Recognizing Depression & Anxiety: When to Get Help for a Family Member

Recognizing Depression & Anxiety: When to Get Help for a Family Member

In this episode of On Call with Southern New Hampshire Health, host Keith Baldi sits down with Dr. Ciara Kazakis, primary care internal medicine provider at Downtown Medical Associates, to discuss how to recognize the signs of depression and anxiety in loved ones and ourselves. Dr. Kazakis shares how mental health conversations have evolved over time, why stigma continues to keep many people from seeking help, and the subtle symptoms that are often overlooked.

The conversation also explores how mental health symptoms can present differently in men and women, when loved ones should encourage someone to seek professional help, and practical ways to approach difficult conversations with empathy and support. Dr. Kazakis offers reassuring guidance for anyone struggling with anxiety or depression and emphasizes the importance of early intervention, therapy, and accessible resources like the 988 Suicide & Crisis Lifeline.

Listeners will come away with a better understanding of how to support others, how to recognize when it may be time to seek help, and why mental health care is an important part of overall wellness.

Dr. Ciara Kazakis is a board-certified physician who earned a Doctor of Osteopathic Medicine (DO) from Kentucky College of Osteopathic Medicine in Pikeville, Kentucky, a Master of Science from University of South Florida, in Tampa, Florida, and a Bachelor of Science in molecular, cellular, and developmental biology from University of New Hampshire in Durham, New Hampshire. She completed her residency at Samaritan Medical Center in Watertown, New York, and has worked as an internal medicine physician since then.

 

 

 

 

Complete Transcript: 

Keith: Welcome to On Call with Southern New Hampshire Health. I'm your host, Keith Baldi. On Call delivers the latest health care news and updates along with insights into the latest medical innovations and technologies.

Southern New Hampshire Health is a non-profit system serving the communities in Greater Nashua, New Hampshire, and Northern Massachusetts. The health system includes an 188-bed hospital, one of Southern New Hampshire's most comprehensive teams of primary and specialty care providers, and five walk-in immediate care locations open seven days a week for urgent needs. Southern New Hampshire Health- expert care, close to home.

Thanks for joining us for today's episode of On Call. We're talking about detecting depression and anxiety in loved ones. This is certainly a topic that has become important as society recognizes the significance of behavioral health.

Joining us today to talk about this is Dr. Ciara Kazakis, primary care internal medicine provider at Southern New Hampshire Health Downtown Medical Associates. Dr. Kazakis, thanks for joining us.

Dr. Kazakis: Thank you so much for having me, Keith. I'm excited to be here.

Keith: So, we always like to start out a little bit, you know, just getting to know the doctors on our program. Tell me a little bit about yourself and why you decided to become a doctor.

Dr. Kazakis: Yeah, for sure. Again, thanks for having me today. Initially, I went into medicine.

I always, it was between becoming a veterinarian and a human doctor. I love animals. I'm still a huge empath for animals.

As I started getting older, my mom unfortunately got sick. She dealt with some mental health issues.

My grandfather was diagnosed with prostate cancer, and I was really able to see how the providers and the doctors that they worked with were able to help them through those tough times, not just with medicine and their recommendations, but by their empathy, with their compassion towards both my grandfather and my mom with her struggles. And that really kind of clinched it for me that I wanted to be hopefully that person in someone's life to be able to make a difference like that long-term. So that was really kind of the turning point for me to pursue a career in medicine.

Keith: Well, I'm sorry to hear that, but, you know, those experiences shape us all in some ways. And so we're thankful to have you as a doctor, however it came to be here.

So we're talking today about mental health. You know, as patients, my age especially, we didn't use to think of mental health as something that you would bring up to your primary care provider. That's changed, right?

Dr. Kazakis: It has. And we're very thankful it has changed. And it's funny that you talk about that, because I was listening to another podcast of professionals talking about mental health. And, you know, it was back in the day, everyone, you know, on the street that you lived on, everyone had the perfect marriage, right? Everyone had, you know, the perfect children, and everyone was happy, you know, there wasn't stress, and certainly didn't talk about it, right?

