Anxiety disorders are the most common psychiatric disorders. People can be preoccupied with persistent anxiety such as illness anxiety, generalized anxiety, social anxiety, agoraphobia, panic attacks, or somatic (physical) symptoms. Anxiety can lead to insomnia, fatigue, headaches, muscle tension, or restlessness. People may find comfort in avoidance, like by procrastinating on doing an assignment if it feels too overwhelming, or avoiding leaving home because of fear of having a panic attack. Exposing yourself gradually to the anxiety triggers will help to eventually overcome the anxiety. Cognitive behavioral therapy, medications, meditation, yoga, and stress relief techniques are also effective. The therapeutic approach is based on each patient’s unique needs, preferences, and goals.

Depression is a disorder which truly affects the whole person. Depression is when a person experiences at least two weeks of symptoms that may include sadness, empty or irritable mood, low motivation, low drive, or feeling devoid of pleasure or hope. It can make everything feel like a hassle and like nothing is worthwhile. Some people can struggle with low energy, sleep changes, or weight and appetite changes. It is human nature to have some negative thoughts but the mind in depression tends to magnify negative thoughts. People’s relationships, job productivity, creativity, and physical well being may suffer. Depression has been linked to chronic fatigue, chronic pain, and irritable bowel symptoms.

Primary depression can be spontaneous, triggered by a stressor or stage of life issue, or seasonal changes (due to shorter days in the fall and winter). Secondary depression is when depression is due to an underlying medical illness (e.g. hypothyroidism), adverse effect of medications or due to substance abuse (e.g. alcoholism). These underlying causes need to be ruled out or treated.

Risk factors for depression include a family history of depression, chronic pain, medical illness burden, childhood trauma, parental loss, neglect, impaired social supports, loneliness, difficult life circumstances, and unhealthy substance use.

For moderate to severe depression, medication is recommended with therapy as both together have a more rapid and sustained response than either alone. In mild depression therapy alone can be effective. Adjunct strategies include behavioral activation, exercise, light therapy, meditation, and the Mediterranean diet. The choice of treatment depends on the subtype of depression, and any co-morbid medical or psychiatric illnesses. All potential contributors to the depression should be considered.

People with bipolar illness experience the opposite “pole” of depression called mania or hypomania. During a hypomanic episode a person may have a lack of sleep for several nights but have persistently increased energy, activity, racing thoughts, talkativeness, inflated sense of self, agitation, irritability, or distractibility. A manic episode describes when the lack of sleep persists for longer, and progresses to significantly impact functioning, such as by causing psychotic symptoms or an inability to take care of yourself. During these episodes people may lack their usual judgement and make impulsive decisions, like donating all their life savings to a charity. Manic episodes can lead to overactivity of certain neurotransmitters (e.g. glutamate) which can lead to neuronal damage and treatment prevents this.

In addition to manic or hypomanic episodes, people with bipolar illness often also experience depressive episodes. Generally, depressive episodes predominate in a person’s life as the most common mood episode but there are people with bipolar I disorder who only experience manic episodes. The goal is to treat mood episodes, prevent recurrence, and maintain periods of stability or euthymia.

Some episodes can be substance induced or secondary to a medical condition. Bipolar disorder is most often inherited but there are non-familial cases. Management includes sleep hygiene, stress reduction, keeping a daily routine, daily medications, and sobriety from psychoactive substances.

Self harm is purposely harming yourself for example by cutting, scratching, or burning without suicidal intent. Self harm should be evaluated by a clinician since it signifies significant emotional distress. We try to understand the triggers leading to self harm and to find alternative ways of bearing emotional pain.

Personalities are the constellation of traits that make up who we are. Sometimes due to genetics, or an upbringing that was neglectful, traumatic, or invalidating, people can experience more intense and more reactive moods. People with this disorder may struggle with reckless behaviors, unstable relationships, difficulty with anger management, self harming, among other symptoms. Dialectical behavioral therapy (DBT) is the cornerstone for treatment of borderline personality disorder. DBT teaches skills in distress tolerance, mindfulness, emotion regulation, and interpersonal effectiveness. This disorder is often comorbid with other psychiatric disorders and comorbidities should be treated too.

While a personality disorder sounds fixed, personality is not static. The brain is neuroplastic and molds as we practice coping in new ways. The more we reinforce those neural circuits the easier making healthier choices becomes.

