Anxiety and ADHD in Women

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Transcript

Chrissy Billau:

Welcome to Prescribed Listening from the University of Toledo Medical Center. On this podcast, we interview our experts to get the answers you need and can trust. I'm your host, Chrissy Billau. This episode is for the girls, or if you're looking to understand women in your life better.

Have you ever asked yourself: what is wrong with me? Do I have anxiety? Do I have ADHD? Am I depressed? Well, we are talking to UTMC psychiatrist, Dr. Victoria Kelly, about women's mental health.

Let's jump right in and ask the expert. Dr. Kelly, thank you for being here.

Dr. Victoria Kelly:

Hi, yeah, thanks for having me.

Chrissy Billau:

In our research, we found that more than one in five women in the US experienced a mental health condition in the past year, such as depression or anxiety. How can mental health be different for different genders?

Dr. Victoria Kelly:

Yeah. I think we've come a long way these past few years with really understanding the differences in our society, we've had a lot of social movements and such. I think that the COVID pandemic has actually highlighted some of that even moreso.

Interestingly, what the data says is, it seems like women are diagnosed or treated with mental health disorders more often than men, but that's fake news. Actually, what happens is women have a pattern of behavior that often leads them to seek treatment sooner than males do. It's not necessarily that they're having more rates of the illnesses, it's they are more help seeking. That's one really important aspect. And if you look at it the other way, it's probably one of the things that contributes to overall higher mortality rates in men, that they might avoid going to the doctor, doing things like that.

Chrissy Billau:

Yeah, just to get them to the doctor just for a regular checkup, your annual, this is not a big deal, but when there's actually a real issue, society tells me you don't talk about it. You just [inaudible 00:02:05] and bear it. You're manly, right?

Dr. Victoria Kelly:

Yes, exactly. But there really, truly are socially constructed differences in the roles and responsibilities, status, power, and overall, women tend to earn less money, have jobs that have less power and autonomy, and I don't think it's a surprise to anybody that they tend to bear the load of any family demands at home, regardless of anything else, whether there's the presence of a job, a spouse, a partner, we do kind that burden of everything.

Chrissy Billau:

As women and as parents, there's an expectation to be able to do it all: work full-time, take care of the children, everything else, and sometimes, it feels like that if you ask for help on any of those little things, you're doing something wrong. And that expectation, that mindset, you know deep down, that's a recipe for failure, but you resign yourself to that thought process of, well, this is the way it is, suck it up. What do you say to those women who are suffering through that way of living?

Dr. Victoria Kelly:

I say, "Well, just stop it." No, I'm kidding. "Don't do the laundry. Dr. Kelly told you it's okay."

Chrissy Billau:

Don't do the chores.

Dr. Victoria Kelly:

No. But in reality, it's a simple, yet difficult fix. It's really easy to sit across from a table and tell a patient, "Well, take care of yourself more," or. "Sleep more," but when the reality of the situation is that you have jobs to do and these literal tasks and child rearing responsibilities, there's not enough time in the day. Often, it really comes with first recognizing what's going on, getting the lay of the land, because so much of what we do is autopilot.

Tying back to COVID, what we noticed is the world shut down. We could hear the birds, the sounds in our environments got quiet, there weren't cars and trains and we weren't hustle and bustle every day so as a society, we were forced to be alone with our thoughts and it really made everybody rethink things at that time. And what a lot of people found is that they were dissatisfied with parts of their life or themselves, and they really did take advantage of it to make a difference for the future.

We're now about two years out from the main rush of the COVID quarantine and restrictions, but one of my biggest recommendations for my patients is, don't forget about the quiet. Don't get lost in the hustle and bustle. Take a moment to stop and think and make a conscious decision about what you're doing, and is it in line with what you want to be doing? Is it in line with your life goals, with who you want to be and the boundaries, perhaps, that you've drawn in your life?

An example was, the holidays are always so tricky, right?

Chrissy Billau:

Oh, my gosh.

Dr. Victoria Kelly:

And we just finished a holiday, but it was easy during COVID, oh, maybe that family member that you just don't really care if you see, it was really easy to just be like, "Oh, no, no, quarantine's going on." But now, since things are back to normal, it takes effort to maintain healthy boundaries with other people and yourself. And in general, because of some of that socialization process that females have, literally from birth, when women get stressed, they tend to demonstrate more internalizing behaviors or disorders such as depressive disorders, anxiety disorders, eating disorders, social withdrawal, feeling more lonely. For men, the opposite is true: when, because of socialization, a variety of other factors, when they get stressed or overwhelmed, they tend to demonstrate externalizing behaviors like using substances, being more impulsive, aggressive behaviors and what we would call anti-social behaviors.

