56 - The Basics on Mood & Anxiety Disorders with Dr. Howard Weeks

Transcript

Ellie Pike:
If you know our show, you're familiar with the typical episode format. Someone's personal story sprinkled with bits of technical or medical insight. I love those stories. They help ground abstract or even frightening diagnoses in relatable human experiences. But sometimes, we just need to nerd out on some of the basics of mental health. Y'all have questions that need answering, and today's the day to tackle them. Specifically, we're going to focus on common questions from listeners and patients about mood and anxiety disorders. I'm really excited about this discussion for two reasons. First, it's fascinating materia. Second, while it is fascinating. Researching all of this by yourself can be daunting. So think of this as a little one stop shop overview of the basics. We'll start with anxiety, then move on to mood disorders. And finally, end on questions about treatment and treatment methods. Sound good? Dr. Howard Weeks will be our gracious question answerer. He is the chief medical officer at Pathlight Mood & Anxiety Center. Most importantly, he has a special way of communicating complex information that brings clarity rather than getting. lost in the weeds. Finally, this episode is a little longer than our typical show, but fear not. It's no snooze fest. For those of you more interested in one topic over the other, we've included timestamps for different subjects in our show notes. You're listening to Mental Note podcast, I'm Ellie Pike. Meet Dr. Weeks.

Dr. Howard Weeks:
I'm Dr. Howard Weeks. I'm a child and adolescent psychiatrist and adult psychiatrist and pediatrician. I'm the chief medical officer of Pathlight Mood & Anxiety Centers.

Ellie Pike:
I'm so grateful to have you. I think that you can help answer a lot of questions that our listeners have. So I'm just going to go ahead and jump right in and talk about anxiety. So what is anxiety in itself?

Dr. Howard Weeks:
Yeah, anxiety is that emotional state that is very normal, right? It's what we all experience at different times in our life, in stressful events. That could be anticipation of having to give a talk or going to a party and seeing a whole group of new people that you don't know. And anxiety is a way for our body to tell us to be on alert. It's designed evolutionarily back when we were worried about getting eaten by lions, tigers and bears. So it was a way to help be aware of potential danger. In our society where we see anxiety more is kind of social situations, work situations, performance situations. And while anxiety is normal to have, there are certainly times when people have, what we call anxiety disorders. Where basically that emotional floodgate gets out of whack and it gets out of overwhelming for the person so that their anxiety states impeding their ability to actually function.

Ellie Pike:
So if I were to try to rephrase what you just said, anxiety's normal. It's actually a signal to us. It can actually help us in many situations. It could tell us that something's wrong or that we need to be on heightened awareness. So if it was on a scale of say one to 10, maybe a three or fours, if I were taking an exam or giving a presentation. But maybe if it got closer to nine or 10, it could actually provide a reason for me to get help.

Dr. Howard Weeks:
Right. Like so knowing that you and I were going to be talking today, I had more anxiety this morning because I wanted to make sure my computer was working, my headphones and microphone were working. And so I would say I was probably around a three or four before we got started. Now, if my anxiety had gotten up to a nine or a 10, then maybe that would even impair my ability to get my microphone ready or get my computer turned on. So I wouldn't really be able to function and even start to have a conversation with you. So those higher levels are what causes us problems in being able to function and do our routines.

Ellie Pike:
So when you talk about those higher levels, what are some of the symptoms to look for?

Dr. Howard Weeks:
Yeah. So some of the classic symptoms of anxiety are like a beating heart rate, so an increased heart rate, you feel like your heart is thumping out of your chest. Some people can start to sweat, you can get dizzy. People even have decreased vision as their anxiety levels rise. Because you start to have a lot of hormonal release, which then affects how your heart rate's going up, it affects how your stomach feels. Some people will get stomach aches, you can get tingling, weird sensations or what we call depersonalization where you start to feel kind of like out of body experience. And it's all kind of being spun up by the anxiety. But the classic I would say is breathing fast, heart rate and sweating.

