Common myths about mental health and why it should be a primary care issue

By Dr Sora Al Rowas MD, MSc

Dr Sora Al Rowas is an internist who is passionate about general internal medicine and its role in medical education. She is also excited by underserved medicine and enjoys educating medical professionals on a range of topics.

Common myths about mental health and why it should be a primary care issue

Mental health myths

Having worked as a primary care doctor in the USA and the Middle East, I have noticed surprising similarities concerning stigmas about mental health issues. My goal today is to debunk some common myths I’ve seen in my practice and make the case for why primary care providers need to take mental health seriously.

Myth #1: Only people who are weak need mental health care

Everyone needs quality mental health care.

We live in a world with increasing demands on young adults in particular, especially where life-long learning is an expectation in most fields. Anxiety and depression are extremely common and treatable in primary care when addressed early enough. Teaching people coping mechanisms for common conditions like anxiety and depression can help avoid thought patterns and behaviors that could lead to serious illnesses later in life. Schools should teach stress coping mechanisms and resilience techniques to teenagers. This can be done via group or individual sessions to help teens gain insight about the sources of stress and help give them tools to respond rather than reacting without awareness. Fostering a sense of community can also greatly help improve resilience.

Myth #2: Antidepressants and anti-anxiety medications make you a different person

AntidepressantsWho you are is so much more than how much of a particular neurotransmitter you may have. Both anxiety and depression can be associated with serious chemical imbalances when they are severe enough. Although mild to moderate cases can often be treated with therapy alone, it is extremely difficult to treat serious cases of anxiety and depression without medication. This is similar to a person who has diabetes; it is theoretically possible for them to treat it with diet and exercise alone but once the diabetes is bad enough it becomes extremely difficult to treat it without medications, even if changes to diet and lifestyle are made.

Myth #3: Physical and mental illness are entirely separate affairs

This couldn’t be further from the truth. They are so closely related that something as physical as knee pain can be affected by someone’s mental state. Depression is known to affect a patient’s perception of pain where patients with depression require more pain medications for the same issue, like back pain, than patients without it.1 Patients who struggle with autoimmune disease or neurological issues often develop depression as a result of having to deal with their chronic illness. There are certain classes of blood pressure medications that are known to contribute to developing depression. Furthermore, physical symptoms such as back pain, joint pain, insomnia, poor appetite, headache, can often present as a symptom of depression.

Myth #4: If you are feeling better, it is best to stop the medications as soon as possible — otherwise you’ll depend on them.

Once the decision to start medications is made, the recommendation is to remain on the medications for two years before trying to get off them. This gives the highest chances of successfully remaining off medications in the long run. Anxiety and depression both have a proven chemical component in addition to factors related to thought patterns and coping mechanisms.

Often it is only after the effect of the medication is appreciated and a person is feeling better that they are in a position to address the thought patterns that contributed to forming depression in the first place. Prematurely stopping those medications can seriously set back the recovery process. If a patient relapses after stopping medications, it can be an argument to remain on the medicines for life. This should not be seen as a failure—it should be treated the same way you would treat someone who needs to be on blood pressure medications for life.

Myth #5: One cannot develop clinical depression in response to a major life event

Both depression and anxiety are often triggered by specific stressors. Traumatic events like the death of a loved one can trigger a grief reaction. However, if this lasts more than six months, one should treat this like major depression. Regardless, serious reactions to life stressors with symptoms of major depression or anxiety disorder should still be treated with all available options, including therapy and medications.

Common misconception about the treatment of mental health

Another common misconception among patients and primary care doctors is that the treatment of mental health belongs solely in a psychiatrist’s or a therapist’s office. One of the reasons this isn’t true is the sheer volume of patients who suffer from some degree of depression or anxiety.

Doctor counselling patientIn my practice, I always asked a patient to see a therapist and often referred them to a psychiatrist when the case was beyond my comfort zone. The fact is that there aren’t enough psychiatrists to take care of every single patient with anxiety and depression. Insurance restrictions further deny many patients access to psychiatrists or other mental health providers. Patients with severe cases often cannot afford the delay in care that would result from waiting to find a psychiatrist, leaving it up to the primary care doctor to take responsibility.

A concern among primary care providers is lack of comfort treating mental health issues. I found that a good remedy to this is to start talking with colleagues and enlisting the help of psychiatrists who would be willing to give a “phone consult.” There are great courses in geriatric conferences and primary care conferences that can help bring a primary care doctor get up to speed. Reading review articles on depression and anxiety in primary care can also help increase comfort by learning the evidence for various drugs.

Given how common depression and anxiety is, a primary care doctor can increase their comfort with treating them in no time. We have to stop denying patients the opportunity to be treated “as a whole,” which is ultimately what primary care is all about in the first place.

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