For the record, antisocial isn't "I don't like society." It basically is, "Society's rules don't necessarily apply to me," so it's anti-society rules. Anyway, that leads to a lot of invisible load that just gets lathered on in our minds for women. It takes conscious effort to see it, first of all, and then be aware of what you want to do. I think, again, a lot of people just don't know, and it's one foot in front of the other, it's survival mode. And for a lot of women, if you stop having that mentality, then it's really scary because what's next? We don't know. And sometimes, it's a lot easier to go with the flow even if it's unhealthy than to make some changes that you might need in your life.

Chrissy Billau:

Yeah, the devil you know. "I know how this day's going to end, I'll just get through it."

Dr. Victoria Kelly:

Yeah. Every year, I recommend for my patients to step back and take stock of things and in some ways, society's been helpful with that. Again, there's a big push for meditation, the Calm app, and all of these things that have now entered the common society's language that are easy resources to use. That's the first step, is just stop, pause, breathe, where are you? What are you feeling? What do you want to do next? Yeah, that invisible load, and for a lot of women, I think they also forget, if you are blessed and lucky enough to have supports in your life, whether it's a partner, family member or whatever, you do need to use them. And that sounds like, "Ugh, I don't want to use them," but they are a resource and a support and nothing exists in our lives without support. Buildings have supports, bridges have supports in order to function and do what they need to do. You got to use your supports, so it's really a reframe.

Chrissy Billau:

Well, in some cases, those supports, some are actively, they'd love to help, but they don't know you need help. In other cases, it's going to be an uncomfortable shift in whatever's happening, but it can over time, "Okay, we can do this."

Dr. Victoria Kelly:

Right. I think the stereotypical one is what often ends up with people in couples counseling or something like that. You're just like, "Oh, fine, I'll just do it." And then it's like, "Well, that's not the best of communication styles," and it really is. You stop, pause, think about it, and then you sit for a minute and think, "I am feeling lonely. I'm feeling scared. I'm feeling sad. I'm feeling whatever it is." And really in that moment, what you want is connection. But again, so used to survival mode and it's difficult to let that go. About improving communication, you got to tell those people what you want, what you need.

Chrissy Billau:

In our research for this episode, we looked at questions women have about themselves and their own mental health. Here's one example for you.

Dr. Victoria Kelly:

Okay.

Chrissy Billau:

"Nothing happened in my childhood, so why do I struggle with mental health?" This person may tell you, "I wasn't sexually assaulted. I have never been physically abused. My parents are still alive. They've never divorced. Why am I struggling?"

Dr. Victoria Kelly:

That is an excellent question, and I think it points out that we all think we're pretty normal. And the truth is, nobody is normal.

Chrissy Billau:

We're all weird.

Dr. Victoria Kelly:

But that's the beauty of life and that's the beauty of friendships and relationships. If everybody had the same upbringing and the same experiences, it would be boring. But again, I think that actually points to the stigma of mental health disorders.

It doesn't have to be that something bad has happened. We know so much about the nature, meaning the genetics, and the environment gene interaction, so the nature and nurture and how those interplay together and their impact on our symptoms, our ability to cope, our ability to deal with impulsive thoughts and whatnot.

If you look at the data behind breast cancer, let's say, that has been robust and researched for 50 years, and we are at such a great place with our knowledge about how genetics impact breast cancer. We know if you've got the risk for these genes, you're going to have a higher risk of this and this happening, et cetera. Mental health disorders, though, the research is probably lagging by about 50 years. We are on our way, and we're learning more and more.

I do teach the police officers, and I use this analogy with them very, very often. Anybody might think, "Okay, me and my sister, or my sibling, we had the same parents. We grew up in the same house, went to the same school." But y'all have different personalities. And our personalities, it's a combination of how we see ourselves based off of genetics, based off of our experiences.

One example is the ... I'm going to get all sciencey here for a second.

Chrissy Billau:

Okay.

Dr. Victoria Kelly:

All right. Is the serotonin transporter gene. You've heard of Zoloft, Celexa, Lexapro, right?

Chrissy Billau:

Yes. I've seen the commercials.

Dr. Victoria Kelly:

These are brand names. Oh, yes, all over the place. These are the brand names for different types of antidepressants called selective serotonin re-uptake inhibitors, SSRIs. What happens is, our brains have neurons, they talk to each other. One neuron will poof out some serotonin, it makes the serotonin and poofs it out and it floats around, and then it hits on the other neuron to talk, and then it sets off a chain of events. Okay, cool. What do you do with all the serotonin that's hanging around now? You suck it back up and you tell the brain, "All right, chill out. Our factory is cool. We've reached the status quo. Maintenance is good. You can shut the factory off." What these antidepressants do is they block that message so that the brain doesn't get the message to shut off production so it just continues to make serotonin. Theoretically, that should help give us more happy neurotransmitters, right? Genetically, though, we all have genes from our parents, so yes, one way or another, a parent screwed us over. But-

Chrissy Billau:

Another thing to complain to my mom about.