Ellie Pike:
Which we all know feels really uncomfortable. And I think a lot of people can identify with that, but they might not always label it as anxiety. For example, I remember when I was in high school and I started to have a lot of those symptoms, I thought I had asthma. And I went and talked to my mom, she took me to the doctor. Unfortunately, they just did a breathing test, told me you're probably pretty good go home. But I didn't have the language for what anxiety could be like. So this is helpful to pay attention to those physical symptoms. So when we talk about anxiety, can you explain some of the types of anxiety that might be out there when it comes to actual diagnoses?

Dr. Howard Weeks:
Right. So anxiety is a symptom, it's not diagnostic. And what you can see from a medical standpoint, when we think about it in psychiatry. When people have certain types of anxiety that cause them distress, we clump them together into different categories. So kind of the classic would be what we call generalized anxiety disorder. And that's going to be someone that has this flooding of anxiety for a lot of different things. So they're worried about social situations, they're worried about fears that disasters or bad things at work are going to happen to them and it's kind of a constant, multiple triggers can set off that anxiety. Whereas, you think about specific phobias. It may be that I have severe anxiety around heights. I personally don't like heights. I don't have a true phobia, but I do get very uncomfortable around heights.

But when you have that phobia, it can get to the point that's very impairing. So some people can't even ride elevators up into buildings because the fear of Heights is so strong. And so that would be an example of a specific phobia. So it's not generalized, it's not anxiety in lots of other areas, but it's very focused. We also think about obsessive compulsive disorder, which is an anxiety disorder spectrum. And now that takes a little bit of a... It's a mechanistically different. It's not so much that I'm worried about external events. With OCD, you get this combination of this anxiety and fear response but then you have these compulsions typically of rituals that you have to either physically do or mentally do to help relieve that anxiety. And so this is where people get into checking behaviors, like having to open and close locks or open and close drawers, or go back and check things multiple times because it's what's decreasing that kind of overwhelming anxiety that's popping up.

And then the last, what would traditionally be called an anxiety kind of spectrum disorder, would be like post traumatic stress disorder or PTSD. And that comes on after a traumatic event. The classic was when PTSD was first recognized was during wars from the exposure to battlefield events. But now what we know is any traumatic event. So car wrecks, physical attacks, assaults. Even sometimes emotional and verbal can trigger a PTSD reaction where basically your body becomes heightened and triggered from this one event that then can start to spill over to similar events that occur. And when someone is in the midst of having that trigger go off, they have a lot of those kind of overwhelming symptoms of anxiety. Increased heart rate, difficulty breathing, their mood can get very volatile. And the cause of it's being triggered from that traumatic stressful event, as opposed to just a generalized worry or a specific phobia. So those are the classic kind of four psychiatric diagnoses that fall in that anxiety spectrum.

Ellie Pike:
And one thing we haven't talked about is panic attacks. Would you like to speak to that at all?

Dr. Howard Weeks:
Yeah. So panic attacks are kind of like a subset of anxiety and that's that intense moment where that anxiety gets very overwhelming and it can be very debilitating. They typically are very short, five to 10 minutes in length, but that for the person experiencing those panic attacks, it can feel like it's going to last forever and it's never going to end. They often have a sense of impending doom or even death. Like they feel like they're going to die because their heart rate's going up so fast, they're having difficulty breathing and their brain is in effect so overwhelmed with the anxiety. And people can have panic attacks with all these other diagnoses. So it's kind of like a comorbid event that occurs that can then cause kind of even worsening of their underlying anxiety disorder, because then you get this fear of having that panic attack coming up.

Ellie Pike:
Great. Thank you so much for the description and for those who are suffering with any of those diagnoses, it can feel really challenging to do the day to day life. And some people may not even have that diagnosis. So where should someone dealing with anxiety go for help?