And so it has really come a full 180, you know, mental health has been recognized as something that affects most people. I think at some point in time, everyone deals with anxiety or depression. And it is now a very accepted medical diagnosis as much as COPD, or lung disease, or cancer is.

And we recognize now that it's not just something you can will away, you know, it's not something you just say, well, you know, pull your bootstraps up and carry on. It is significant, it's impactful, it can harm families, it can end lives. And it's something that is now, really, like I said, full circle.

And we're very grateful for that, because a lot of people have struggled for many, many years, because they were shamed into not getting the help, and they felt embarrassed. And that stigma has really been lifted. And now people are getting help, and they are thriving in their lives.

And they are making meaningful connections and relationships and building a support network. And that's been very, very helpful for the mental health community.

Keith: Yeah, dispelling that taboo is so important, right? I mean, if you can't talk about it, especially because it's not like, you know, quote, unquote, physical ailment where people can see you're not feeling well, you don't look well, you know, you have a broken leg, whatever it may be, right? I mean, that's just the... It's not an objective thing for a lot of people.

And, like you said, a lot of the time, it was kind of shrouded, and it was, you know, looked down on to have a mental illness. But again, there's been a lot of research; culture has changed. And we now recognize it as, you know, a significant, you know, disease, significant ailment that affects people, and they can get help for it.

Dr. Kazakis: Right. And look at the numbers. I was just listening to something today that talked about the number of people who called 988, which is the suicide and crisis helpline. It is a great resource.

And it just shows by the numbers that people are seeking it out, and it's helping people. So, you know, what are some of the signs of depression or anxiety, you know, early, subtle indications that, you know, sometimes people might overlook? Yeah. So like I said, I truly believe everyone, you know, deals with elements of depression and anxiety, but it can look different for different folks, different populations, different genders.

So I think it's important to be able to recognize the characteristics. Some of the first signs of a mental health challenge could be just irritability. You know, people are just, they're more likely to have negative interactions with things that maybe they wouldn't have had in the past if they weren't struggling with an element of anxiety or sadness.

So irritability, even with loved ones, you know, really, really is something, and even clinically is something I see as well. So, just being a little bit more negative, things that, you know, someone cut you off in traffic that maybe if you were in a better headspace, you'd be able to handle more- kind of fly off the handlebars, or your child spills milk, you know, and suddenly, like that, that is very overwhelming for you. And maybe you react in a way that you feel bad about later, you know, so irritability, I would say, is the biggest thing.

What we oftentimes see too is struggle sleeping, fatigue, because again, it's hard to prepare your mind for sleep, quiet your mind to get restoration when you're ruminating about things that are concerning to you. You're ruminating, and it's just hard to kind of quiet your brain. So even if you do get to sleep, sometimes you don't stay asleep.

So irritability, fatigue, sometimes people even go to bed at nine o'clock and, you know, get a full eight hours of sleep, and then they wake up in the morning, and they still don't feel rested, you know, they're tossing, they're turning. And we know that to be a sign as well. So sleep patterns, sleep habits, and restlessness as well.

Concentration is also a big kind of harbinger for mental health. Concentration goes down, inability to focus. We see that a lot.

I would say men kind of present with that too, an inability to focus at work, having a challenging time concentrating. And from that will stem feelings of irritability and anger. So it can even be poor performance at work, you know, when work starts to slip.

And then, of course, you know, we do kind of have the other classical things, just feelings, you know, loneliness, you're not finding pleasure in things you used to derive enjoyment from. Those are kind of all the classical things that people think of for depression or anxiety. But there are also, like I said, subtle things in the irritability, more fatigue, and insomnia kind of come to mind.

Keith: Those are great because, as you said, they're subtle and you may not realize what's going on. Of course, attributed to something else. Now, these symptoms can differ from person to person, right? I mean, across different age groups, male to female.

