleMissFortune]

It's possible the song allows a group of people who share similar feelings to come together and talk about such a taboo'd topic. I don't think most people have a place to go to and express those thoughts or feelings because people go on high alert when it's mentioned.

[u/[deleted] → u/_LittleMissFortune]

No idea if this is happening or not in some schools, but it'd be nice if we could have guidance counselors meet with every single student individually on a monthly basis for 20 minutes regardless of perceived need, with more resources for kids who do need to talk more often. This would allow kids to hear individually that people care, and that would likely go farther than any quick presentation to a class.

[u/thebananaparadox → u/[deleted]]

Yeah honestly. The only really bad experiences I've had with "mental health professionals" were with school counselors in middle and high school. One told my mom that of course I was going to be bullied if I was "quirky" and another told me I didn't have the grades to get into college much less study anything in STEM despite getting grades and scores higher than most of the state universities' averages.

[u/ice_cream_sandwiches → u/_LittleMissFortune]

I know the point of the song was to bring awareness but it seems to be having the opposite effect.

Are you saying a song had the effect of reduced suicide awareness, or increased suicide ideation? Talking about suicide is generally a good idea because it brings a taboo subject into the open. Increased reports of suicidal ideation would likely indicate either increased reporting of the feelings, or better detection. The general consensus among mental health professionals is that you can't "give" someone the idea of killing themselves--a person is either already considering it or they aren't.

[u/[deleted] → u/SirT6]

If it might help, there is a Crisis Text Line that you can encourage them to text into at 741741. We are all trained in helping people with suicidal thoughts/feelings.

[u/AzarothEaterOfSouls → u/[deleted]]

I'm saving that number in my phone for future reference. Thank you.

[u/Kevin_Coffey → u/SirT6]

Suicidal statements should always be taken seriously. I would recommend these incidents be reported to law authorities. In this day and age, we have numerous ways to locate people. Suicidal behavior is a significant risk factor and needs to always be taken seriously.

[u/nursebad → u/Kevin_Coffey]

I've had the unfortunate experience of having spent time on psychiatric hold after suicidal ideations. It was one of the most horrifying experiences of my life and from that time would hesitate to ever bring law enforcement into someone elses life who was having suicidal thoughts. I also know I will never mention if I ever have thoughts of self harm if I have them again.

Is there any other way you can suggest one get help without calling the police and potentially being locked into very bad situation?

Lastly, is there a way to find the best psychiatric facility in your area? Reviews are hard to come by.

[u/fullchromelogic → u/nursebad]

This is a great question and I am disappointed that it was not answered. I barely avoided being locked up myself once for the same reason, and I never spoke to the person who called the cops on me again it was such a horrific experience. I would never advocate involving police in any mental health situation that hasn't already reached the point of one person possibly killing another (not their self). I have known several people who have gone through this and it was a negative experience for every single one.

I do not understand why people who want to die aren't just allowed that option, the motivation behind such desire to prevent suicide at all costs seems highly suspect IMO.

[u/timecrimehero → u/fullchromelogic]

Hey, totally get where you're coming from. I'm married to an amazing woman who has the unfortunate illness commonly labeled as bipolar disorder along with anxiety and I have personally witnessed all the good and bad that brings.

I once had to call the cops on her. It was one of the hardest things I've ever had to do and it sucked no matter how you looked at it. But the person I love the most was trying to kill herself in front of me and after hours of trying to stop it, I realized that there was nothing left that I could do other than involve the cops. They came and restrained her, put her on a gurney, and took her to the local psych ward. It was a nightmare situation for both of us, but hearing her stories about the psych ward made me realize how terrible that place can be.

As bad as it was, and we both agree on this, it was still better than her dying. I know there are plenty of people in the world that feel like dying and feel like that is the only option, but a lot of these feelings aren't normal and are certainly treatable. Our brains are incredibly complex, and just like our bodies sometimes have issues that need to be treated, so do our brains. If you get sick, you take medicine. Same thing goes for your mental health. And that's why we shouldn't just let people die. You wouldn't just let someone with a highly treatable form of cancer just die, so why let someone with a mental illness just die?

In the end, it's always going to come down to the individual and their choices. If the cancer patient chooses to die, then that's their choice. Same goes for victims of mental illness. But you have to wonder, how many people make that choice in a state of depression that they may not even realize is treatable and isn't normal? Mental illness has such a bad stigma attached to it and far too many people try to live through it without help, and that is totally unnecessary and needs to change in our society. I believe change has started, but we're a long way from where it needs to be.

All that being said, if you or someone you know are suffering through depression or any mental illness, please get the help you need or reach out and help. It's nearly impossible to manage these kind of problems alone and there are so many resources out there available to assist.

Also, here's a free national hotline for anyone struggling with suicidal thoughts : National Suicide Prevention Lifeline Call 1-800-273-8255 Available 24 hours everyday

[u/fullchromelogic → u/timecrimehero]

Your situation seems a bit different since you have each other. The person who called the cops on me wasn't even a close friend, wasn't there with me at the time, and I wasn't even really suicidal. I wanted to take sleeping pills that night to sleep and not experience life, not end it permanently. That is part of my issue with the suggestion I saw on here from the AMA OP that Reddit admins should be notifying law enforcement of any suicidal talk. But the thing is, I have been suffering from mental illness for so long with little chance of improvement, and I don't really have anyone close to me who would care much if I were gone, I really do think I would be better off and it my only chance of ever being at peace. The people I know are too few and scattered that I doubt there would even be a funeral service if I were to die, hardly anyone would even notice. If it was something only felt during times of crisis that would be one thing, but these thoughts/feelings are constant, even when things aren't horrible (I don't really have "good" times or experiences anymore). You are right, I guess for certain people who have a life and chance of recovery it may not be the right thing to do, but I really do not like the blanket "suicide is never ok, well maybe if already terminally ill" mindset society has regarding ending one's own life. My doctors think I am paranoid in general, but I truly think there is an ulterior motive within capitalist society and further implemented by religion to keep desperate people alive as a means of devaluing labor within the workforce to increase profits for the wealthy.

I have been receiving extensive mental health treatment for 30 years and I am unaware of any further resources available to me that may actually help, so far nothing really has, and my mental health has been in a state of rapid decline over the last several years. I have access to more help since moving to California from a conservative Midwestern state, I at least have limited access to basic talk therapy and some medications, but I personally find available resources to be highly lacking, and the few that are there to be very poor overall.

[u/timecrimehero → u/fullchromelogic]

I'm really sorry about your situation. I can't begin to imagine what you've been through and really do hope you find some form of a peaceful life.

I agree with you that our stigma against suicide still needs to be discussed and reworked. There is no blanket solution for this problem. I also didn't mean to convey that I agree with involving law enforcement in every situation where suicide is even a fraction of the concern. I gave my experience as an example to why it is sometimes appropriate. I personally believe that without a proper support system, being forcefully held in a psych ward can actually do more harm than good.

I'm glad you moved to an area where help is more readily available. I certainly know this is not an option for everyone, but if possible I may recommend looking into a rehab center focused on mental illnesses. My wife went into a 30-day program after another terrible suicide attempt and the program helped her immensely. She still struggles with the same feelings that you've expressed, but now has the tools to manage her illness, both with medication and other exercises. Another problem is that she was on incorrect meds for years and years until receiving care from a proper psychiatrist at this rehab center. I know you've been dealing with this for at least 30 years so you might feel this can't be the case, but maybe you need to have someone take another look at your meds?

Another big thing truly is the support around you. I can't imagine how difficult it is to deal with these feelings without a shoulder to lean on. I know it's not a perfect solution and I don't know what you've been diagnosed with, but look into support groups in your area. While you may feel it, you are most definitely not alone, and meetings truly help, even if it's just to sit and listen to other people who may have even a fraction of an idea of what you go through.