Dr. Howard Weeks:
You know that's a really good question. And I think we need to recognize that it's a spectrum of symptoms. And you know, the most important thing is recognizing if you're having anxiety or what you believe is anxiety is talking to someone about it can be helpful. Certainly talking to friends and family, but you may, for some people they need to see a professional. So that could be a therapist, could be a psychiatrist, their primary care provider to initially have some conversations to say, this is what's going on and trying to help sort out, do they need kind of higher level treatment? Like do they need therapy? Do they need medications? Do they need to be enrolled in a program to kind of help? And that all depends on the severity of the symptoms and the level of impairment that the person's having.

Ellie Pike:
And what treatment options are available?

Dr. Howard Weeks:
There's a whole lot of treatment options, which is actually something that's really nice because anxiety is very treatable and kind of the classic approach to thinking about anxiety from a treatment standpoint would be therapy, meditation. You know, techniques. So you use therapy to help learn different techniques that can help self sooth and help recenter and calm someone down. So you can get through that kind of flood of catecholamine that get released in your brain when you have anxiety and that's what's causing your heart rate and your breathing to go up.

There are some patients that even with that frontline of therapy and meditation may need to consider things like medications. I don't typically jump straight to medications for patients because oftentimes kind of the non-pharmacologic approaches can be extremely effective and are less invasive and have less side effects. For some patients that have tried therapies and medications, they may need even more formalized treatment such as groups or specific types of therapies. Like for OCD we think about exposure response prevention to really help them get over the specific compulsion or specific phobia. And that's going to require a lot more intensive work with a therapist, for instance.

Ellie Pike:
So folks could find an outpatient provider that they might see weekly and they may seek someone out if medication is needed. But then if those interventions aren't working, it sounds like more intensive treatment could be considered.

Dr. Howard Weeks:
Certainly. We always want to treat people in the least restrictive environment possible because it's a time investment as well as sometimes a monetary investment. And we want to try to get people, use the techniques and the treatment options that's going to meet them where they're at to get them back on their feet as quickly as we can.

Ellie Pike:
And I know that question out there is this really treatable? Is full recovery actually possible from anxiety?

Dr. Howard Weeks:
The, the good news is yes, the vast majority of patients with treatment will improve. There are certainly some patients that have very severe anxiety that are going to struggle and need more intensive care. But even those patients tend to have dramatic improvements. You may not always completely resolve the anxiety, but you can get it to a manageable level so that you're able to function in your life and lead a happy, healthy life.

Ellie Pike:
I really like how Dr. Weeks emphasize the power of behavioral changes when treating anxiety disorders. In fact, there's no better way to tend to your mental health than by practicing some wellbeing basics. Here are doctor Weeks's top five recommendations. One, every day take a little time away from your stimulating devices like TVs, phones, and computers. Two, get enough sleep on a regular basis. Three, move your body mindfully to ease pent up stress. Four, observe your caffeine consumption. Is it making you more anxious or getting in the way of rest? Five, alcohol and other substances are unhelpful ways to self medicate. Their short term relief quickly wears off and your brain is then more likely to experience depression and anxiety. Okay, have you had your fill on anxiety talk? It's time to turn our attention to questions about mood disorders. What are mood disorders?

Dr. Howard Weeks:
Sure. So mood disorders are kind of classically what we talk about when we think about depression or bipolar disorder. So depression is that state where people become sad. Sad is a normal human, physical emotion. Depression is not normal. Depression is constant, its severe sadness. It kind of takes sadness from a normal level of one or two and moves it up to a hundred. That's what we would call melancholy. It's just that very, very severe negative feelings. And depression is more than just a feeling. It has significant effects on your body, can have cardiovascular effects, can have weight effects. And it also has cognitive effects. When people are severely depressed, they cognitively aren't functioning as well. So they don't think as clearly as they normally do. And in fact, when people get severely depressed, you can actually become psychotic where you start to hallucinate, either have visual or auditory hallucinations.

