When is it time to visit a mental health professional and get support?
People have been dealing with mental health challenges since long before the pandemic, but the moment we got locked inside our homes the numbers started to rise drastically.
Now more than ever it’s important we acknowledge the need for help and take better care of your mental health.
I had the pleasure of chatting about mental health with Dr. Hengameh Mahgerefteh, a licensed Clinical Psychologist, and the creator of Vitamood, a supplement designed to improve low mood and help maintain a positive mindset. Dr. Hengameh – or Dr. H, as she is called- has made it her mission to bridge the gap between mental health and nutrition while bringing greater awareness to mental health issues in the general population.
Check out our full conversation!
TALKING ABOUT ANXIETY: DR. H SHARES THE TREND SHE’S NOTICED IN RELATION TO MENTAL HEALTH CONCERNS EVER SINCE COVID STARTED
Dr. Adrienne
So you are in the trenches, seeing patients and educating trainees. So first off, I just want you to share with us, what are you seeing these days? What are you seeing in your clinical practice?
Dr. Hengameh
Sure. So, a lot of what we’re seeing is an increase in anxiety and depression, with anxiety, specifically. An increase in health anxiety is something that I’ve personally noticed and an increase in anxiety around socializing; socializing with peers, and friends, going on dates, and not really knowing how to approach people. That’s definitely something that I’ve seen an increase in, ever since the COVID era started.
Dr. Adrienne
Yeah, that’s definitely specific to this era, so to speak. And so, how is that kind of presenting? Do people just report that they’re having more anxiety? Are they coming in with symptoms that are attributed to the anxiety, that they’re not quite sure where they’re coming from? How’s that being seen?
Dr. Hengameh
It depends on the patient. Sometimes, people come in and they know exactly what’s going on for them. Other times, they experience a couple of symptoms, or maybe a friend or family member encourages them to come in and see a therapist or a psychologist. But mostly, when someone comes in, we assess. We assess for anxiety, we assess for depression, and we assess for other mental health disorders, and diagnoses, to really see what’s going on. I feel like, sometimes, what happens is they’ll come in and they’ll tell us a little bit about what’s going on, but then we dig deeper to understand what’s the root issue.
WITH A NAME OR WITHOUT: WHAT ARE SOME OF ANXIETY’S SYMPTOMS THAT PEOPLE CAN TAKE NOTE OF? WHY SHOULDN’T WE PUSH OFF THERAPY?
Dr. Adrienne
I think people know the feeling of anxiety or the sense of anxiety in their minds, but what are some of the physical symptoms that people kind of come in with that they may not attribute to their anxiety?
Dr. Hengameh
Definitely. So rapid heart rate, sweating, sweaty palms, tense muscles, difficulty in breathing, and not being able to catch the breath. A lot of symptoms are actually associated with panic disorder; I noticed. And in addition, which is not physical but more of a psychological piece, there’s a lot of rumination, a lot of focusing and obsessing about different things related to health, related to life. But definitely, with the physical, it’s a lot of the heart rate, the breathing, the sweating. Maybe even tightness in the stomach, feeling of nausea, feeling faint. Sometimes, when it’s even severe, people have an out-of-body experience. It really depends.
Dr. Adrienne
I think rumination is such an important point to hone in on, because I think that is like a very human experience, revisiting, reliving, but definitely, that’s a symptom that has been escalated. And so there’s like this range of the types of symptoms that people can have, and I would say that a lot of people maybe don’t present to therapy because they feel like they’re ruminating or they’re having mild symptoms but it doesn’t warrant therapy or it’s not bad enough, which I think is turning to their detriment. Can you speak to that a little bit?
Dr. Hengameh
Absolutely. I do think it’s to their detriment. I think, the more you wait and push off therapy, the more severe your symptoms can become and the more difficult they are to treat. So as soon as you notice something going on, I think that it’s great to actually touch base with a therapist or psychologist, so you can nip it in the bud earlier. Get some coping tools to use, some strategies, explore what’s going on, why the rumination is happening, and how you can really address it. If you don’t address it right away, it can escalate and get out of control, and then some of the rumination can actually cause the physical symptoms that we were talking about and just increase the whole experience that they’re having.