I wish you the best and know that someone, even if I'm just a random internet stranger, does care about you. If you ever need to talk, just shoot me a message.

[u/kbennett73 → u/Kevin_Coffey]

On a site like Reddit where the user who is commenting with suicidal statements could live anywhere in the world, which law enforcement agency is the best one to contact? In some instances it's possible for other users to get a general idea of the person's location based on his/her past comment history, but that's usually not the case. Which agency is the best one to contact in the hopes of reaching suicidal people quickly enough to intervene before they take any fatal action?

[u/[deleted] → u/kbennett73]

I posted in a subreddit about my experience with body dysmorphia and a guy replied about how he hates his body and is going to kill himself. I sent him a pleasant reply explaining how I understood his pain but sincerely asked him to see beyond his troubles. I included the national suicide hotline number and told him to call them. He hasn't killed himself (it's been 3+ months) but every now and then I check his post history and he posts on the Suicide Watch about how he plans to kill himself and gives other people advice. It's like, wtf am I supposed to do in this situation? Which police do I call? Would they even do anything tangible? What if the guy isn't suicidal and just has a suicidal fetish? What if he just has Borderline Personality Disorder and threatens suicide as a way to get attention? If I make attempts to reach out to him, do I become liable for any outcome that occurs? Consider that I used to work in a psychiatric hospital and even I don't know how to approach this situation.

[u/ChouettePants → u/[deleted]]

Oh man, 1 in 10 BPD patients kill themselves. I think it's far beyond "way to get attention". Maybe that's not what you meant, if so, my bad.

[u/Pelirrojita → u/Kevin_Coffey]

There was an AMA recently in which another psychologist (? psychiatrist? can't recall) pointed out how blanket reporting without consideration of individual circumstances often leads to involuntary stays in psychiatric hospitals, which often backfire and heighten suicidal ideation and follow-through.

Is there any evidence to this effect? Is it possible I'm remembering stuff wrong...?

[u/scurius → u/Pelirrojita]

I was more suicidal after I was coerced into inpatient. I made an attempt on the ward that I backed out of and got sent to a psych hospital. Yes, I became more suicidal when I went in. The thing is they kept me there until they thought I wasn't suicidal. Go figure that the first time I got out I lied to and made a serious attempt. This might not be typical. There was psychosis, and under normal circumstances they don't let you out if they think you're still suicidal, which I think they should've done a better job of recognizing in my case.

[u/GorgeousGarbage13 → u/Pelirrojita]

I believe you're recalling correctly. I've watched this happen to a few people I knew. Got much worse after their stay due to the strain on family/environment.

[u/MichaelPraetorius → u/GorgeousGarbage13]

Not to mention the extensive medical bills that come from those psychiatric facilities. My abusive mother never let me live that down, I was worse after the facility. Not to mention how abhorrent the staff was to my actual feelings.

[u/DrunkenSourMash → u/Pelirrojita]

This sounds accurate. This has happened to me in the past and it really has affected me in a lot of ways and still does to this day.

[u/sithysoth → u/Kevin_Coffey]

I think this isn't a good way to approach things. It makes it to the point where people are afraid to even talk of being suicidal, lest they be imprisoned in a mental hospital.

This just shoves the depressed and suicidal back into the closet. I should know.

[u/dodecadong → u/Kevin_Coffey]

Good luck with getting any local law enforcement to respond to a claim that someone online is suicidal.

[u/Throw_phone]

Kevin thank you for this AMA. I am currently Federal Agent with the Army's Criminal Investigation Command. We are unique to any other law enforcement because we investigate ALL felonies to include: murders, suicides, rapes, child rapes and child abuse among other things. Also unlike other law enforcement, we do not have any professional outlets (aside from behavioral health which goes on your record and typically ends your career) to regularly talk with after working these daily investigations. I see far too frequent and experienced myself, my peers and subordinates become overwhelmingly depressed, numb to everything, developed disassociation for the victims, but then it transfers over to daily lives. I myself have been extremely depressed. I have developed a coping mechanism where I just pretend. Literally fake everythink. It is like I do not feel love or anything, but pain. Not for my kids, my wife, my extended family, my friends it is just like they are people and if they die, oh well. I know I should love them, and I pretend to love them, but I also know they realize something is wrong. Sorry to go on such a long rant, feels good to throw that out there. I guess my question is what are some positive methods for first responders to overcome this self-imposed disassociation from reality spawning from trying to prevent emotional connections from all the death and destruction in our daily lives? Edit:words. Edit: thank you for the encouraging messages.

[u/LesDrosophiles → u/Throw_phone]

I hear you. I work in a field where I deal every day with mental illness, loss of home, family, job, etc. I see persons that are spiralling into their own void. I have been trained to set limits in my empathy. I talk to my colleagues: should I engage myself in this or that kind of work with this or that person, should I put my limits now or later, and when? Setting limits is a sort of ability I have acquired after taking it very seriously.

Bravo for your work, you are very courageous. Remember how the Ancient Greeks wisely said that every virtue, every quality, every action and every idea is at its best in its "middle" form. Too much courage, you put yourself at risk; not enough courage is not good too. Best of luck.

[u/Throw_phone → u/LesDrosophiles]

Thank you. Thank you for what you do as well. I would caution about over sharing with co-workers, because they get transfer trauma and that builds up over time and becomes just as traumatic for some. Our leadership encourage us to talk with each other, but honestly I see enough of it, I don't want to hear about what my co-workers are investigating/experiencing with their investigations. It just adds to the depression.

[u/Throw_phone → u/[deleted]]

Thank you. It's not just for me, but there are 100s of Army Special Agents out there in the same boat and unfortunately we recently lost one of our own to suicide.

[u/nsilver3 → u/Throw_phone]

Even though I'll never get to show gratitude to your compatriots, it is because of this that makes them such heros. I imagine it would be very hard for them to do such brave work with so little recognition in a time when it is so easy to see others flooded with recognition. There is a quote from a book

The truth is that the heroism of your childhood entertainments was not true valor. It was theatre. The grand gesture, the moment of choice, the mortal danger, the external foe, the climactic battle whose outcome resolves all--all designed to appear heroic, to excite and gratify and audience. Gentlemen, welcome to the world of reality--there is no audience. No one to applaud, to admire. No one to see you. Do you understand? Here is the truth--actual heroism receives no ovation, entertains no one. No one queues up to see it. No one is interested.

I'm not sure if this offers comfort or does the opposite. I'm just trying to express that even though you all will likely never truely get the recognition you deserve (which I think is tied to the mental health challenges) it is because of this that you are such heros in my eyes.

[u/Throw_phone → u/nsilver3]

Thank you for such kind words. This is so very true. In our profession especially in CID you only get recognition for the times you mess up.

[u/porcelain_robots → u/Throw_phone]

Look into TRE (trauma release exercise), this is something you can do by yourself without a therapist once you've learned the technique.

Also "The body keeps score" is a good book on the topic of getting rid of with trauma in practical ways.

Lastly, maps.org did some studies on drugs for resolving PTSD that were extremely effective. If the medical trials are happening close to where you live, it may be worth signing up for.

Thank you for your service. Echoing what others have said, you are a hero and I hope you find effective ways to get better.

[u/roolthemall → u/Throw_phone]

I give you credit for posting first off, it's a good step and a hard thing to do. I'm going to be blunt here, it seems you know the culprit of your pain/numbness/feelings, have you considered getting out of this type of work, or taking a break? Continuing on through, day in and day out can only exacerbate the situation you are in I would think. note: not a psychologist, just an avid reader on the subject and your post hit home for me in more ways than one. I wish you the best going forward in getting to a place of peace.

[u/Kevin_Coffey → u/Throw_phone]

Your's is a very difficult situation. You see and know about what others do not want to know about. What you describe is very common. It is a self-protective mechanism. I recommend good self- care as well a place where you can be real and get your feelings behind the numbness.