Obsessive compulsive disorder is when an individual experiences obsessions (repetitive, unwanted thoughts, ideas, or images), and/or performs compulsions (repetitive behaviors) to decrease the anxiety created by these obsessions. There can be an underlying suspicion that something terrible will happen if not completing the compulsions. For others there can be an internal feeling that “things just don’t feel quite right” until the compulsions are completed. Some common content relating to OCD includes contamination fears, checking compulsions, doubts about accidental harm, obsessions with symmetry or counting, or performing mental rituals. OCD is treated with primarily serotonergic medications and exposure response prevention therapy.

Eating disorders are when a person has an unhealthy relationship with food and/or preoccupations with their body weight that predominates over a person’s life. Eating disorders include binge eating disorders, bulimia, or anorexia. Factors that can contribute to eating disorder risk include cultural pressures like media images that are defining beauty as thinness. Perfectionism, impulsivity, peer pressures like bullying or ridicule because of size and family history of eating disorders can also increase risk. Treatment options include psychotherapy, nutrition education, daily medications, and more intensive partial hospitalization or day programs.

Attention deficit and hyperactivity disorder describes a pattern of inattention and easy distractibility that is impairing either a child or adult in different settings of their life. There can also be hyperactivity, impulsivity, or the feeling of “being driven by a motor.” There are various treatments for ADHD including medications such as stimulants and non-stimulants and/or training in executive functioning.

Sleep issues can be a symptom of other psychiatric conditions or medical conditions, such as urinary issues, obstructive sleep apnea or an underlying anxiety disorder. Ruling out and treating possible root causes and practicing sleep hygiene are the first steps in managing insomnia. Sometimes medications can be prescribed.

PMDD describes when there are clinically significant premenstrual mood changes (e.g. depressed mood, anxiety, irritability) and often physical symptoms (e.g. breast tenderness, fatigue, headaches) that cause social or occupational issues and/or are extremely distressing. In PMDD symptoms start 1-2 weeks prior to menses and resolve with menses onset. Women with this disorder have normal hormone levels but have a greater sensitivity to the normal fluctuations in estrogen and progesterone levels. Randomized controlled trials support the effectiveness of serotonergic medications and cognitive therapies for PMDD. Other strategies include regular aerobic exercise, avoiding caffeine and salty foods, treating pain with NSAIDs, getting regular sleep, and taking supplemental calcium.

There are role transitions, stress, body changes, hormonal changes, and sleep changes that make pregnancy and postpartum periods a vulnerable time. Women with a history of mood disorder or OCD are at high risk of recurrence or exacerbation in the perinatal period. There are psychiatric medications that are considered relatively safe in pregnant and breastfeeding women and taking medications may be recommended. We try to keep mothers feeling well because untreated mental illness increases the risk for maternal and infant mortality and morbidity. Each specific psychiatric medication should be discussed with your psychiatrist as there is different reproductive and breastfeeding safety data available for each medication.

A history of life threatening trauma or sexual assault can make someone feel like the world is not a safe place. PTSD can involve hypervigilance or intrusive symptoms like nightmares and flashbacks, or feeling like you are reliving the trauma. There can also be avoidance behaviors that develop to avoid recalling the trauma, like avoiding a place that reminds you of the trauma. People with PTSD can have negative alterations in cognition or mood, like persistently feeling sad or detached from people or having negative beliefs about themselves.

There are evidence-based medications and therapies which include trauma focused cognitive behavioral therapy and eye movement desensitization and reprocessing therapy (EMDR) . Goals of treatment include reducing distress related to intrusive symptoms, dampening hyperarousal, reducing avoidant behaviors, and improving relationship dynamics.

Substance use disorders occur often in the context of other psychiatric disorders. We treat substance use disorders and co-occurring mental illnesses at the same time. Sobriety is possible with self compassion, persistence, finding your inner motivation, and sometimes there may be medications that can help. Community support is highly effective like participating in Alcoholics Anonymous and Smart Recovery support groups. A higher level of care like inpatient detoxification, a residential program or intensive outpatient program is sometimes recommended.

Stigma is when people, or even the affected person, view a person negatively once knowing he/she/they have a certain condition. Stigma may be being judged once someone knows some new aspect about you. Stigma can breed fear or silence that prevents people from seeking treatment. Some psychiatric illnesses are historically stigmatized in U.S. culture and have negative media portrayals. An individual’s stigma experience can vary depending on a person’s subcultures and familial upbringings. Being stigmatized by others can lead to feelings of isolation, feeling “weak” or “not normal” and contribute to a lack of well being. Participating in support groups and listening to first hand accounts from people with mental illnesses are some first steps in breaking down the stigma.

It is also society’s responsibility to change the discourse surrounding mental illnesses.