Dr. Adrienne
Yeah. So the point being is that you don’t have to feel like it’s really pathologic or even has a pathology, like a diagnosis or a name to it. You must be feeling kind of out of sorts, and know that that’s so normal, not only for the pandemic time, which I think we’ve spent a lot of time talking about, but this kind of post, I don’t know if that’s really posted, but this kind of languishing time period where a lot of those things are still present. People need to know that that’s okay. The expectation is not that we’re done with this, nor are we done with the psychological difficulty that came with it.
Dr. Hengameh
Right. I agree with you 100%. You don’t have to have any psychological difficulty to take care of your mental health, to participate in therapy, whether it’s individual therapy, group therapy, couples, or family. Whatever it is. Just wanting personal growth, wanting change, maybe a better lifestyle to be focused on wellness, that’s all you really need in order to engage in therapy. You don’t have to have symptoms. You don’t have to have a diagnosis. So I recommend it for anybody, honestly.
Dr. Adrienne
It’s kind of a luxury, right?
Dr. Hengameh
Yeah.
TRY THESE: DR. H DISCUSSES WHAT COPING PRACTICES ONE COULD USE TO DEAL WITH VARIOUS FORMS OF ANXIETY, OF RUMINATION
Dr. Adrienne
And so, you mentioned earlier coping tools. So what are some of the tools that you would recommend, specifically for anxious-type symptoms?
Dr. Hengameh
Sure. So depending on what the anxiety is about, frequency, the intensity, it’s going to vary. But a lot of mindfulness exercises, and deep breathing exercises are really good. Teaching patients to differentiate between breathing in the chest and breathing from the diaphragm is really helpful. A lot of mindfulness exercises, deep breathing exercises, specifically diaphragmatic breathing. Differentiating between the breathing of the chest and the breathing through the diaphragm which is really the way to become relaxed. Mindfulness throughout the day, whether it’s mindful eating, checking in with your senses, or relaxing your body. Progressive muscle relaxation is also very helpful.
For the rumination, we teach techniques such as thought stopping. I use a lot of CBT at my private practice. That’s cognitive behavioral therapy. We work with thoughts, feelings, and actions and how they interrelate with each other. So we actually tackle the negative thinking patterns and the rumination and get them to decrease and become more healthy rational thoughts, instead of anxiety-provoking, irrational, fear-based, future thoughts.
Dr. Adrienne
Lately, there’s been so much more conversation about mindfulness, breathing exercises, and breathing activities. It’s something that even five years ago, we weren’t talking about so much. 10 years ago, certainly, we weren’t talking about it.
Dr. Hengameh
Right.
Dr. Adrienne
And they really are so powerful, right? But I also think that even though people know and they hear about it, they have a hard time doing it in the moment or latching on to it.
Dr. Hengameh
Right.
Dr. Adrienne
So how do you recommend it for someone who kind of knows they’ve heard it but hasn’t really initiated a practice? What would you recommend on how to get themselves started in the mindset of doing these things more often?
Dr. Hengameh
Sure. I think if you are in therapy, starting out with your therapist in the sessions is a really good way, and then you can generalize to your life when you go home, throughout your week. But the most important thing to know is to take small goals, like baby steps, that you can tackle easily.
Something that I noticed is people will come in and they say, “Oh, I want to meditate for an hour tomorrow.” And we’re like, “Okay, let’s backtrack. How about two minutes or five minutes? Something that’s doable, a goal that’s attainable, and you’ll feel positive reinforcement; you’ll feel better about yourself because you’re able to do it. So keeping the goals small and attainable and realistic, I think, is the most important thing.
Dr. Adrienne
Yeah, that’s such a good point. Bite-size, like we like to say.
Dr. Hengameh
Bite-size, yeah. Like a health bite!
RECOGNIZE, CONTROL, AND REPLACE: WHAT IS THE EXERCISE CALLED “THOUGHT STOPPING” ALL ABOUT?
Dr. Adrienne
So there was one tool, though, that you mentioned that I hadn’t heard about. Think stopping?