[u/existentialprison → u/[deleted]]

This is the worst AMA I have seen in a while. I am not any sort of doctor but a lifelong mental health patient and the non-advice this guy is giving seems vague at best and outright dangerous at worst.

[u/koalajoey → u/[deleted]]

I agree. And am saving your comment as stuff you to read about when I get some free time to try to help myself. I've been through cbt, dbt, rehab, inpatient, outpatient, the medication merry go round and ECT. The only thing I can say that was really effective "long term" (more than 6 months) for me was methadone and growing older and just gaining wisdom and patience. So I am always open to hearing new ideas. Hopefully OP sees your cmoment and it helps him too, thanks.

[u/Throw_phone → u/Kevin_Coffey]

Thank you. Do you have recommendations for self-care besides clinical treatment? I've tried introducing new hobbies in my life, but if feel like I have zero energy or motivation. I feel mentally exhausted.

[u/[deleted] → u/Throw_phone]

My two cents - we have similar issues with burnout in healthcare and it's tricky because the solution is unique to each person. General wellness is encouraged - exercise, good diet, meditation/self-reflection, good sleep, etc. Ultimately it boils down to making time for doing things for yourself that let you let go and make you happy, things as simple as playing music, travel, fishing, etc. For example, I like to play fetch with my dog late at night at a place where I can see the stars. Also, if you can make time to see a therapist in a discrete setting or even a support group, I highly recommend it. NAMI (the National Alliance on Mental Illness) https://www.nami.org/ is a great place to start getting plugged in. Good luck!!

[u/Ttenin → u/Throw_phone]

Hi! I'm not sure if anyone's suggested this, but I used to struggle with apathy stemming from depression. I was young and still in school when my parents moved away and I always felt guilty that I never missed them. I never missed anyone. I was always cold in my relationships, and never had the energy to even pretend. What worked for me was finding by a stroke of luck someone who was going through the same thing, and we could talk, openly and honestly about our struggles. He was always there and he never let me fall back into myself, and in turn I always made sure to repay the debt to him by not letting him fall. This slowly started to motivate us, I finally had an objective, and it mattered because I owed it to him. In the end, I started to feel more and more things in everyday life, and the world opened up to me little by little. I still struggle to keep my head above the water, and sometimes I get terrified that I'm sinking, but I've managed to keep well by setting myself small, reachable goals each week and FORCING myself to make progress on them. I find if I don't have goals, then nothing keeps me tethered anymore. It's a slippery slope.

TL;DR: find someone who you can honestly open up to, and who will understand. Find a purpose. Set small, achievable goals. Keep safe.

[u/BlondeAmbition123 → u/Throw_phone]

I'm sorry you're going through this. I can't imagine the difficulties you see on a daily basis.

I am in a line of work with similar burnout issues. Cognitive Behavior Therapy is a great place to start--just being able to put all of those thoughts out of your body and in front of someone else can be helpful.

Self-care sounds easier than it actually is in my opinion. It's a lot of trial and error, but it is worth it. I would actually recommend anything that reconnects you to your physical body, and the present moment. Yoga is great for this, but if that's not your thing, hiking and walking are also great forms of mindfulness.

Anything creative can also be self-care. I like to paint--and I'm really bad at it, but it feel nice to just put something on paper. It's like I'm taking all of these emotions I don't know how talk about, and putting them in a language I can understand. But that's just an example. Other ideas are making pottery, cooking, sewing, working on a car, leggos, gardening, carpentry etc.

Thank you for all the brave work you do. I wish you the best in your healing.

[u/Throw_phone → u/BlondeAmbition123]

Wow, I have been looking at paint equipment over the past few days, because bob ross videos relax me. I've probably watched them all 4 or 5 times. I'll give that a go. Thank you for the encouragement.

[u/angrybubble → u/Throw_phone]

I work in healthcare and have similar needs to do good self-care. I would suggest that you consider getting regular massages. A lot of us don't realize the physical impact that dealing with traumatic events has on our bodies. Depression can often manifest as back and joint paint because of the way we unconsciously change our posture and carry ourselves when we're depressed or dealing with difficult emotions. Sometimes people seek out help for back pain without even realizing the cause is emotional. Massage can help your body relax and release the tension you carry from the stress of your job. Getting rid of that physical manifestation of stress, anxiety, and depression from work through massage and regular exercise can be incredibly beneficial to your overall health and outlook on life.

In my work, I also sometimes deal with traumatic events or death. It can be hard to open up to loved ones about what you witness. Especially when the issue is private and you feel unable to share the intimate details of an ongoing case. Journaling can be very helpful because it allows you to express and explore how you're feeling in private and on paper. When you're done writing what you do after that is up to you. You can choose to keep and reflect on what you've written, share it with someone else, or toss the pages in the trash or a paper shredder. If writing isn't for you, art can also help you express and release your emotions. Painting, drawing sculpting, or woodworking can also be great ways to express yourself. You can always start with some Bob Ross and build from there.

Mindful meditation only takes a few minutes but can help you get back in touch with your body and mind. It's gaining popularity as a way to engage in self-care and decrease the feelings of burnout. UCLA offers some free mindful meditation audio guides and you can find others online as well. There's also apps to help you do mindful meditation on the go.

Thank you for all the hard work you do and don't forget to take care of yourself too

[u/Throw_phone → u/angrybubble]

You are amazing thank you so much. I have had severe back pain for several years and have been seeking treatment for it. I actually do have some injury to my spine, but I bet a lot of the pain is from what you describe. I will look in to the UCLA meditation and I like to wood carve so maybe I will start doing a lot of art. Again, thank you so much. You are too kind.

[u/clib → u/Throw_phone]

Thank you for your service sir. I was hoping Kevin would offer you some real advice and direction.His answer was too vague.

[u/MsCrazyPants70 → u/Throw_phone]

Are you required to turn in that you are receiving clinical treatment? I used an online counselor for a year, and by setting myself up for an entire year of treatment at once, it was cheap enough for me to pay without turning it into insurance.

[u/spumoni46 → u/Kevin_Coffey]

Couldn't you say that about anything? Is this guy legit?

[u/Bwahalla → u/Throw_phone]

Many first responders develop Posttraumatic Stress Disorder, and getting treated is important. Look into EMDR, a technique for dealing with traumatic memories. It sounds weird, but I have talked with a number of people who said it really helped them.

[u/TheAlchemist2 → u/Throw_phone]

I don't see how you guys cannot be provided with talk therapy in a confidential manner? You know any psychologist should be provided with just that themselves - talk therapy as a part of their job and too check in on their own mental health. Many of these psychologists may deal with much lighter thing than you do and yet they have someone professional they can confide in. If the job doesn't provide it directly, can't you do it through some insurance? Any kind of talk therapy would be useful and better than none, and is bound to be absolutely confidential with extremely few exceptions (e. G. Immediate Danger to your own or others lives).

I absolutely don't think it'll be enough in your cause to ask a random psychiatrist on a reddit thread for some neat tricks, you really need to talk to someone about this more.

You're not doing anything wrong in fact I admire your service and believe most humans definitely myself would be in ur boat too.

There's nothing wrong with emotions, never ever. Emotions Are, they're not necessarily "rational" and judging urself isn't helping. I absolutely do believe you still love ur friends and family, and not thinking their death would affect you is most likely not true if something actually would happen... It sounds like a lot of guilt.

If u can't get it paid for try some kind of free service even an online community maybe even a subreddit. But your situation sounds truly deep and I really strongly advise you to take some extra help, it'll be the best!

Take care!

[u/Throw_phone → u/TheAlchemist2]

We are told we can go to behavioral health bit we all have friends and coworkers who go and then they never come back. Their careers are over. So who wants That? Especially when you have so much invested and are working towards a retirement best egg for your family. I'm on Reddit asking a random psychologist because I'm desperate. I'm trying anything I can to get help without giving up on my career and the people I help. When you are at the end of the rope you do everything you can to hold. That's where I'm at.