You can have disordered thinking and delusions. And also when people come severely depressed, they also can become suicidal and have thoughts about wanting to hurt or kill themselves. Now the opposite of depression is something we would call mania and mania is this extreme euphoria. And you would think that sounds good. You know, feeling good but it's extreme. It's feeling too good. And what happens is people's brains stop working very well. So they think they're doing very well, but in fact, they're really not. They're not making a lot of sense and you have decreased, like for instance, sleep. So you start making poor judgments, you have tons and tons of energy and you start going down paths that in retrospect, like when you're out of the mania, you may look back at that and go, wow, that didn't make a lot of sense. Why was I doing that?

And your mood can become very unstable. People can become very irritable and reactive. And this spectrum is what we call mood disorders. Some people just have depression where they end up on one side. Some people have what we formally call bipolar disorder, and that's where they have episodes of depression, but they also have that interspersed with episodes of mania. And then of course, you can have people in between that have something we call cyclothymia. That's where you kind of go back and forth between elevated mood and depressed mood, but you're not really meeting full depression or full bipolar and you can have some other variations. But it's that spectrum that gets there and what it's having to do with is that mood state that someone's in.

And again, I think the key thing to understand is this is different than the normal emotions that we all feel when something bad happens. Where if I have a loved one die, I'm going to be sad and go through bereavement and that is normal response. Depression doesn't have to be triggered by some bad event. It often happens for no particular reason, but then we tend to link that to things going on in my life and kind of anchor on them. But it wasn't that those things necessarily going in my life really caused the depression. It's a biologic illness that then affects the lens for which I kind of experienced the entire world through.

Ellie Pike:
Can you speak to that a little bit about what you mean when you say it's a biological illness?

Dr. Howard Weeks:
Yeah, I think one of the unfortunate things we've seen in psychiatry and mental health is there has always been this tendency to think about mental illness as being as a character flaw or something that a patient needs to pull themselves up by their bootstraps and just get over it. And that is not the case. We would never say that with someone with asthma or diabetes or cancer or cardiac disease. And we know actually that depression, bipolar, anxiety disorders are real physical disorders with brain changes, chemical changes in your body. And they of course affect how we act.

I think a good example would be someone that has cancer and is on medications, could be severely nauseated and they're not going to feel good. So they may be irritable, they may be short tempered, but that's because of their illness causing that. And we all tend to understand that because it seems like, oh, it's a physical thing that you can see. But you're getting the same response when you're severely depressed. Just like if I was taking a medication for my cancer and I may be irritable, I may not feel like doing things, but that's not a choice because if the biologic changes that are going on in my brain.

Ellie Pike:
You know, I really appreciate how you talked about someone with cancer and you separate the cancer from the person. And I think there's something to that as we talk about depression or bipolar, we can separate the individual from what's happening in their brain.

Dr. Howard Weeks:
Right. Because the classic thing we see in our society will say, oh, that's a depressed patient or that's a patient with schizophrenia though. They're schizophrenic. And we tend to label patients. And really what we need to say is, no, I'm someone that has depression or I'm someone that has bipolar disorder. I am not a bipolar, this is an illness. I don't say I'm someone that's cancer. It's like, oh, I have cancer or I have asthma, but it's not who I am. It's just part of my experience of the world.

Ellie Pike:
I think that mentality of a person centered language can really help the support person, separate their loved one from their disorder and really help see their loved one as the person that they love who's affected by this illness. So thank you for approaching that conversation. And can you speak a little to the genetic aspect of these disorders?

Dr. Howard Weeks:
Yeah. I think one of the important things to understand when we talk about, are these illnesses biologic? The key thing is there's clearly genetic linkages. Now we don't have kind of the classic genetic where there's just one single chromosome that leads to anxiety or leads to depression or bipolar. It seems to be multifactorial. But what we can clearly see is like severe depression or bipolar or anxiety or schizophrenia can run in families. So we know there's genetic components to it. Now we're learning more and more. And as the human genome project has gone on, we're getting gaining huge amounts of insight. Hopefully, one day will be to the point where we're going to be able to use some of that information to help identify patients and better identify treatment options. We are not there yet. So there's not a test that I can take that's going to tell me, even if I'm at risk for psychiatric illness. But I do hope in the future, that's going to give us more insight, which may actually lead to better treatment options for us.

