In life we are faced with challenges from every day: relationship issues, financial problems, health concerns. Many of us cope with the challenges, many of us don’t. Whether something becomes a problem in our lives, is relative and personal to us: an issue for one person would be brushed off by another. How we cope with the problem is dependent on many factors.
I have patients with major problems in their lives who are low in mood or anxious. The first thing I would say to them is that it is normal to feel like this in this situation. I will give you my example. I have a young family member who lives abroad, who has been diagnosed with a terminal brain tumour and is currently in ICU. My wife has gone back to spend time with him and has taken the kids too. Pretty deep stuff. I remain here, doing a job I love but without the support network that usually surrounds me. Needless to say, I feel a bit flat - but who wouldn’t be? If I was jumping for joy, you would probably think I was a bit weird! So what should I do?
What the doctor will tell you
Most people in this situation will give it a bit of time and see if the situation changes. They will wait to see whether their mood picks up. Sometimes it does but often it doesn’t. They would probably deny that there was a problem and get on with life. They may be thinking that they needed to see the doctor, but would find excuses not to. I am too busy to make an appointment. I am sure this will go away. Will the doctor laugh at me? It is too embarrassing to talk about my feelings.
Unfortunately, this is the biggest and hardest hurdle to overcome. The first part of dealing with a problem is admitting that there is a problem in the first place. I always commend my patients when they come to see me to discuss a mood problem, because it is really hard.
Once in the office, I would often ask people about the problem, but also how it is affecting you: your sleep, appetite, concentration, memory, motivation, energy levels and maybe your sex drive. This is because mood problems affect these factors. Tick all the boxes and you are pretty depressed. Tick one or two boxes then maybe the problem is mild. If things are really bad then people may have suicidal thoughts.
Once I have worked out how bad the problem is, we can work out a plan. For mild to moderate mood problems, there are 3 things that will support your mood. Exercise, cognitive behavioural therapy and medications. If you came to see me, I would have a frank discussion about all of these options.
I am a huge advocate of lifestyle changes to optimise health. I can and do prescribe medication but if a lifestyle change is a safe and potentially effective alternative option then it should strongly be considered.
Exercise is beneficial to heart health, weight, diabetes risk and also your mood. Why your mood, I hear you ask? When we exercise we channel physical energy into the activity but we also channel mental energy. At the end of an exercise session, you will feel physically drained but any clutter that was fogging up your mind gets cleared. With regular exercise we will start to feel physically good but also mentally good. More importantly, you will feel mentally tough.
Exercise challenges you and when you meet that challenge, it gives you mental strength. For example when you start exercising, you may only be able to run 1km. You challenge yourself to run 3km in the next 6 weeks. With time and training you meet that goal. This will give you mental strength and prove to you that you can deal with a challenge that is presented to you. Next time you have a problem in your life, you will meet that challenge because your exercise has trained you to do that.
With all lifestyle changes, be that exercise or diet, it is important that the changes are sustainable. Find an exercise that you enjoy, (it can be running, swimming or even ballroom dancing) that you can easily incorporate it in your life, so that it can be done regularly throughout the week…..and I really mean this, for the next 30, 40, 50 years of your life. This is not a fad or a short term solution but a real sustainable lifestyle change.
I have numerous patients who I have accompanied along the journey of their life problems. They have done the exercise, seen a psychologist (see below) and have taken and now ceased medications. They got through the challenges of their life. Then six months later they see me and their mood has dropped. I ask about life, money, relationships and they respond that there are no issues from this point of view. They are still seeing a psychologist. I then ask if they are exercising…...they say no. I ask when they stopped exercising, they say 6 weeks ago. I finally ask when their mood dropped, they say 6 weeks ago. Do you think there is a connection?
Sometimes we treat a mood problem with exercise without even realising there is a mood problem.
2. Cognitive Behavioural Therapy (CBT)
As mentioned above, when presented with a difficult scenario in our life, it can cause changes to our mood. We can become very negative in our mindset and our behaviour and it can be very difficult to change this. Having the support of a psychologist who does CBT can be really beneficial. They will over a few sessions ask you to talk about yourself and your problems such that they can understand your situation. It is important to understand everything about you from childhood issues to current concerns. Once they have a good grasp of you problem, they can then suggest strategies to help you change your pattern of negative thoughts and behaviours and enable you to find a positive solution for your dilemma. Quite literally, they try and rewire your brain to improve your mental health.