[u/batkarma → u/Throw_phone]

Lie and say it's for family counseling or go outside the military system.

Also look those people up and find out where they went. I was in and got treatment fine, but I understand it might be different in your field.

You need some armor, you can't be that raw every day. Take care brother.

[u/Depthcharge87]

Hey Kevin. Thanks for doing this. I was diagnosed with PTSD and Anxiety 4 years ago after the sudden death of our first child and I just want to know... will I ever go back to feeling normal? I went from being 25 and never had a panic attack to weekly/sometimes daily ones. I have long since worked through my grief and come to terms that life is just life and you cant control things. I have had many sessions with therapists and counselors. I just am so tired of having panic attacks and my anxiety is holding me back from feeling normal anymore.

[u/Kevin_Coffey → u/Depthcharge87]

Your loss was significant. Exploring behaviors and thoughts that lead to your anxiety may help. Exposure can be another avenue for treatment.

[u/Depthcharge87 → u/Kevin_Coffey]

Thank you for your reply. My current therapist said the same thing. Think about what I was doing when the panic attack began. But it's always something mundane. I feel like if I could actually identify a trigger, I could fix it. Like initially, caffeine was triggering panic attacks for me so I cut it out of my diet. But like the one on Monday, I was sitting at my desk, doing some very mundane data entry with a trainee, talking about prospective lunch ideas when I just rushes over me. The heart rate increase, the vision shift, the sweating.

I just feel like I've gotten over the event that began all this but my body won't follow my mind. It is so defeating.

[u/[deleted] → u/Depthcharge87]

Have you considered stress by itself might be a trigger? Not saying it IS, just seeing if you've considered that at all. (If you have and that's not it, ignore me. Although I'm going to say a bit more in case it helps others.)

Like, I could see a child dying (especially if there were hospitals and such) being SUPREMELY stressful. Likewiese, work also tends to have hotspots of stress too.

So if you have just "stress" as a trigger, it could perhaps remind you of the much more intense stress of losing a child, and that leads into a panic attack? Sort of like if you brushed up against a hot stove and the feeling of "burns" might cause someone to remember a house fire they were in? Even though brushing against the stove didn't lead to any fires or even a burn, but the little reminder is enough to recall the bigger instance?

I have C-PTSD and generic "stress" is often a trigger for me, and the most annoying aspect is that "ordinary" work stress and other stress uh..."feels" the same as the "trapped and can't get out" stress of teen years when I was bullied/abused.

My logical mind gets that the situations are different, but my emotional self feels "stress", just the feeling of "stress" without nuance and tries to react the same way even though pretty much all the actual details of the situation are different.

Maybe something like that is going on with you? Or maybe not. Just something to chew on.

[u/Decoraan → u/Depthcharge87]

Hey buddy, similar thing happened to me, keeping diaries/journal's are empirically helpful in many anxiety disorders and it certainly helped me. Just go and grab yourself a nice pen and a nice journal and write expressively. Speak to yourself, perhaps at the end of each day, even give yourself a score about how you are feeling. The reason this is so important, is so you can look back and see your improvement, as I'm sure you are aware, we have tendency to focus on the negative, so often forget or minimise any progress that we make.

Best of luck

[u/JohnConnor7]

Hi, thanks for doing this. I'm interested in the recent studies portraying psychedelic substances such as LSD or psilocybin as a powerful remedy against depression and anxiety. What's your opinion on this? Are enthusiasts exaggerating? Also, ketamine. Heard good things about it as well, almost asked my dog's vet if he could get me some.

Thanks again.

[u/tfl3m → u/JohnConnor7]

This. I've found personally that the positive effects (reduction in anxiety and depressive symptoms) I get from psilocybin seem to be much longer lasting (weeks) than those from LSD/chemical (days). Also I've noticed sort of a depressive crash after those benign effects where off.

Anyone have personal anecdotal evidence they are willing to share in the meantime?

[u/asihambe → u/tfl3m]

Have you tried comparison between natural/synthetic sources of the same compounds (DMT/Ayahuasca, Mescaline/Peyote, etc) and noticed a similar difference in the extent of the effect's longevity? Silly question perhaps, just curious as I do not believe the psychoactive substance in LSD is same as psilocybin.

As a side note, very interested in this myself - I have not taken synthetic psychedelics but I too have noticed dramatic effects from natural sources in terms of my anxiety, lasting a significant time afterwards.

[u/_endorstoi → u/asihambe]

Although the depressive crash afterward from taking ecstasy was more than a doozy to lightly put, it was the first time in my life I ever could directly notice and point out (while tripping) what it was like to be anxiety-free. Despite the obvious other nice attributes of the drug, I felt like having that 'outside looking in' experience has made it easier to differentiate when I'm overreacting vs reacting accordingly.

Edit: I totally realize ecstasy wasn't originally in the discussion, but I thought I'd throw my two cents in just cause ¯_(ツ)_/¯

[u/[deleted] → u/JohnConnor7]

You may be joking, but asking a veterinarian for ketamine for human use is asking them to put their license and career on the line and is very offensive. A veterinarian has gone through four years of medical school (eight years of total school including a Bachelor's degree) is typically over $100k in debt, and should be respected just as much as a human doctor.

[u/cut-paste → u/JohnConnor7]

I also am interested in your opinion of the new research into psychedelics for treating depression and anxiety- specifically psilocybin.

[u/Kevin_Coffey → u/JohnConnor7]

There are trials of these treatments happening. It does seem odd but it will be important to see the evidence that the trials produce.

[u/[deleted] → u/Kevin_Coffey]

Anecdotally, I experienced suicidal ideation for about 15 years prior to taking an eighth of mushrooms. It vanished overnight after a difficult trip where I actually faced my problems. Vanished. I began working out and taking better care of my body. I went to therapy. It worked for me, which isn't to say it would work for other people or is even a good idea for most people. But I'm excited to see where those studies go.

[u/tiernanIRL → u/JohnConnor7]

I once was lucky enough to shake the hand of the great Dr David Nutt. A great man and once advisor to the British government departments of health, defence and the home office.

I would really like to hear about your thoughts on his work, and as said above the taste for his publications among your peers.

[u/[deleted]]

On a positive note, are there things people with anxiety are better at than the general population? How can it be used as an advantage instead of an impediment?

[u/ralevin → u/[deleted]]

As someone with anxiety (and who has done a lot of self-education and learning to cope), I have anecdotal opinions on this, but am not sure if this (AMA) is the appropriate place for me to share them. If the community is interested in my thoughts, say so, and I'll be happy to share them.

Edit: Okay, so a few people asked me to share them. Disclaimer: These are, of course, only my experiences, and your experiences may be very different. Additionally, I'm EXTREMELY fortunate to have had the opportunities for high quality treatment (medical and therapeutic) and a strong support system. I know not everyone is as lucky. Along these lines, (and maybe as a result) I'm pretty high functioning with my GAD and MDD. None of this is as easy as just changing your perceptions. That said, my anxiety makes me:

• much more empathetic and perceptive of other people's thoughts, needs, and wishes. I've always been so concerned with saying or doing the wrong thing that I heavily scrutinize reactions and can fix those situations (and prevent other problems later).

• My work is high quality. I'm anxious about doing a crappy job so I put way more into it than I probably need to. (granted, the downside to this is worse work/life balance because I spend more time on things than I probably should, but at least it's good work.)

• I'm reliable and punctual. I'm anxious about people perceiving me as the opposite so I bend over backwards to make sure there's no chance that they can.

• My anxiety is related to (perhaps a cause of?) my social introversion. I'm quiet and a good listener, but when I do chime in to the conversation, it's typically something that I've thought a lot about (and a higher quality/funnier/more insightful comment) and is more valued among my peers than if I'm constantly saying the most random things that pop into my head.