Ellie Pike:
So when should someone seek professional help for a mood disorder?

Dr. Howard Weeks:
Well, again, kind of very similar to what I'd say for anxiety is when their mood disorder is impairing their ability to function and live life to the fullest, I think you need to seek some help. Now, when you say professional help. I think that kind of varies of people certainly have support groups that they may engage with and if they can get good benefit from that, that's fantastic. But again, if they're not continuing to improve, that's when reaching out to a therapist, a primary care provider, or potentially even a mental health provider for evaluation of whether medications are appropriate or not is very reasonable.

Ellie Pike:
And are there any hotlines that could be helpful for those who might be suffering in an emergency situation?

Dr. Howard Weeks:
There is. We certainly have the national suicide hotline that we'll make sure that there's a link to that here. And you know, certainly also your local emergency room is always an option for patients. And what we see, especially with depression is the thing we all worry about is when people get severely depressed, if they become suicidal. And so that becomes kind of an emergency situation. That's a little bit different than for instance, we talk about anxiety and anxiety can feel very overwhelming. But the biggest risk we have for depression is when people become suicidal, they may act on that. And so that's why it's a life threatening emergency and that's why we have a national suicide prevention line. There are a lot of support groups that are out there and we want people to get help so that we can help reduce the risk of them acting on the suicidal impulses.

Ellie Pike:
I like that you highlighted support groups because there's many that are local, but we also Eating Recovery Center and Pathlight Mood and Anxiety Center also offer almost 20 support groups a week that are free for folks and really easy for them just to tap into and hop on one time a week. And that group support can be so essential.

Dr. Howard Weeks:
And I think support groups are a great way to kind of continue that kind of maintenance and kind of like booster for helping someone get back a little bit. But when someone's in an acute crisis, that's when you need to kind of reach out and use like the suicide prevention hotline. Because then we can rally local community resources to really help that patient in that urgent situation.

Ellie Pike:
That's very important. And you know, for many people experiencing that emergency situation or even that ongoing experience of a mood disorder. And let's talk depression, for example, is recovery fully possible from depression?

Dr. Howard Weeks:
Yes, it is. Depression is a very treatable illness. It can be a difficult one to treat, but actually what we're finding is when we talk about statistics, most patients, if they seek treatment will actually improve. The problem we have is some estimates are up to 70% of people, for instance, with depression, don't seek care. And so what that means is they're not getting the benefits of exposures to therapy, to potentially to medications, to support groups. And so they're not showing improvement. So when you look at people that do get treatment, the vast majority actually improve with treatment. But when you look at it from a population base, you go, wow, people aren't getting better with depression. And unfortunately, a lot of that is they're not accessing care because we do have effective treatments for depression. That does not mean someone has to be on a medication.

And sometimes that's what people think about. And admittedly in our society, we do tend to think about, I have an ear infection, I have an ache. I'm going to go to the doctor and I'm going to get a pill. And that can play an important role in mental health, but unfortunately meds by themselves aren't the magic solution. I wish it was, it would make my job so much better. And it is difficult and it can be time intensive for treatments, especially for people with severe mood disorders, but it is imminently treatable.

Ellie Pike:
And can you speak to the recovery journey for someone who has bipolar disorder?

Dr. Howard Weeks:
Yeah, so bipolar disorder in a lot of ways can be a tougher illness to treat than kind of classic depression. And part of that is because a lot of the medications, for instance, that we use for depression can actually trigger a manic episode. You know, the anti-depressants can flip you into mania. So then you have to use a medicine to help control the mania, but how well do those medicines actually help treat the depression? So it can be a little bit of a battle trying to find the right medication combination. And we're always trying to kind of balance side effects and worsening of the illness, be it the mania or the depression with trying to maintain the patient back in that what we call euthymic, that kind of mood stable space that we would normally experience in our life.