Dr. Hengameh
Thought stopping.
Dr. Adrienne
Thought stopping.
Dr. Hengameh
Right.
Dr. Adrienne
Talk about that. What is that exactly?
Dr. Hengameh
Sure. There are different ways that you can engage in thought-stopping. Sometimes people find it helpful to have a physical sensation. I don’t know if you’ve ever seen people with a rubber band and they’ll snap it to get themselves to stop thinking.
Dr. Adrienne
I see.
Dr. Hengameh
You can use a physical sensation. You can use visualization. If you notice yourself thinking in the pattern that you’re trying to avoid, maybe visualize a red stop sign and get yourself to backtrack a little bit. You can think about alternative thoughts. That’s more in line with the CBT, where your therapist or psychologist will teach you what alternative thoughts to think about and replace. So the first step is to be able to recognize the thoughts, then to be able to stop and control them, then you’re going to be able to change them into healthier thoughts.
Dr. Adrienne
Yeah. And I was going to say that awareness is the cornerstone, right? And how often do people start ruminating or start having negative thought processes that they’re not even attuned to because it’s so much a part of their norm? It just becomes routine. And it’s routine for all of us to engage in negative thoughts. But being able to train yourself to just notice that moment where it begins or where you’re engaged in it. But noticing it is the first step to being able to have agency around it.
Dr. Hengameh
Absolutely. And what I noticed in my private practice with my trainees that see patients as well is you’ll have some individuals that have been in therapy before and they’re a little bit savvier in terms of picking up what thoughts they’re having, the intensity, the frequency of the rumination, so they come in knowing. But then you’ll get individuals that have never experienced that before. And so for them, like you’re saying, it’s a part of their life. They don’t even really realize what they’re engaging in. So then it becomes our job as psychologists or therapists to help them identify, to help them gain insight into what’s going on for them.
AT-RISK OR NOT: SIGNS THAT YOUR SYMPTOMS OF DEPRESSION ARE GETTING SERIOUS AND NEEDED TO BE ADDRESSED IMMEDIATELY
Dr. Adrienne
I like that we started with anxiety because again, it’s so relevant right now. Your clinical experience is showing that that’s one of the main things that people are coming in with. But obviously, it’s top of mind, I think, for a lot of people. And probably, second to that is depression; an increase in depression.
Dr. Hengameh
Right.
Dr. Adrienne
And this, of course, is not stand to replace any medical or psychological treatment or advice, but where would you say, for people with depression, where they may need to look for help sooner rather than later? What are some of the signs? Because again, depression is one of those things that we use colloquially; you know, being depressed. But when is it something that they need to be attuned to as more of a risk factor?
Dr. Hengameh
Right. How do you know when to come in? How do you know when you need help?
Dr. Adrienne
Yeah.
Dr. Hengameh
I think some things to look to are your mood. So, a decrease in your mood, how sad you feel. Feeling a general sense of sadness, feeling down, not feeling happy. But people feel that, right? It’s normal to have a range of emotions, and they change from day-to-day.
Dr. Adrienne
Minute to minute. Second to second.
Dr. Hengameh
Right. Minute to minute. Second to second. But is this going on for a week? Is it every day, that you’re feeling this way? Is it to the point where you don’t want to really get out of bed? You don’t have the energy to execute the things that you had planned for yourself throughout the day. You lose interest in things that used to excite you. So for example, if you really enjoyed going to your exercise class and you’re feeling so depressed that you just don’t want to go or you don’t want to go out with your friends for coffee to socialize. Really losing interest, losing pleasure in things that you once found pleasurable, and then also the change in the mood.
Some other things to look out for are changes in sleep. So either an increase or a decrease in the quality and quantity of sleep. And then also with eating as well; your appetite changes.
I think those are the four of the biggest things to look for. Of course, when depression is very severe, you might even have suicidal thoughts, or ideations. And I definitely recommend for someone to get help immediately if they’re experiencing those.
Dr. Adrienne
That’s where we crossed to an emergency.
Dr. Hengameh
Right. An emergency. Exactly.