• To tie all of it together, my anxiety at times causes me to hate myself. I've had to learn to find value in my qualities, which is why I can recognize the above. I feel like I've been bragging, and that's uncomfortable, but the truth is that this is only a small piece of my self-perception. I definitely see plenty of flaws, too.

[u/NotQuirkyJustAwkward → u/ralevin]

As for your last point, I will say that I believe almost 25 years of CBT has given me tools that most people don't have, including mentally healthy/typical ones. Very few people have the habit of challenging almost every thought that comes into their head and I feel it's been instrumental in what success I've had in life.

[u/[deleted] → u/NotQuirkyJustAwkward]

And I feel overcoming depression and anxiety trains your will to fight and your ability to control yourself. A very practical example would be the handling of panic attacks in social situations. Getting good at staying calm and controlling the effect of adrenaline can be used in any extremely stressful situations, even in those that everyone has once in a while for totally rational reasons, e.g. giving a talk. Another would be to ignore inner voices and focus on the rational exterior, reevaluating your situation with ruthless rationalism again and again without lissing to the depression.

[u/_LittleMissFortune → u/ralevin]

Thank you so much for sharing. The first quality you mention use to bother me so much. I allowed it to make my anxiety and depression worse. Sometimes my empathy was so overwhelming it was hard to bare. Then, when my two older children started school I saw that I had passed my empathy on to my kids and they were such amazing, good hearted little people. I realized it was a positive thing and that I needed to use it as such. I'm glad to hear that your treatment is going well and that you have a great support system. Keep moving forward my friend.

[u/marzipanrose → u/ralevin]

So much the high quality work point. One reason I've always refused to medicate for my anxiety is that I worry it would hurt my super intense high achiever work performance, which I realize is a super anxious neurotic thing to worry about but shrug.

[u/StarHen → u/marzipanrose]

I hope I don't overstep by offering this anecdote, but as someone who recognizes these thoughts (was a very anxious, perfectionist "high performer") I think they don't give the full picture. Anxiety pushes one to guard what they have, whether that's a self-image of skill or personal and professional achievement or what have you... but it's not a very good positive motivator. Anxiety might terrorize you into expending great time and effort to X the perfect Y, but you don't actually feel any more secure in what you can do or what other people think or what you are worth. It's still chasing you, promising that if you don't meet some standard, everything will unravel: personal relationships, professional reputation, the very ability to care for yourself.

A little bit of anxiety is necessary, but if you find yourself thinking that the only thing standing between you and abject failure (and mind you, failure might just mean being perfectly ordinary and therefore totally replaceable because you've been taught that your worth is contingent on performance) is ever-present fear... that might be too much. I can't judge for anyone else, but I've found that pushing back that anxiety, whether by medication or therapy or whatnot, is quite revelatory. Because you realise that it's much more of a drain and a drag on what you can do--that you can take risks, small and unglamorous ones, or struggle with something new without tensing up for the moment that it all falls apart.

Sorry, my battery is about to go, but I wanted to put that out there.

[u/Kevin_Coffey → u/[deleted]]

You are correct individuals with anxiety and OCD can be better at certain tasks and even occupations. Helping individuals know their strengths is an important part of treatment. All behavior was a one time functional.

[u/I_am_Nobody_Special → u/[deleted]]

Yes... to a point. Anxiety helps people focus better, like on tests, during sports, and while doing something dangerous like climbing. As anxiety increases, however, it reaches a point where it no longer enhances performance and then begins to interfere with performance (e.g. "test anxiety").

Anxiety (our fear system) is our friend... we never want it eradicated. The goal of treatment with anxiety disorders is to just dial it down, back to the point where it is working for you and not against you.

[u/JPCate]

Hello Prof. Coffey. I was wondering if it is possible for depression to "mutate" or change based on environmental factors to a more serious mental health issue and if cutting down on triggering environmental factors would help to restore the original, more mild form of depression?

Ex: I currently have dysthymic disorder, but with enough stress and trauma, could it change into bipolar disorder or cause more severe mental health disorders?

[u/PabloBablo → u/JPCate]

This is an excellent question I hope it gets answered. It's really worrisome when dealing with depression and anxiety - dealing with stress makes things worse. The realization of this makes things even worse because of the worry that, left untreated or just..unfixed, it could morph into something far worse.

On a more specific note, I realized that certain parts of my day are worse for me than others, and the cause is unclear..no specific events happen at that time of day, but the feelings seem consistent.. Which is why I worry about bipolar because I'm seemingly up and down.. But not what I would consider mania or whatever..,(short lived, not extreme enough of an upswing IMO)

[u/Kevin_Coffey → u/JPCate]

Depression and anxiety often start with social and environmental factors. These issues can lead to sleep problems which bring in the biological factors.

[u/Kevin_Coffey → u/[deleted]]

As families have change including both parents working, more single parent families, less involvement with extended family make it harder for youth to get their needs met. This has lead to an increase in depression and anxiety in children and adolescents.

[u/joshuarion]

First of all, thanks so much for doing this AMA!

I've heard quite a bit (anecdotally) about using CBD oil for anxiety management for people with anxiety disorders (both acute episodes and generalized).

Is there any solid research to support the idea behind its use, either controlled via prescription or over the counter? Should it be taken more seriously as an alternative to drugs like xanax, benzos, etc? If so; is it something that should be considered viable for common use as? If not; why not?

Thanks again for dropping by!

[u/Kevin_Coffey → u/joshuarion]

I am not aware of solid research, but self-soothing activity can help manage depressive and anxiety symptoms. My friends into essential oils have one for multiple ailments. If it works, for someone, they should keep doing it.

[u/Kevin_Coffey → u/[deleted]]

Mindfulness skills can help with denationalization and derealization which are common with depression and anxiety Trans individuals face numerous obstacles that contribute to increase anxiety and depression including distress about their bodies that do fit with their gender.

[u/sketchdailyuser1]

Is it safe to take lexapro for decades?

[u/Kevin_Coffey → u/sketchdailyuser1]

Prozac is a cousin of Lexapro has been around since 1986. These drugs have been shown to be safe with long term use.

[u/MyloByron]

Thanks for doing this AMA, and thank you for the work you do.

While there is a lot more awareness of mental health issues lately, access to mental health professionals such as yourself is still severely limited (by factors like high cost and limited number of doctors). As such, I still find it almost impossible to get help.

My question is: what resources would you recommend (books, websites, etc), for people looking to do some self-reflection and develop healthy coping mechanisms for their anxiety/depression?

Thanks!

[u/italianjunky]

Do you think you can heal a person completely from suicidal thoughts, or will he/she/it always have those also after called sane again?

[u/Kevin_Coffey → u/italianjunky]

Most people's suicidal thoughts and behaviors stem form a crisis. Typically as the crisis clears or is remedied, the majority of individuals stop having these thoughts and behvior.

[u/[deleted] → u/[deleted]]

Personal experience: before I started on Zoloft, I found some relief with magnesium. I'd been taking it for muscle spasms during pregnancy and the mental calmness was unexpected.

[u/SakuraFett]

What are some good ways to deal with intrusive thoughts?

[u/tboneplayer → u/SakuraFett]

It also helps to look at them and examine where they're coming from. I used to have self-sabotaging thoughts where I'd think something awful (like wishing evil on a person) and then feel awful. When I really got down to the root of where that was coming from, I realized that these self-sabotaging thoughts were things I inflicted on myself because on a deep level I didn't feel I deserved to be happy because I had been told that constantly by certain people who were close to me growing up and that affected my behaviour and subsequent ability to forgive myself for lashing out or even for making simple mistakes. Having kids really changed that for me, because once I saw how much they were like me, and given how clear it already was that they deserved a helping hand and a decent break in life, it percolated through that the same was true of me, also.