Ellie Pike:
So for someone with bipolar disorder, is it always the case that they would need medication?

Dr. Howard Weeks:
I will never say always for anything. But if someone has a true biologic bipolar disorder, they are pretty much, most likely going to need to be on some form of medication. But that is not true for every single patient. And sometimes, in my experience there's people that have, they're kind of on the spectrum of bipolar versus kind of someone with that classic bipolar illness. And patients with severe bipolar are going to need medication support. Patients on the other side may not or find a combination of things or medicines for a period of time and then they're doing well enough that they don't need medications. And they're able to continue for instance, therapy support. There are non-medication treatment options for severe illnesses like severe depression or bipolar disorder or even OCD.

That would be things like transcranial magnetic stimulation or even ECT. Recently, there's been a lot of interest and some good benefit for using a medication called ketamine for depression, but they are all still procedures or interactions with the healthcare system someone needs. And they're not cures. They can again, help someone get over an episode, but that doesn't mean they're never going to have another episode later in life. But we use those for a period of time until the patient's stabilized. And then we stop doing those interventions and they continue in therapy and may continue on some maintenance medications, for instance.

Ellie Pike:
I appreciate you talking about maintenance because long term recovery can really mean seeking ongoing care throughout their lives. Can you speak to what treatment options are available?

Dr. Howard Weeks:
Sure. So when we think of all psychiatric illnesses that we have a spectrum. When someone is in acute danger, like suicidal or psychotic or flawedly manic, that's when we think about like acute inpatient hospitalization. And that's for a relatively short period of time, it's designed to help stabilize someone. I think of that as like the intensive critical care unit when someone's been in a car wreck and they, and they just need that high level of care. And then we would step them down to something called like residential level of care. And that's where they still need a lot of support because they can't function on their own yet. So they need nursing support and therapeutic support. Again, I would think about this as kind of like rehab for someone that's had been in a major car accident and need to have surgery.

They need some time for their body to heal and they need that extra support. After residential care, the next level of care down is something called partial hospitalization or day treatment. And that's a program that's often six to 10 hours a day where you're provided therapy, you have psychiatrists to help with medication management, you have group therapies and individual therapies to continue to kind of solidify the skills that someone's learned as they've been stepping down. Then we think about if they don't need that level of care, that kind of intensive partial hospitalization, we think of intensive outpatient. So that would be groups that meet for three to five hours a week, sometimes a couple of times a week. There's also now something called virtual IOP because what we found was there's a lot of places that, you know, if I have to drive to a meeting, that's great. Except I might live in a more rural remote area and I can't do that.

But with telepsychiatry, we can actually now gain more access. Like we talked about people who didn't have access to treatments. So now you can do that IOP but via the computer. You're still talking to people and seeing them, you're just not physically in the same space. And so you have this spectrum of care, and then you step down to what we consider as the traditional outpatient. And that's where you see like a prescriber or psychiatrist or a nurse practitioner, maybe once a month. A therapist you might be seeing once a week. The difficulty is if someone is not doing well, they may need more care than that outpatient team can provide. And that's where that whole next level comes in. And so I described kind of starting from inpatient and going down, but what's really important is to understand is these are the levels of care.

And I can insert myself into any level of care based on what I need. So I have outpatient providers that will call and say, Hey, my patient's struggling more. We need to get them into IOP to kind of step them up a little bit, but they don't need acute inpatient, they don't need residential right now. I just need some extra support for my outpatient. Or I'll have, as a child psychiatrist, I'll see kids failing in school and they're struggling a lot. We might think, hey, they need to be in that partial hospitalization because we can have intensive work. They get seen by a psychiatrist and their therapist multiple times during the week, they have school support. So we can work with them intensively and then step them back down, out to outpatient and back into their school or work environment. So it lets us move the patient up and down that continuum to where they need to be.