What are some of the things that, you know, might be a little different?

Dr. Kazakis: So what I notice is sometimes it can be a gender thing too. So, men sometimes, especially with depression, we see them slip into coping mechanisms for their mental health that they think are easier to kind of conceal. You know, they don't want to make their significant other or their partner upset or their family upset.

So they might, you know, start using alcohol a little bit more frequently as really unhealthy coping mechanisms, you know, kind of come about in what I've seen and what the studies have shown for men. So sometimes depression can come about in men drinking a little bit more. And, you know, it's not just that they're maybe struggling with, you know, addiction or alcohol use disorder.

It's they're covering up a symptom from something deeper. So that's something to be mindful of, especially in the male population. Sometimes men will also turn to what they call escapist behavior.

So that's really kind of trying to dive into their work or, you know, dive into a project and, just to kind of escape whatever's driving that mental health, those negative mental health feelings, whether it's home life or, you know, a marital issue or a child issue. And they just really kind of, again, escapist behavior. They don't know how to deal with what's making them hurt.

So they dive into what they know. They dive into what's familiar. You know, that's their work.

That's their computer time. So spending a lot of extra time at work, you know, really kind of grinding it out. Those are all kinds of concerning red flags, you know, and again, more for the male population.

Not that women cannot demonstrate these behaviors, but men sometimes present, you know, a little bit differently. What's also really important to understand, too, and why I really try to encourage men to come and talk to their doctor, is because although women, statistically speaking, are more likely to attempt or talk about suicide, men are statistically speaking more likely to complete it. So that and that's concerning, you know.

So I really, you know, for everyone, but I really try to encourage men. I really try to encourage them to come talk to their doctor. You know, these are not feelings you should be ashamed of.

Whatever's happened is in the past. There's always a way forward. But just having that courage can be hard.

But to understand that your doctor's aware. None of us in health care, you know, primary care specialists, have the notion that men don't suffer from mental health. You know, we know, we know.

Keith: So we're not surprised, you know. So I would say men can present, you know, a little differently. Well, and also, as you said, we were talking about stigma before.

Dr. Kazakis: Yes. It's a little different for men. There's still that idea of, like you said, you grind it out at work.

Keith: You do. You know, you can get through it no matter what. You don't need help.

Dr. Kazakis: Right. That still exists in our society. It does.

It does, too, to an extent. You know, they're the pillar of the house. They're the column.

You know, they can't have a shaky foundation. Right. And that's just not realistic thinking anymore.

We know that the world is very confusing. It's very chaotic right now. Relationships can be challenging for men and women.

So mental health can and does affect men. Unfortunately, men are just late to presentation.

Women are very good about knowing that they're not feeling well. There's less of a stigma kind of attached to them getting mental health help from their perspective, not from ours. So for women, you know, we do kind of see weight changes sometimes.

Sometimes women will find, you know, comfort in in food or maybe not eating as much. So weight changes, you know, can come about, especially in our female population. Again, the irritability, the restlessness, feelings of being overwhelmed, kind of flying off the handlebars at that, you know, kid that spilled milk on the kitchen table.

Those are some of the things. And again, this is not a box. You know, everyone, these things can kind of bleed into each other.

But if you're asking for what I've seen, kind of, you know, what the research has supported, what surveys have supported, those are some of the characteristics that we see with mental health, which, again, can differ, you know, between genders. And you touched on this, but I think there's a fine line sometimes in people's minds. And we're talking about loved ones who are looking out for people in their family of what might just be OK.

So and so is off today. They're a little irritable. Maybe they had a bad day at work or they had a bad day at school, and then taking it to the level of concern, right?

And that's, I guess that's tough sometimes. Yes, yes. And it can be challenging, and it can be daunting to approach a loved one, especially if they're not in the territory to accept a conversation like that.