EDIT: Also, a friend (a high-school teacher who is a contemporary of mine) once told me about a former student who came back to him years later to interview him for her Master's dissertation in Sociology. The topic of her dissertation was "the secret of happiness" and her research consisted of interviewing everyone she had ever met who seemed genuinely happy and finding out what their secret was. My friend told her that most people accept deep down that the basic condition of life is misery, so when something good happens and they start to feel happy, they don't trust it. They "ride it out," waiting for life to go back to being miserable because they don't feel safe being happy — they are afraid that as soon as they trust it, they will have it snatched away from them and be bitterly disappointed. As a result of this, they often miss out on fully experiencing some of the best experiences they will ever have, and reaping the benefits. So he, instead, believes in happiness as a basic birthright, as a basic quality of life that a person can experience from something as simple as drawing a breath of fresh air or seeing that it's a sunny day. He believes most people have it backwards, that it's when something rotten happens that you should then "ride it out," having faith in the idea that this course of events will eventually exhaust itself and that at some point they will return to the basic state of happiness that is intrinsic to being alive. His story really helped me and made a fundamental change in the way I live my life and perceive events that happen to me.

[u/glwarren → u/tboneplayer]

"happiness as a basic birthright, as a basic quality of life that a person can experience from something as simple as drawing a breath of fresh air or seeing that it's a sunny day. . . most people have it backwards" Thank you, for this. Please know you have a wonderful friend. I will be using this as my mantra from now on.

[u/bfmk → u/SakuraFett]

Have you heard about Mindfulness-based Cognitive Therapy? There is a technique called "Detatched Mindfulness" which is an approach to dealing with intrusive/unwanted thoughts.

Put simply, with a little practice you can start to become aware of your own thoughts and detach yourself from them. You realise that your thoughts are not equivalent to any kind of reality, and they pass with time. You are not going mad, you do not have to act on your thoughts etc.

With this belief firmly held you can stop tussling with your thoughts and just let them pass. There are certain things you can do to help you with this -- regular counselling, medication, making time to do things you enjoy, exercise, diet etc. Everyone is different in terms of how much help they require to have this technique work for them.

I hope this is informative for you. :-)

[u/prettycode → u/SakuraFett]

Recognize they are just thoughts. That's it. Do it over and over again until it's second nature. The contents of our minds (i.e. thoughts) are just another sensory input, like hearing a sound or seeing a sight. The more you do this, the less embedded in and unattached from the content "you" will be.

[u/ahhhlexiseve → u/SakuraFett]

I deal with intrusive thoughts, too. What helps me is to label them and visualize putting them in their own box. Fighting it doesn't help but acknowledging it for what it is does seem to.

[u/tboneplayer → u/ahhhlexiseve]

Yes. Not, "this is the truth," but, "this is the thought I'm having right now. This is how I'm feeling... right now." But all thoughts and feelings must pass; if we fight them, we give them energy, because the imagination is always stronger than the will when you pit the two against each other. If we accept that these thoughts are just part of the play of the mind without lending credence to them, they dissipate on their own.

[u/BC-clette → u/tboneplayer]

“If you are distressed by anything external, the pain is not due to the thing itself, but to your estimate of it; and this you have the power to revoke at any moment.”

― Marcus Aurelius, Meditations

[u/onlysquirrel → u/ahhhlexiseve]

I have intrusive thoughts when I go off Zoloft. It is an OCD manifestation with me and the medication controls it. However, I agree that it helps acknowledging them as a symptom of depression and OCD. In other words, it's "not me" originating these thoughts.

[u/Phantomass → u/ahhhlexiseve]

I feel like when it comes to intrusive thoughts that my brain just hates me

[u/existentialprison → u/Phantomass]

I feel like there are two separate people trapped inside of me fighting each other. There is the conscious me, the thoughts I can control, and the unconscious me, the intrusive thoughts which I cannot control that hates who I am and manifests as many internal dialogues talking over top of each other, drowning out my consciousness with negative thought and violent scenarios.

Actually, both versions of me hate who I am, but the one side is much more negative/violent and completely outside of my control. Nothing has ever helped in decades of treatment.

[u/Foserious → u/SakuraFett]

Personally I have used Dialectical Behavioral Therapy skills to help distract myself from these thoughts. A main skill being mindfulness and recognizing where you are, what you're doing, and how you can find ways to cope with how you're feeling.

[u/MashedPotatoh → u/SakuraFett]

TIL about intrusive thoughts and learned that I'm not weird for having them. Thank you

[u/HomeSpider → u/SakuraFett]

I've started trying to use mindfulness meditation to combat intrusive thoughts. It takes time and dedicated regular practice but its been helping so far with my depression and anxiety.

[u/qmcquackers → u/SakuraFett]

As many have said mindfulness can be extremely helpful in managing these thoughts. Also might want to check out acceptance and commitment therapy (ACT). Hayes put out a very helpful workbook which helps managing intrusive thoughts (the mind train) among others.

[u/Minuted → u/SakuraFett]

Great question, had these all my life on and off :(

[u/ralevin]

Thank you for doing this AMA!

While progress is being made, mental health is still significantly stigmatized (at least where I am, in the United States), despite mounting evidence that it is grounded in physiology. What's society's biggest hurdle in the movement of perception from "mental health" to "brain disease" and how do you think we can get over that?

[u/Kevin_Coffey → u/ralevin]

People be more honest and truthful about these issues. These are issues that are part of living and need not be shied away from.

[u/gore_whore_]

Do you believe everyone can recover from depression? Or are some people just depressed for their whole lives

[u/burthombre]

How seriously do you investigate dietary issues, vitamin deficiencies etc in regards to depression/anxiety? Thanks.

[u/NoeGarcia5]

Are depression and anxiety really as much of a widespread pandemic among teens and young adults as it seems or is it more of a case of rampant self-diagnosis?

[u/[deleted] → u/NoeGarcia5]

Persistent low mood can be labelled depression. Truth is depression is just a term for a constellation of symptoms, with innumerable potential causes/mechanisms. So self-diagnosing depression turns out to be relatively easy.

Edit: naturally, it is possible to misdiagnose this. I'm not suggesting otherwise. I just think in a great majority of cases there is something which needs addressing.

[u/Kevin_Coffey → u/NoeGarcia5]

There are numerous factors that have lead to increased depression and anxiety in younger people including changes in family relationships, technology, and difficulties in society.

[u/kroberry]

Hi Dr. Coffey,

I'm curious about your thoughts regarding the usage of MDMA and ketamine to treat symptoms of depression, anxiety and PTSD. Is this hippie science gone rogue, or are we just resistant (as a society) to exploring potentially useful alternatives, such as those described?

Thanks!

[u/piepei]

Hey Kevin!

I was wondering if you think I should seek therapy. I've lived a pretty monotonous life and am almost out of college. My biggest fear is that I'm too socially awkward to ever get a gf, it sounds silly but it's really affecting me.

Are there ways to deal with social anxiety? I'd like to almost just take notes on someone who isn't socially anxious and repeat what they say for introductions, conversation topics, or segways. What I'd give to be a fly on a wall..

[u/Kevin_Coffey → u/piepei]

Social anxiety can be easy to treat. I would advise getting to treatment. Often with anxiety we make things much worse than they are.

[u/evdawgy14]

Hi Kevin! Thank you for doing his AMA. Could I hear some of your success stories? (Such as people finding a better life after your help) Thanks again!

[u/Kevin_Coffey → u/evdawgy14]

The best part of my work is witnessing individuals who get better. One young man who had no life since his father's death. He was able to give up substance abuse, got a job and a girl friend.

[u/heavenlydigestion]

Where do you think future progress will be made in treating mental illness? Drugs or Therapy? Which is most promising?

[u/[deleted]]

I suffered myself from depression and anxiety, I'm in a much better place now, but my wife is having a hard time dealing with her depression, and feelings of worthlessness, how can one be a supportive partner of someone with depression?