Because what we want to avoid is just putting people on the inpatient unit. Now, there's times that they need that, especially for the acutely suicidal patient, but that's a very restrictive place because it has to be for safety. And typically patients don't get to be there very long. It's very costly to be in an acute inpatient unit, it's like being in the ICU. And so you want to get people to that lower level of care as quickly as you can because it's more freedom. It's more therapeutic, it also cost less, which is good for our healthcare system. But the key is it provides the right level of intervention for what the patient needs right then.

Ellie Pike:
I appreciate your emphasis on the levels of care because oftentimes folks believe that there might be their outpatient providers and then there's crisis care, but maybe not anything in the middle. And it's really important for them to know the options that are available to them while they're still in work or while they're still in school to keep them out of crisis care. So we'll certainly link to our admissions line in our show notes, if anyone is interested in learning more about treatment. And with that being said, I'd really love to understand more about what Pathlight offers. So what does Pathlight offer that's different from other healthcare providers?

Dr. Howard Weeks:
You know, what I think is really unique about Pathlight is we're very focused on that intermediate level of care because we've recognized that's a big gap in access for patients across the country. I mean, we don't have enough inpatient, acute psychiatric units. Let me be very clear about that. There's a shortage of that. But what we know is even if you can get into one of those, when you're discharged, you're not really to that point of being able to go back just to your outpatient provider, oftentimes. And people get into this kind of vicious cycle of outpatient and back to inpatient. And then intermediate level of care, which is the residential level, the partial hospitalization and the IOPs, gives us that full spectrum. And what's unique about us is we live in that full spectrum. So we can have a patient that needs IOP and we can put them into IOP or if they need to step up to partial hospitalization for a period of time and then step back down, we can do that.

And we can do it in one system, which is very different than in effect what happens right now for crisis cares is you get admitted to one system. You're not really cared for by people that know you, that you're cared for by very caring professionals, but they're focused on the acute crisis stabilization. And then they discharge you back out. And what we're trying to do is have a continuum of care where we can work with patients in that intermediate level for an extended period of time, more than three to seven days. We want people in treatment for weeks so that we can really stabilize and then work closely with their outpatient providers to get them back to them. So that then the outpatient providers can continue the work. Because even when someone finishes working with us, it's not a magical cure. There's still work that needs to be done and they need that support. And what we can try to do is prevent people getting sick enough that they need to go into the hospital.

I think the analogy I think about from primary care is like with diabetes. We want someone coming in and seeing their primary care doctor, going to groups, managing their insulin so that we keep them from going into DKA or diabetic ketoacidosis where they need acute inpatient hospitalization because that's expensive and there's not enough beds. So if we can keep people out of acute inpatient psych units by treating them at a lower level of care, then we can reserve those acute inpatient units for those patients that are suicidal or the psychotic, that there is no other safe place for them. And that's actually going to help access for the entire country. So I think one of the unique things that we have is this is an area we focus on is not the acute stabilization. It's the intermediate level and working closely with the acute people, because they need a place to send someone because they know they're going to fail if they go straight to outpatient.

And then our outpatient partners, because they know that they can't see the patient daily or even several times a week. And so they need more support. So that then once the patient gets to that point, they can then manage them on a weekly or a monthly basis.

Ellie Pike:
And I know for some who might be seeking treatment, they really want to know what they would be getting. So sure, they might go to intensive outpatient and receive three days a week, three hours a day or partial hospitalization seven days a week. But what does treatment look like as far as who their treatment team is and how anxiety, depression and trauma related disorders are actually treated?