So, I do think being mindful about how you approach a loved one and making sure that you use a lot of open-ended questions, trying to stay away from anything that could be punitive, you know, or derogative, like, “Oh, hey, I noticed you're not sleeping. That's really bad for your health.” You know, you didn't wake up this morning and put gas in my car, you know, trying to make sure that you're staying away from, you know, blame-shifting and creating a space that, say, you know, you seem a little bit more tired lately.

Is there anything I can do for you? Leaving open-ended questions, making sure that when you approach what I like to do is I always like to approach it with a question that puts folks less on the defensive. So, is there something that I'm doing that's maybe causing you to not get more sleep? And, you know, I think, oh, well, you know, I'm not ready to talk about this yet, you know, so she's giving me an out, you know, I can say, well, you know, now that I'm thinking about it, you keep your phone on it. Now, you know, they have an out, or, well, it doesn't really sound like this is a negative connotation.

So maybe I will discuss, well, it's not really anything you're doing. But I have noticed that when I go to sleep at night, I just can't really shut my brain off. And that's all you need.

You just need a little tiny bit of an entryway for them to feel comfortable discussing and exploring. It might not happen on the first conversation, you know, it might be the 30th conversation. But having those regular check-ins, you know, and what I always tell people, too, and this is powerful, and this was a psychologist that I was listening to.

And he said, when you're concerned about someone and they're going through a challenging, you know, time in their life, the environment for them is challenging, they're dealing with something. Instead of telling them, if you need anything, come to me. Don't leave it up to them.

Say, I'm going to come back and I'm going to come back and talk to you, you know, I'm gonna come back in a week or so, you know, I'm gonna come back and, and just see how you're doing, you know, and that, that makes them feel like you're, you're taking a step for them, instead of leaving it in their court, you know, because a lot of times people with mental health, they don't want to be a burden, they don't want people, their loved ones to have to, you know, to have to figure out their problems. And again, even if that's not real, that's their perspective.

So to have that off their chest, like, oh, well, she's going to come and talk to me, you know, it's also kind of, all right, well, it's a little hopeful, reassuring, it's reassuring that they're going to come back, they're going to check, they're not leaving it in my court to do, that's not another thing I have to do, right?

Keith: So, right, especially when it becomes like you're, like you're saying, overwhelmed, or, I mean, depression obviously has a part to it that, you know, you can see if someone is lacking motivation, right? I mean, they sleep longer, as you said, or whatever, you don't feel rested. So, if it's if the onus is on you, right, you may not simply do it.

So, when this is, this is great, because you're, you know, you're describing these conversations that are pretty universal to a lot of people, right? I mean, especially between spouses, parents, and their children, especially when they get older, right? The support networks that we have, we need to rely on, right? So, when do you think someone should encourage their loved one to get, you know, professional help to see, you know, their doctor to see, you know, maybe a psychologist, social work therapist?

Dr. Kazakis: Yeah, that's a great question. Everyone has a bad day. And, you know, you had mentioned this before, and that's fine. Everyone's allowed a bad day.

And we need to meet people where they're at. What I say is when it's starting to affect their activities during the day, when it's starting to affect relationships, whether it's a relationship with their co-workers, a relationship with their boss, a relationship with their partner or their children, in a negative way, that's when you really should, you know, kind of move forward with the process. Because again, everyone has a bad day, everyone snaps at people every once in a while.

And we're humans; we're allowed to do that. You know, it's nice when you can go back and say, you know, “Hey, Keith, I'm sorry, I had a bad morning this morning, maybe came off a little sharp. Hope you forgive me.”

I'll be more mindful in the future. But it's when it becomes a pattern, you know, it's like, yeah, every week, or every, you know, a couple of days, she's coming into work, and she, she seems very irritable. You know, I had asked her if she could just sign this paper. She kind of snapped at me a little bit, and it's becoming more of a pattern, you know, kind of starting to not really like the way I feel when I talk to her, when I approach her.