Medication has a role in mood problems. It is something that should be discussed in greater detail with your physician. The theory is that there is a chemical imbalance in your brain that is causing your mood problem. By manipulating the chemical we can stabilise your mood. Different pills work in different ways but they take their time to work and they are not a happy pill. You will not wake up and think you feel amazing. More likely, you will be presented with a situation which would normally have caused a problem with your mood and you do not react. That is when there is the realisation that the pill may be working. Many people say they feel numb on the medication: things do not make them sad or anxious but they also do not laugh out loudly any more.
Medications are complex and you need to want to commit to taking them because you will probably need to take them for a while. As with all medications, there are risks of side effects but whether you will get them or not, is impossible to predict.
When you have a disturbance in your mood, these are the three mainstream strategies that can help. Working with your doctor, you can decide what combination of treatments will work for you. I describe them to my patients as the scaffolding that supports your mood. We try and put these structures in place to support your mood. If you did commit to medication, we would hope that if you did want to come off the medication in due course, then the regular exercise and the techniques learnt from the psychologist would support your mood from further disturbance due to problems in your life.
How health technology can help
Sometimes people cannot commit to the mainstream treatment regimes above due to a variety of reasons. This is where technology can be really useful. Healthcare is changing and the way we utilize and access healthcare will be drastically different in a few years time. So where does it fit in with mood problems?
1. We talked about the role of exercise and the need for it to be sustainable. Numerous apps are available to track your sessions, give you goals to meet and make it fun to exercise. They offer social interaction with like minded individuals that can act as a support group to motivate you to keep going when you really cannot be bothered. Wearable technology can now train you within your chosen activity much like a personal coach. All of this helps support your physical and mental wellbeing.
2. Accessing healthcare is a major problem to many people. We work long hours and find it hard to see a physician or psychologist. It is, however, now possible to see a health professional online at a time and place that is convenient to you. I have patients who are based in Australia and seeing a psychologist in the USA. Whilst this is an extreme example, online health professionals are available relatively locally. I do not believe that online consultations will take over how we access healthcare but for a particular illness or problem, it will be part of the journey. What we will find for example, is that you may see a psychologist face to face a couple of times and then online a few more times before being seen face to face once the problem is nearing resolution.
3. CBT strategies used by psychologists are available online to read through if you have the time to do so. The techniques can be learnt and applied to deal with ongoing issues. Whilst CBT is best done with the supervision of a health professional, these resources can help reinforce what the psychologist may be telling you.
4. There is much to be said about the eastern arts: Yoga, Tai Chi and Meditation. Breathing techniques form a large part of these arts and these help with mental focus and relaxation. Mainstream medicine is now aware of the benefits of these practices. Yoga, Tai Chi and meditation apps are aplenty on the internet as are online classes that can be accessed at any time of the day.
5. Finally Mindfulness is a concept gaining momentum in medical circles. The concept is that if you live in the past, you can become low in mood. If you live in the future, you can become anxious, so it teaches you to live in the present, using meditation techniques. In the UK my nephew is being taught it at school as a means to prepare him for the stresses in life. Once again apps are plentiful and it enables you to access support where and when you need it.
Hopefully now you will have an understanding of the strategies available to you to help you if you are having a hard time in life. I like to think I practice what I preach and in my time of current stress I have been exercising, performing yoga and meditating to help my situation. Sometimes I really do not feel like doing anything, especially after a 70 hour working week, but as I say to my patients when motivation is a problem, “exercise is the pill that I prescribe to you”. I treat it like a medicine until I get that sense of feeling physically and mentally good, such that I start to look forward to my next training session.
I have been running using a run tracking app that gives me goals to target. In addition I have been using a wearable product that acts as a personal coach to spur me to train harder. I have been accessing online yoga classes and using a meditation app to help with relaxation. At present this regime is helping me support my well being, on top of the daily challenges of life. Being a doctor gives me insight into what my mainstream or health technology options are, should things become harder. Hopefully now, with the help of your own physician, you will know your options too.
Disclaimer: This text does not serve as medical advice and before any health regime is commenced, seek advice from your doctor.
Blog post written by Dr Khurram Akhter.
Khurram is an experienced primary care physician and a thought leader
in the field of digital health.
Disclaimer: This text does not serve as medical advice and if you have any questions, seek advice from your doctor.