Dr. Adrienne
But to your point, a lot of these symptoms are feeling gloomy, feeling sad, and not having interests – these things may arise from time to time. But it’s the persistence of symptoms once they interfere or the degree to which they interfere with your quality of life, as well as disengagement, like not wanting to engage in people or things that you used to take joy in.
Dr. Hengameh
Right. Exactly. And what you really see is when individuals have these symptoms, it will start affecting their work life. It’ll start affecting their family life, their social life. So it’s really, really important to get the help so it doesn’t start to affect your whole life.
SUBSTANCE USE AND ABUSE, AND ALCOHOL: “IN ORDER TO TREAT SOMETHING LIKE SUBSTANCE USE, YOU REALLY HAVE TO UNDERSTAND WHY IT’S HAPPENING.”
Dr. Adrienne
What can you say about substance use or substance abuse? Because definitely, there’s data and also just anecdotal experience that that’s on the rise. What are you seeing there?
Dr. Hengameh
Since we were talking about the COVID era, as well, there’s definitely an increase in substance use during COVID. And I don’t know if it’s ended or not, but still, it’s going on. I feel like people have used substances as a way to cope with the isolation that we’ve all experienced, to cope with the anxiety, and to cope with the depression. And I think that it exacerbates other things that might be going on. And really, when you start with substance use and it starts to take hold of you, it’s kind of difficult to let go. So definitely, that’s something of concern as well.
Dr. Adrienne
And I think another barrier, and we talked about this a few episodes ago; I talked about alcohol use and the effects of alcohol, the sedating effects, as well as the stimulating or anxiety-provoking effects. But I think one of the impediments in our society is the way we think about alcohol. There’s this like dichotomy in terms of people who are like sophisticated drinkers who can handle their alcohol versus people who are alcoholics, who are drinking scotch for breakfast, and really, the majority of people are somewhere in between. And so, it’s really encouraging people to look at their use without labeling; taking all the labels away. We don’t need to have a label of alcoholic or what have you in order to just be curious about how we’re using substances.
Dr. Hengameh
Right. And I think curiosity is really key. When we look at substance use, we want to understand why it’s happening. So is it happening to cope with the anxiety? Is it happening to cope with depression? Is it happening to cope with isolation? Or are you out having a social drink with a friend? Those are two very different scenarios. And so in order to treat something like substance use, you really have to understand why is it happening? How often is it happening? How is it affecting your quality of life? Is it turning into a full-blown addiction? Even binge drinking.
Dr. Adrienne
Right.
Dr. Hengamhe
You’re not waking up every morning drinking alcohol or engaging in substance use, right? But when you do go out or when you’re at home and you start drinking, you don’t really stop. You go until you kind of blackout.
So that’s also of concern. And that’s something that I’ve been seeing too.
Dr. Adrienne
So, the degree to it. But also, what I’m hearing you say is the intention, which I think is one thing that has changed, because it was initially maybe socialization or like zoom happy hour, right? But then it increasingly became kind of “taking the edge off”. And the degree to which that’s required to “take the edge off” determines the kind of the intention, which in essence is removing the anxiety or the depression, taking away negative emotions, in essence.
Dr. Hengameh
Absolutely. And that becomes more difficult to treat when you get to that point, having a dual diagnosis, because you have to then treat the substance use and then the underlying depression, anxiety; whatever it might be that you’re experiencing.
WAIT, THERE’S MORE: DR. H TALKS ABOUT SOCIAL ANXIETY AND EATING DISORDERS AS SHE AND DR. ADRIENNE REMIND US THAT WE’RE NOT ALONE
Dr. Adrienne
Is there anything outside of these kinds of common scenarios – anxiety, depression, substance use: these are like the common ones – that you’ve seen an uptick in that you think people should be aware of in terms of mental health diagnoses?
Dr. Hengameh
That’s a good question. I know we talked about anxiety in general, but I’ve seen a lot of social anxiety as well, which is its own kind of category. So not feeling confident engaging with others, lack of eye contact, feeling really nervous going out in public. And I think there are two issues going on here. I think people have kind of forgotten how to practice being social with others, but I think there’s another issue where people are worried about the health portion, of what can happen to my health if I interact with another human being.