I think at that point is when an intervention needs to, you know, and I say interventions, not something crazy. But, you know, I think a change needs to happen. So, to kind of long story short, when it starts negatively affecting relationships, I think that that's, that's when steps need to be made.

Certainly, and this usually comes later, certainly when your health is affected as well. So, we kind of talked about the unhealthy coping mechanisms. Certainly, you know, whether it's tobacco or alcohol use, you know, if those things start to show health concerns, you're at a real cross point. By that point, usually, at that stage, relationships have already been affected, usually negatively. So, I would say the first thing to really kind of notice is how people are feeling after they interact with this person, you know, especially when they don't seem like they're in a good state of mind, you know, how is their son interpreting their behavior? How is their partner interpreting their behavior? And how do you feel? You know, do you feel good after you talk to this person? Or do you kind of feel down? Like, do you feel slighted? Do you feel angry after you talk to this person? And that should definitely start setting off bells that maybe we need to consider, you know, a conversation.

It's important to build relationships ahead of time with people. And that's when you get close, like we're talking about our families, that we should be able to notice.

Keith: It's so important. So, you know, if someone is, has that significant anxiety or depression in that moment, you know, what are a few helpful things that a loved one can do? I mean, we kind of talked about this, but you get that encouragement to move forward to maybe to reach out to someone.

Dr. Kazakis: Yes. And what I would have to say too, and this is something I even struggle with, with folks in my family, it's important, and it's hard. It's important not to react.

It's important not to react. And they may snap at you, they may do things that, gosh darn it, make you angry, you know, but don't react. If you have to say nothing at all, bite your tongue, don't say anything.

It's better to pause, even if it's an awkward pause, take a breath, and say, I'm not really sure I'm ready to respond to you right now. That's fine. That's perfectly acceptable.

So, but also understanding that it's really nothing personally directed against you. You are just unfortunately the body in front of them at that particular time that they're having that challenge. It could be anyone, you know, it could be Britney Spears in front of them, and they would, they'd react the same way.

So, and again, it's hard because, as humans, we want to take things personally, but when you're dealing with a loved one who is struggling, who's really kind of going through it, going through negative emotions, having these repeated bad days, to understand that it's not you, right? You're not the one that's causing this. They're not trying to direct their anger at you. You just happen to be there.

So don't react, you know, and just kind of take a deep breath and say, again, I'm not really sure I'm ready to respond to you right now. I'm going to take a couple of minutes, maybe go walk outside for a moment, and then come back. People close to us, it's always hardest.

Keith: Yes, it is. And I didn't have a Britney Spears on my bingo card today to pop up in this. So I'm, I'm, I'm very happy that we were able to throw that out there. So, Britney has struggled as well. So, we spent most of our time today talking about how to spot the signs and others.

And, and in doing that, we're talking about how to spot the signs in yourself, I suppose, too, but, you know, this is something if someone's listening, these signs you can get help yourself, right? I mean, you don't just need to be looking out for your partner or your child, your neighbor, or whatever. Yeah, you need to look out for yourself to know.

And, and in doing that, we're talking about how to spot the signs in yourself, I suppose, too, but, you know, this is something if someone's listening, these signs you can get help yourself, right? I mean, you don't just need to be looking out for your partner or your child, your neighbor or whatever. Yeah, you need to look out for yourself to know.
Dr. Kazakis: Definitely. And, you know, and I think, and it is hard it is it is challenging. And like I said, I've dealt with my own bouts of anxiety and depression throughout my life. And it can be challenging to accept help. But the people who are closest to you and love you want you to do well.

You know, your doctor wants you to do well. Every physician you interact with wants their patients to feel good. It's the best thing in the world. When I see a patient who is struggling, they come back a few months later. They're involved in therapy. They're getting the help they need, and they feel good. It just makes my day.

