No, I'm not OK, and that's OK

Almost 18% of the United States is being treated for depression as of May. That doesn't touch the number who aren't being treated.

It is depressing (pun intended) that we devote a single day to the world's mental health. A month is only slightly more tolerable. As someone who studied evidence-based medicine and delivered patient care (obligatory disclaimer: I am not a licensed anything, anymore) I can say that at minimum 50% of the things I witnessed in the emergency department were at least partially based on a mental health issue.

Mental health isn't neat and tidy. I remember the medical schools offered literally dozens of subspecialties and hospitals had residencies on the rarest of physical ailments, but "mental health" was largely just lumped as "psychiatry" if you are looking for someone who can prescribe. Aside from the miserable wait lists to see a psychiatrist, we often forget that physicians are also humans, and they, too, have mental health struggles.

This is not meant to diminish the heroic work of psychologists and other behavioral health professionals, but as a researcher, I look at the data, and two things emerge. First, almost 18% of the United States is being treated for depression as of May. That doesn't touch the number who aren't being treated. Second, while etiology doesn't work neatly on mental health, we do know that a deficiency or overabundance of certain neurochemicals causes many mental health issues.

Put plainly, an unknown-but-quantifiable amount of the mental health crisis in the United States (and the world) could be treated by medications. However prescribing medications is limited to people with medical degrees, and access to those people is dependent upon insurance. You either must be in poverty to receive access to free care (in the United States) or lucky enough to have an income and insurance that grants you access. However, as discussed above, having access is like entering the lottery and hoping you win a ticket to see a licensed prescriber.

More than 25 years ago while an undergrad in college, I was having horrible chest pains. I kept going to the student clinic on campus, where one of the nurse practitioners decided I had asthma and prescribed me an inhaler. (For those who are unfamiliar, "rescue" inhalers are essentially vaporized adrenaline-like substances). This made things worse. Many of the physicians with whom I worked in the emergency department in the evenings told me I was overloaded and prescribed me small doses of benzodiazepines, medications like Xanax.

I will reiterate what shouldn't need to be said, yet so desperately does: it's okay not to be okay

It was pure luck that I "aged out" of being covered by my parent's medical plan, and thus had to get my own coverage and thus find my own doctor. In this, I won the jackpot. My new physician's first words to me weren't a form of "hello" or any other perfunctory greeting. They were, "My god, you're having a panic attack!" She was only two years out of residency and is, in my opinion, an angel personified. She calmly explained that her nurse was going to come in and give me a shot of something that would help me calm down and that while I wouldn't believe her, I would feel better in a little while.

Fast forward twenty minutes, and I felt something I hadn't felt in years- normal and safe. While I had been studying things in physiology like the "flight or fight" response, they don't detail how one feels when stuck in one in perpetuity, or at least for years. Next, my new doctor told me she would be referring me to a psychiatrist for a "proper evaluation." She pulled some strings, and I was seen within a week.

My psychiatrist, who was so close to retirement that I only got to see her for six months, diagnosed me with "generalized anxiety disorder" within five minutes. She explained to me how different medications had different half-lives, meaning they were not as effective at treating GAD. She told me that Xanax, the drug my well-meaning ER doctors prescribed, was actually terrible for people with GAD. I'll spare the scientific explanation, but she drew what looked like a roller coaster and said, pointing, "This is Xanax. You need to take it every 4-6 hours or you feel like hell again." She then drew out charts for other options and explained why she was changing me to a different medication. I have been on it ever since.

The stigma around mental health remains, though. Diabetics are never told to stop taking their insulin (if they're type I, certainly) and society doesn't shame them because they are diabetic. (Scientifically speaking, I know there's at least one idiot out there who has shamed someone for being diabetic) But I honestly cannot count the number of times people in life have told me I need to "get off those pills" or accused me of being addicted to them.

The FDA has guidelines about prescribing anxiety medications but doesn't have a similar page on insulin. When I began taking my medication, I was given a 90-day supply with one refill. Now I cannot get any refills, I must submit my request with less than seven days remaining (and often, I run out of medication due to delays in communication between the pharmacy, my doctor, and the pharmacy's unwillingness to keep the drug in stock until they have a prescription for it, even though I've been getting it for decades). Even in the medical community, there is a stigma on my condition.

Even controlled, anxiety disorder is omnipresent, just like a physical condition such as diabetes. There have been days (pre-COVID) when I was in the office and I would start to get tunnel vision and just need to sit down, alone, for five minutes and let it pass. Working from home during COVID was a godsend, as I could just go off camera (if I was in a meeting) and still listen in. While I am largely extroverted, my sudden need for isolation has led many people to falsely believe I am introverted. I learned the hard way not to say, "I'm just having a mild panic attack and need a few minutes" while in an office. People thought I was joking or they called an ambulance: there was little gray area.

I have been incredibly lucky to have amazing leaders later in my career, including but not limited to Keith Koch , Dan Bennett , Dean Barker , Cindy Marinak , Amy Heymans , Hans Hage , and Bridget Feickert . All of them shared the trait of caring about the people for whom they led, and that allowed me to focus on what needed doing instead of worrying about what I would need to do should anxiety strike again.

Mental health often intersects with neurodivergence - something I've discussed in excellent conversations with Thomas W. . While I deal with anxiety, I know of people struggling with depression or other so-called "disorders." To any and all who are dealing with mental health struggles, I will reiterate what shouldn't need to be said, yet so desperately does: it's okay not to be okay.

Until the day that there is no stigma, I hope others will share their stories. Just as there is no shame in lacking the gene to produce insulin, there should equally be no shame if you lack the genetics to produce enough dopamine, GABA, or serotonin. As a leader, I always encourage my employees to bring their authentic selves to work and be proud of their differences.

Mental health is a part of overall health. If you live in North America and are having a mental health emergency, dial 988. You can also call 800-273-8255 or text TALK to 741741.

#WorldMentalHealthMonth #MentalHealth #NoShame