Dr. Adrienne
Which just validates the experience as in some degree warranted, or at least it was, and we’re still being told to exercise caution, of course. And so again, just normalizing it, right? But to say that you’re not alone in having these symptoms, it’s warranted in terms of how it came to be. But if again, it is interfering with the quality of life, interfering in day-to-day affairs to a significant degree that it needs to be addressed.
Dr. Hengameh
Absolutely.
You asked me about what other symptoms and disorders I’ve seen an uptick in. In addition to substance use, eating disorders, because that’s another way of coping, where people cope with their difficulties through eating. So it can become comfort eating, start out as soothing, and then it can quickly turn into binge eating. So that’s also something that I’ve seen.
Dr. Adrienne
And also restrictive eating, right? We’ve so much about weight gain during the pandemic, but I think people don’t realize that overly restrictive dietary patterns are also a way of exercising control over uncertain situations.
Dr. Hengameh
Absolutely.
BIRTH OF VITAMOOD: DR. H’S INTEREST IN THE RELATIONSHIP OF FOOD AND MOOD THAT FUELED HER TO START RESEARCHING ABOUT SUPPLEMENTS
Dr. Adrienne
So, I like the strategies you talked about. Of course, not to replace therapy when needed, or more acute interventions when needed, but I also know that you’re very passionate about dietary and food strategies. We had a whole episode where we talked about food and mood as well. But tell me a little bit about what brought your interest or piqued your interest in food and mood. Was there personal experiences, patient experiences, or data that you think was really telling for you?
Dr. Hengameh
A little bit of each one, actually. So, it all started with personal experiences. Working one on one with patients, I noticed that sometimes, people needed a little bit of extra boost or extra help when they were in therapy. So they were engaging in therapy, they were doing everything that they could, and they just need a little bit more support. So I started to look into different herbal remedies and actually remembered my childhood.
So, I am Middle Eastern. I grew up with a lot of saffron in my house, and I remember loving saffron chicken when I was very young. I remember my grandma would always tell me to take it easy, take it easy on the saffron rice, take it easy on the saffron chicken, and I didn’t understand why she would tell me that. I asked her one day, and she told me, “Well, you’re gonna laugh a lot.” And I was like, what is she talking about? How is this gonna make me laugh, right? I’m like, what is she talking about? I have no idea. Is she joking? Is she being serious? And she told me, “No. Saffron makes you happy. It makes you laugh.” So that was when I was about eight years old.
Fast forward, here I am in mental health. And honestly, I did the research, and it’s true. Saffron makes you happy. So I utilize that in my product.
Dr. Adrienne
It’s really interesting, the data around saffron, that actually be Prozac in terms of antidepressant efficacy.
Dr. Hengameh
Absolutely. And all of the research that I did, looking at all of the journals, the articles, the clinical studies, and trials, that it’s just as effective as antidepressants, without the symptoms that people experience.
So what I saw was that you need about 30 milligrams a day in order to achieve that effect, and that’s what I put in my product.
Dr. Adrienne
So you actually have Vitamood as your company and you’ve actually created a supplement out of saffron.
Dr. Hengameh
Yes. And not only does it have saffron. I also added good boosting ingredients like vitamin D, B6, B12, zinc, magnesium, and folate, so they really compliment each other and help to boost your mood, and it’s just a natural way to achieve that effect.
Dr. Adrienne
Yeah, that’s wonderful.
So in terms of dietary strategies, because B vitamins that you mentioned, including folate, are very much predominant in leafy green vegetables, right? So what kind of strategies, or do you recommend food strategies to patients as well, in addition to supplementation?
Dr. Hengameh
I have not personally recommended food strategies. I think that’s your expertise. Just what I’ve been researching is the supplements, really. The herbs, the vitamins, and the blends that people can utilize.
And of course, there are some individuals that need to see a psychiatrist and take the medication that they’re prescribed. But then, there are some that just might need a supplement or something more naturalistic that might be able to help them. So I was really focused on those individuals. I really wanted to help that specific population that was looking for something extra, to give them a little bit of oomph, a little bit of a boost, a little bit of something to add as an adjunct to the therapy.