Dr. Howard Weeks:
Sure. I think that's a really good point. In fact, one of the driving forces why I joined this provider is because of the focus on quality care. So we're physician led, psychiatrist led treat multidisciplinary treatment teams. So we have a psychiatrist involved with every patient, a therapist involved with every patient. Plus, we have a whole team that includes nursing, other therapists, behavioral health counselors, to provide that structure for the patient. And we follow the patient through that system so that we can get to know the patient, they can get to know us, we can get to know the family. And while we have professionals involved, we also have a very strong focus on family involvement because I can do a great job of talking to a patient, prescribing a medication, and my therapist can do a fantastic job of working through therapeutic processes.

But if we don't help that patient understand their support, their family and get them understanding what's going on, it's going to continue to be a challenge. And we're leaving a crucial tool on the table. And I think we get much better success the more family involvement we have. And your treatment with Pathlight, depending on the level of care is really how often you see your treatment team and how intensive it is. And then you're also in your involvement back in the community, be it at work, be it with your family or back at school. But we have that continuum of a treatment team. That's going to follow you, pay close attention and then coordinate closely with your outpatient providers. Now, admittedly, we have sometimes patients that come to us that don't have outpatient providers. So when we do see those, that's one of the first things we're starting to try to figure out is, well, who's going to help take care of this patient when they are out of our kind of level of care? And so we need to start working very quickly to help identify who their outpatient provider is.

And we have connections in people's communities, and we can try to help work to set that up so that when they discharge from us, it's a smooth landing.

Ellie Pike:
Like what you were saying about long term maintenance. And so when someone enters Pathlight, the goal is to continue them in care for the support that they need depending on where they are in life. And thank you for your emphasis on family involvement. And we will be sure to link to the family involvement in our show notes. Pathlight families of adults and children and adolescents can receive weekly education, which is just so pivotal for someone's recovery. So speaking of ages, who can come to treatment and what ages?

Dr. Howard Weeks:
Yeah. So we do divide things up. We have child adolescent programming and adult programming. So adult programming is 18 and above and child and adolescent is typically 12 to 17. It can vary slightly by state, but for the most part, we treat 12 and 17 year olds in our child and adolescent programs and adults 18 and above in the adult programs.

Ellie Pike:
And do you take insurance?

Dr. Howard Weeks:
We do, actually. In fact, we take almost a hundred percent commercial insurance and that's where we focus because we really want to provide as much care as we can for as many patients as we can.

Ellie Pike:
Thank you, Dr. Weeks. And you know, if you were to speak to any of the families or individuals who are listening to this podcast, what's one message that you hope that they take away from this?

Dr. Howard Weeks:
You know, what I really hope is that families recognize that mental illness is not a character flaw, that it's a treatable, medical, biologic illness. Just like anything else that we see that we're very comfortable seeking care for in seeing doctors for. And I hope that they recognize that there is help out there. And our societies come a long way in the last 20 years about decreasing stigma around mental illness. And the more that we can do to talk about it and push for greater access and greater number of providers so that patients aren't having to suffer at home without treatment is the most important thing we can do. And that you should know that there is hope for your loved one and getting in and talking to a provider, your PCP, a therapist is the most important first step.

Ellie Pike:
Whew. I know that was a lot of information to digest. From anxiety disorders to mood disorders, to why we treat them the way we do. I invite you to go back and listen to any parts that you need help remembering. Our show notes have timestamps of where to find different topics, so take a peek. I would like to emphasize Dr. Weeks's optimism about the effectiveness of all treatment for anxiety and mood disorders. If you seek help, you can dramatically improve the quality of your life. Mental Note podcast is brought to you by Eating Recovery Center and Pathlight Mood and Anxiety Center. If you'd like to talk to a trained therapist to see if in person or virtual treatment is right for you, please call them at (877)-850-7199. If you're looking for a free support group for mood or anxiety disorders, our sponsors offer a wide variety at pathlightbh.com/support-groups. If you like our show, sign up for our enewsletter and learn more about the people we interview at mentalnotepodcast.com. We'd also love it if you left us a review on iTunes, it helps others find our podcast. Mental Note is produced and hosted by me, Ellie Pike, and directed and edited by Sam Pike. Till next time.