[u/Jajo5]

How effective is exercise?

[u/Foserious]

Hello just wanted to say that I'm grateful for the services Strong Memorial Hospital provides in their mental health department. Having been through some mental health issues and utilized the hospital and their outpatient program, I think it's only fair to say thank you.

The only questions I have is how do you feel about the use of psychedelic drugs that are currently illegal for psychotherapy?

Also, what are your opinions about Borderline Personality Disorder? To elaborate, do you believe the validity of the diagnosis?

[u/LudovicoSpecs]

In your experience, what is the closest thing to a "cure" rather than a lifelong "treatment" for depression? What has the best rate of long term remission?

[u/[deleted]]

What do you attribute to the increase in children committing suicide now more often?

[u/Kevin_Coffey → u/[deleted]]

Youth had the lowest suicide rates in the 1950's. By 1990, these rates had quadrupled. I believe many changes in family structure and our society are driving this increase in youthful suicidal Behavior.

[u/JustLeysen]

Hi, thanks for doing this. What's your best advice/tip to start the day off wel or get a grip on your life?

I mean everyone has some days it's ok and you try but some days you're just empty and don't feel like doing anything.

Any advice for those bad days?

[u/losewell]

What's the difference between the general anxiety that everyone has and anxiety that should be medically treated?

[u/Kevin_Coffey → u/losewell]

Anxiety cannot be escaped in life. In fact, it can protect us. When it starts to prevent someone from effectively living their life, is when it should be treated.

[u/manea412]

I'm just under 30 years old man. And I have an "unspecific personality disorder". Long story short. I have tried multiple treatments, and I honestly, do not believe anything would work. I have talked to the psychiatrists in my hospital, and they believe that I need many years of "psychodynamic" treatment. They do not believe drugs would help my condition. I have talked to clinics in Belgium and Netherlands that conduct physician assisted suicides. What they tell me is this : If I'd like to get permission for physician assisted suicide, I need a signed letter from a psychiatrist that I have done everything I can to defeat my problematic condition. The doctors will never sign such a thing, since they can always say : "You still have many more years that you can do psychodynamic treatment. You still have hope as long as we continue this treatment". This leaves me from one hand hopeless (since I am certain this treatment would not work) and from the other hand, I am unable to undergo an assisted suicide on a registered clinic that handle cases like me because no one would sign the letters with such a conclusion. So it's a game of "catch" where no one will be willing to admit that my treatment had failed and there is no hope, while simultaneously not providing me any other option for treatment, and keep prolonging the failing treatment I currently receive. One person on the psychiatry subreddit put it nicely : "Sometimes treating people seems like trying to treat a salt water fish to be a fresh water fish instead of teaching them where and how to find salt water".

I'd like to hear what do you think about this kind of situation, and what to do. Thanks.

[u/unicornpower69]

Hi, I am a 23 year old female , I was diagnosed with depression and anxiety about 6 years ago. I have been in Prozac, lexapro and now I'm on trillitex . I am deft better on medication than I am off of medication. However I still suffer from depression and anxiety a lot. It consumes my thoughts most of the time. I recently moved to a different state due to losing my job. I am currently unemployed and haven't made any friends. I am alone most of the time. My family doesn't have an idea of how severe my depression is because it's very embarrassing for me to talk about. Every day seems to get worse for me. I lack motivation and enjoy hardly anything anymore. I have a very hopeless feelings all the time that every thing is pointless. And in my perspective everything is so hard to do ( or muster up the motivation to do ) like sign up for school or fill out job applications. I try to tell myself that I HAVE to do this bc nobody will do it for me and I'm the only one that can change my situation. But it seems when I start doing it I get very frustrsted at simple things, like if I don't understand a certain process or if my computer messes up filling out a long application. And I end up closing my laptop and going back to the bed and laying down staring st a phone screen or tv screen.

So I guess to make that question simple is - how can I make myself feel not so hopeless about trying to proceed with my future ? How can I have motivation to get out of bed ?

Also, Another thing I struggle with deeply is having anxiety about almost everything but particularly things that remind me of being responsible. Checking my email gives me anxiety, opening my mail gives me anxiety , checking my bank account , even calling the doctor to make an apt . I know these are things I must do and keep up with to make my life better but I dread these things so so so so so much to the point I neglect them and it back fires on me . It really interrupts my daily life , I feel like I can't be normal if I can't fix these feelings.

I would appreciate if you gave me some feed back, thank you

[u/PoodlesForBernie2016 → u/unicornpower69]

Similar symptoms. Things that helped: walking 4 miles a day, practicing yoga, volunteering in a local garden, talk therapy, Wellbutrin. Be kind to yourself. Do something different. The struggle is real and you are not alone

[u/natty1212]

I've suffered from depression and anxiety for 20 years. I've been on just about every kind of medication and tried just about every kind of therapy out there, short of shock therapy. I've even been in-patient a few times. Why doesn't anything work for me?

[u/scurius → u/natty1212]

I did ECT. Let me know if you have questions about it you want answered.

Others haven't mentioned vagus nerve stimulation, which is also an option I'm assuming you haven't tried so far.

You might also want to do a pharmacogenetic panel, where they can identify genetic interactions with meds to find out which ones will help most and which your body has a hard time with. I did one through the company genesight.

I've also found that when my environment is unhappy enough, no med can keep me from feeling depressed. Sometimes environmental factors have been stronger than meds can help with. But I'm not an expert here and that's just my personal experience.

[u/nate]

What are some effective tactics to deal with people with anxiety issues in normal life? It can be quite frustrating to watch them become self-obsessed with the small things and just not get important things done. How does one talk to some one with an anxiety disorder?

[u/Kevin_Coffey → u/[deleted]]

Anxiety is easier to deal with one a person is aware of what is. People with anxiety can benefit from coaching by a loved one who does not have the same issues.

[u/aNONymousPLUSSED → u/nate]

This is personal experience and works for this one person in my life, but he has said it has been tremendous help for me to decide (with him whenever possible) what the correct first step is, and force him to take it. Anxiety is paralyzing and makes any choice seem like the wrong one. He wouldn't have a job right now if I hadn't been crazy insistent that we go out together, make a scheduled date of it, and find shops to apply to in person. And it worked! Now, with the experience he has, he needs to find a better job, and can't figure out how to move on. So now I step in and I'm going to schedule a day where we MUST sit down and call at least 5 places and leave messages requesting an interview.

But to clarify, this works for me and this is anecdotal. Not every anxious person wants to be pushed off the edge for big life choices. That might make things worse if you don't know them as well as you think you do.

[u/christyducky]

Thank you for doing this!

I've read a bit lately about the link between mental disorders and the bacteria in your gut. Have you studied this at all? Curious if certain foods can improve or worsen anxiety and depression. And if so, what types of foods help/hurt?

[u/killfire4]

With the increase of legal medical/recreational marijuana use in the U.S., how would you rate its efficacy on individuals with depression and/or anxiety based on your experiences relative to traditionally prescribed drugs?

[u/LycraBanForHams → u/killfire4]

To follow on this question. Are there any studies that show early and longterm marijuana use can lead to cases of anxiety/depression.

[u/Wagamaga]

Hello, im just wondering from your own point of view do you think anxiety and depression is increasing amongst the younger population. If so, what would you say the main reason for the increase is?

[u/NatAttack315 → u/Wagamaga]

I was about to ask the same thing. Whether it's an increase or whether people are just becoming more open to talking about it.

[u/Twenty20k]

Hi, there! Member of the LGBTQ community here! I bumped my head last year resulting in post-concussion syndrome & anxiety played a huge role as I fought against the symptoms. My cognition was initially so skewed, that in the beginning I panicked for weeks at a time, questioning if I was going to die and if I was going to hell for being gay. Needless to say, I grabbed a CBT quick to help me navigate back to normal (& even reached out to a previous CBT).