Dr. Adrienne
Yeah. So maybe just talk therapy or some of these strategies were not completely helpful or there was still a gap, but not quite yet where pharmacotherapy or medications were necessarily indicated.
Dr. Hengameh
Exactly.
BASED ON RESEARCH: SAFFRON AS AN HERBAL ALTERNATIVE FOR ANTIDEPRESSANTS
Dr. Adrienne
So B vitamins, vitamin D, saffron. Is there any interesting research? Other research that you saw in your own personal research of these vitamins and minerals that you think would be interesting for our listeners.
Dr. Hengameh
Honestly, the saffron was the most interesting to me. I had no idea that you can compare it to an antidepressant. That’s pretty strong, for an herbal remedy to be able to utilize it and have the same effects that you would with an antidepressant. I mean, that blew me away, to realize.
Dr. Adrienne
Yeah, that’s pretty powerful.
Dr. Hengameh
Yeah.
Dr. Adrienne
Well, this has been really helpful. I appreciate you being here. And I think the takeaway message that I have in mind or I’m thinking of is really, number one, normalizing the symptoms and normalizing the experience. Anxiety is something that we already had a pretty high baseline of before the pandemic, but really exacerbated during the pandemic for obvious reasons, and that hasn’t necessarily gone away. So, encouraging people to seek out help for that.
Dr. Hengameh
Absolutely.
Dr. Adrienne
And to be mindful that there are other mental health concerns, such as substance abuse or eating disorders, and they may not present in the classic ways that we think about.
Dr. Hengameh
Absolutely.
H’S FINAL THOUGHT: “GO TO THERAPY. TALK TO SOMEONE. GET THE HELP THAT YOU NEED OR WANT.”
Dr. Adrienne
And so, what would be your final thoughts? Is there anything that you would like for us to take away from your experiences?
Dr. Hengameh
My final thoughts would be to go to therapy, talk to someone, and get the help that you need or want. Again, as we were discussing, you don’t have to have a diagnosis to go to therapy. You don’t have to have a symptom to go to therapy. Just wanting to improve your quality of life is enough. So, I would really say that therapy is for everyone, and to encourage individuals to seek out support, whether it’s group therapy, individual therapy, or whatever type of therapy it is.
Dr. Adrienne
Yeah. That’s definitely something that everyone would use an extra dose of these days.
Dr. Hengameh
Right. Absolutely. Even going out and talking with friends. Having a trusted friend, a trusted other. That’s helpful too. Obviously, they’re not a professional, but having someone there to support you through difficult times, times of stress, through happy times. We need people to lean on. We’re social people. We’re social beings, so that’s really important.
Dr. Adrienne
So if people want to learn more about Vitamood, where can they learn more?
Dr. Hengameh
So our website is www.vitamood.co. We also have an Instagram.
Dr. Adrienne
We’d love to take a look. The audio podcast people won’t be able to see it, but it will be on YouTube.
Dr. Hengameh
Sure. Vitamood is our company and Mood Boost is the product, and it’s designed to support a positive mood and mindset.
You were asking me also about other research that I’ve done to put this together. Something really interesting that I came across, and you probably know about this Dr. Adrienne, with the B6 and the folate and the magnesium – a lot of times deficiencies cause imbalances.
Dr. Adrienne
Right.
Dr. Hengameh
So that’s why I chose to include those.
Dr. Adrienne
And the good news is that the B vitamins are water-soluble so you can’t really overdose on them. So it’s something you could easily incorporate without any concern.
Dr. Hengameh
Right.
Dr. Adrienne
That’s amazing. Well, we will definitely link the website as well as in the show notes. And I really appreciate you taking your time. Dr. H is super duper pregnant right now, and she availed herself to us despite all her responsibilities, so thank you for doing that.
Dr. Hengameh
Thanks for having me. It was such a pleasure. It’s so lovely being a part of your podcast. And I hope your viewers enjoyed all of the information.
Dr. Adrienne
It was great information. Thank you.
Dr. Hengameh
Thank you.