So if you're experiencing any of these things, you're thinking, “Oh, geez. Well, you know, I've kind of been working a lot because I, you know, go home and my husband's driving me crazy, or, you know, the house is a mess, or I can't deal with everything that needs to get done at home. And I have spent a lot of time at work.
I don't need to, but I have because, you know, it's hard to go home, right? It really kind of weighs on me.” Recognize those symptoms and understand that those symptoms are normal, right? This is normal. It's just that there are a lot of resources out there that can help you obtain a toolbox, if you will, of, of, you know, utensils that you can use to help you manage that.
And it's not just medication. You know, people think, well, I'm gonna get them. It's not just that there's a lot of things that cognitive based therapy, you know, working with the therapist or a psychologist can just help you with, you know, and just sometimes it's just changing your perspective a little bit, you know, and but like you said, if any of this that we've talked about today has spoken to you and you, you are starting to recognize a pattern, get it early and get it now.

Because what's so disappointing for us is health professionals as when people are kind of at the end of the line, right. You know, they've been dealing with these feelings for years and years. They've been too afraid or ashamed to get help. And it's very hard to do. But it's much harder to do that work when you're on the tenth step versus when you do start to realize that you really feel that grade over the past few months.

Maybe I need to talk to my doctor. Maybe they can get me plugged in with a good therapist. Therapy has come a long way as well. There are telehealth options now. I have plenty of patients who hop on a telehealth in their car, you know, during lunchtime work. And that's been very helpful for them. So, it's not just the classic Freudian lay on the couch going to a psychiatrist, with a warm towel across your forehead.
It, it has it has come a long, long way. The other thing I want to just encourage people to do is if you find a therapist or you find a mental health professional and it doesn't click for you, find another one. You know, we don't take that personally. You know, you have to be able to find someone that you click with.
I had a male patient who was seeing a therapist, and he was probably in his 50s and had a family and, you know, a career profession. And they wanted him to, you know, be with a therapist who was in her 20s, a female. So not really much in common, you know. So that was a challenge for him.
And I just encouraged him. I said, you know, it. Let them know your preference, you know, and they'll work with you, you know, find someone that fits you. So, I just want to make sure people know that. That's okay.

Keith: Oh, that's great, that's great. All great advice for people. And I think it's really important. And as we mentioned, you know, at the beginning, things have changed so much.

And you're there for people and our patients, all of our doctors, clinicians, they're all there for people. And as you said, we all just want people to live healthy, productive, happy lives, right? So, life's too short, you know? So, you want to find the enjoyment in it, and screenings help, too.
I know that, you know, we do screenings in our hospital, and we do. Yes. You know, in your offices. It's important because sometimes people don't want to just bring it up, right?  But when you have that opportunity to fill out a couple of questions, maybe you do start realizing, like you said, right? You're hitting on some of those points that make you make you realize that something's not exactly how it should be or how you want it to be.

Dr. Kazakis: Exactly.

Keith: So, thank you so much. All right, let's pause. Of course. And as we wrap up, I just want to mention that Southern New Hampshire Health has a great way to make sure you can find the best primary care provider available. You can call 1-603-880-EASY. That's 1-603-880-3279, and you'll be matched with someone who best fits your needs.
Dr. Ciara Kazakis is a primary care internal medicine provider at Southern New Hampshire Health Downtown Medical Associates. Thanks so much for joining us.

Dr. Kazakis: Thanks for having me, Keith. I appreciate it. And I just we do throw out there since we talked about it. If anyone is in crisis, they can call 988 as well. Please pick up the phone 24 seven. They're wonderful people on the other end, and they will get you through it. It's great to see you. Thanks.

Keith: Okay, well, thank you so much. As we wrap up, I just want to mention that Southern New Hampshire Health has a great way to make sure that you can find the best primary care provider available. You can call 1-603-880-EASY. That's 1603-880-3279, and you'll be matched with someone who best fits your needs.
You've been listening to on Call with Southern New Hampshire Health. For more information about the health system, or to learn more about some of the topics featured in this podcast, visit us on social media and on our website, SNHhealth.org.