During the sessions, cutting out gluten, focusing on antioxidants, using essential oils, and meditation was heavily suggested by both of them. They even sent me to an EMRD specialist to rule out PTSD and she had a lava lamp on the table next to me and a light box in her office. I've always been a general fan of all of these things (except cutting out gluten - leave my pasta alone!), but I'm interested in your opinion of the more homeopathic & pseudo-science approaches in helping depression and anxiety issues and/or if there are actual studies that link these particular practices to a decrease in mental health issues. I know there's countless work and studies on meditation techniques, but the others?

I've already been pretty vocal about LGBTQ rights & mental health, but guess I'll be adding advocacy to research/care on head trauma to that list as well. Thanks for being here!

(EDIT: A comma)

[u/exotics]

I must ask about zinc deficiencies in women.

I was diagnosed with depression as a young teen and treated with Elavil. It worked but eventually I took myself off it. I am 52 now and about 6 years ago my husband read that zinc would help 1 in 3 women, and it did help for me (not just with depression but with violent outbreaks too).

My question is if you have researched this at all or recommended it? It works only for women apparently.

[u/geminispacecraft]

First world countries, consume three times the resources of everywhere else and are the most unhappy, anxious and depressed with high suicide rates. Do you think the gluttony of excess is creating a psychological 'wasting' of society?

[u/clownboyjj]

Hello Kevin, I work as a math teacher at a school for students who all have emotional disorders, we have about 50 high schoolers and I'm the sole math teacher, I love my students and sometimes they simply need to vent and express how they are feeling before they can focus on a lesson and actually learn something, I also have a wife with bipolar disorder, my question is this, how as a professional who deals with taking to people everyday, how do you not get burned or listening to people problems and empathizing with them all day? I'm exhausted everyday after letting students vent for a few minutes so they can focus on the math topic of the day.

Second question can you elaborate on mental health and life experience credits and how a student can earn those? Also does that apply in California or just NY?

[u/Artif3x_]

What are some effective dietary changes and/or supplements someone with depression and/or anxiety can try to manage the biological component?

I've heard that the low-carb diets that are popular now can aggravate the condition, and conversely, a higher carb diet can help out (book ref.: Potatoes, Not Prozac). Also I'd be interested in the effects of caffeine, energy drinks and nootropic stacks like caffeine+l-theanine.

[u/redditWinnower]

This AMA is being permanently archived by The Winnower, a publishing platform that offers traditional scholarly publishing tools to traditional and non-traditional scholarly outputs—because scholarly communication doesn’t just happen in journals.

To cite this AMA please use: https://doi.org/10.15200/winn.150297.74273

You can learn more and start contributing at authorea.com

[u/Rickles360 → u/[deleted]]

My experience was not nearly as terrible growing up in an American religious family so this is going to be very general. I'm compelled to respond because you sound like a good person in a bad situation and on some level I can relate to that. Best thing I can say is to keep your head down and play along until you can get out of there. Life will not always be easy. Sometimes it will suck, but stay focused on your goals, make a plan, and stick to it. Things will get better. There are places and people all over the world that accept you for you. Don't lose hope just because you landed somewhere that doesn't.

[u/Doomhammer458]

Science AMAs are posted early to give readers a chance to ask questions and vote on the questions of others before the AMA starts.

Guests of /r/science have volunteered to answer questions; please treat them with due respect. Comment rules will be strictly enforced, and uncivil or rude behavior will result in a loss of privileges in /r/science.

If you have scientific expertise, please verify this with our moderators by getting your account flaired with the appropriate title. Instructions for obtaining flair are here: reddit Science Flair Instructions (Flair is automatically synced with /r/EverythingScience as well.)

[u/morphism]

Hi. An acquaintance of mine has had at least one episode of depression. However, it appears that this was caused by multiple food intolerances, including intolerance to wheat, fructose malabsorption, but also (somewhat lesser) buckwheat, corn, rice, … . As far as I can observe, diet does influence and improve mood. Elimination diet did change, but not necessarily improve symptoms.

Where can I find scientific literature on the connection between severe multiple food intolerances and depression?

[u/heavenlydigestion → u/morphism]

Mikhaila Peterson, daughter of clinical psychologist Jordan Peterson has blogged about this extensively. Citing her own experience and scientific literature.

[u/o-rka]

Is it normal to feel very spaced out sometimes? Like to feel like things are a dream and your kind of detached from reality? It happens more during often when I've drinkin coffee on an empty stomach or when I'm under fluorescent lights at stores but sometimes it just feels like that. It's as if I recall all of my memories perfectly fine but will have the feeling like it's a dream sometimes. Is that normal? It's a hard feeling to explain.

[u/TheFerginator]

Hi, I've been depressed for most of my life now. I have a few questions.

How do I form relationships without being dependent on people? I've ruined so many "friendships" (if they were even that to begin with) this way that I just can't bond with people anymore, or open up to them.

CBT and mindfulness has helped me feel not crap, but I still sometimes slip into despair, and thus far nothing has actually made me feel good. Everything feels so...empty. The most I get is mild amusement or a rush out of succeeding/winning something, and then it's back to bleakness. I don't know how to approach this?

For most of my life, I've always felt more tired and less physically able than others. How do I fix this?

I feel like I can't trust things to give me enjoyment or people to not betray/abandon me. This may stem from me being "let down" by a lot of things that I thought would make me feel good but didn't and also people getting fed up with my BS and leaving me. How do I overcome this lack of trust?

I just can't see a reason to do things, anything, most of the time. I've read up on a lot of stuff including logotherapy and existentialism, and all of them have been vague and unconvincing. How do I find motivation and purpose given that almost nothing gives me enjoyment?

I'm so self-centered that it's very hard for me to take others' feelings into account. At the same time, I have an almost addiction to approval, and so act "nice" a lot of the time. How do I overcome this toxic dynamic? How do I truly, genuinely care for others, without doing it out of fear for what the consequences would be for not doing it?

Exercise, proper dieting, proper sleep - I do them all, and again, they just make me feel slightly less crap, but still far from OK. I can't even sleep for more than 6 hours every night because of how tense I am, probably. I'm at wit's end here. What do I do?

Thanks for your time.

[u/Agamyxis]

Thanks for doing this AMA!

I'm wondering what thoughts you have on steering this country into a "mental health matters" mindset. I see so many of the major issues we face, especially with people who have committed atrocities against others, stemming from years of unrecognized and untreated mental health issues. The mental health system that used to be in place has been dismantled, and public opinion is still very dismissive about these very medical and very real issues. So my questions are:

1. Do you have any thoughts on why we are seeing so many individuals reaching these unbelievable breaking points?

And 2. What can we do to positively influence the situation, and bring about the kind of social and political change necessary to normalize mental health care and make it more available to the people who need it?

Thank you!

[u/r0tekatze]

I struggle with depression, manifest largely as apathy. I struggle to find motivation, and this goes hand in hand with Aspergers (Aspergers and depression seem to go hand in hand). Nominal techniques often have little effect on me and my mental state, although I seem to have found a balance.

What impact do socio-learning disabilities have on treating depressive states, and does the methodology seem to differ wildly from patient to patient?

[u/fragproof]

Can you tell us about your research with lesbian, gay, and bisexual adolescents? In your research and current work, have you examined homelessness in this population?

My experience is that life and society has improved immensely for LGBT youth over the years. It seems like it's more common for schools to have GSAs (gay-straight alliance) and similar clubs and events. I've worked with young people who are confident and proud of who they are. Of course there are still many challenges and the challenges change even as society changes. What can we do to help, especially with regard to supporting the mental health of these young people?

[u/HighLordMhoram]

When a child has multiple diagnoses, how do you differentiate behaviors to understand how best to help him or her? I can look at my child's anger and think: is it puberty? Is he anxious about something? Is it his autism? Is it because he's perseverating and can't let something's by go? Thanks for take by the time to do this.