Dr. Victoria Kelly:

This one she had no control over, yes. So you're either born with a short short, long long or a short long. One thing that we know is, if you were born with a short short for the serotonin transporter gene, your feedback mechanism does not work right, period, and it is associated with higher rates of impulsivity, with suicidality, substance use disorders, and the list goes on. And that's one tiny little gene. So why am I struggling? It could have absolutely nothing to do with anything other than you unfortunately have that mix of genes, that your brain and body becomes a little more stressed more quickly than the person sitting next to you, even if that person is a family member. It's just your own plumbing. It is what it is. To some extent, it'll absolve you. It's not your fault.

Chrissy Billau:

Yes. I didn't do anything.

Dr. Victoria Kelly:

But what you do with those thoughts and feelings, the behaviors, 100%, you're able to have within your control.

Chrissy Billau:

What are some ways to check in on your own mental health, whether you're a short short, long long, short long?

Dr. Victoria Kelly:

Yeah, right. Number one is really knowing yourself. If I were to ask you, how do you know when you get stressed?

Chrissy Billau:

My heart rate.

Dr. Victoria Kelly:

Heart rate goes higher? Okay.

Chrissy Billau:

I just ... Sorry.

Dr. Victoria Kelly:

Yeah. For me, I noticed, we were talking about this off radio here a second ago, I drink more coffee. I'm more draggy. I'm just like, "Ugh, I don't want to get out of bed. I don't want to do this," so I require more. For me, even though mentally, I may not be thinking about it, my body will definitely tell me if I'm feeling stressed. This is why, if you correlate that out with symptoms of depression and anxiety, you get a lot of what we call somatic symptoms or body symptoms: decreased appetite, difficulty sleeping. First thing is knowing your own body, your own ecosystem. For me, that's fatigue and the sleep and the bed beckons me every day.

Chrissy Billau:

"I'm just going to stay here."

Dr. Victoria Kelly:

Yeah, exactly. "I'm cool here." That's step one, is knowing yourself and being honest with yourself.

Chrissy Billau:

Well, and it's not just a physical thing, like, "I'm stressed in a moment," but just overall stress, there are things you do in your ... Maybe I'm spending too much time, oh, I'm on social media all the time right now.

Dr. Victoria Kelly:

Oh, the doom scrolling too. That is a serious thing for women, especially moms. It is just go, go, go, right? You wake up, it's immediately to the kids, get them ready for school or get them off to daycare, whatever it is. Then, you immediately go to work, and then you come home and it's immediately get dinner ready, et cetera. You don't even have a spare second. And there's this thing of being touched out. You're just over it. You're tired of everything. You're tired of being touched, tired of being needed. Finally, it's nighttime. Kids are asleep, it's quiet. What are you going to do? Oh, you're just going to scroll endlessly on your phone for hours and screw up your sleep.

Chrissy Billau:

Yes. Delete your app, pick up a book.

Dr. Victoria Kelly:

But for real, that is something, every year, again, for the brand new year, it's an awesome chance for everybody to reset. It's completely normal to have the best of intentions and set boundaries, even if it's with your own cell phone, and just reassess. Having a type of a digital detox is excellent. You know how a lot of times people have a dry January where they give up alcohol for a month? A digital detox, because our brains can really come up with great coping skills when we're feeling stressed and a lot of that is avoidance and procrastination.

Chrissy Billau:

Now, I want to switch gears to ADHD, if that's okay with you. Once thought to primarily affect overstimulated boys, it's now an interesting topic right now, and I'd like to explore that starting with children. Now, according to information we found published by the CDC, boys are more than twice as likely to receive a diagnosis of ADHD as girls. I know we talked about adult women being able to like, "I need help for this." They're more willing to ask for help. But when it comes to children, how does that happen there?

Dr. Victoria Kelly:

Yeah. I think one very important factor related to that statistic is the fact of the type of presentation of ADHD in boys versus girls. ADHD stands for attention deficit hyperactivity disorder and sometimes people will say, "Well, I don't have ADHD. I have ADD." Currently, the way that it's conceptualized, it's one disorder that encompasses both and you can have one primarily or the other or combined type. Those are the options. And what we find is that boys tend to present with the hyperactive type, which really gets the attention of other people, especially teachers.

If your kid can't sit still, they keep fidgeting, as an adult or caregiver, that's going to be annoying, it's going to be disruptive, you won't be able to teach and do whatever. Versus girls, they're able to fly under the radar. They have the disorder, but it often presents more with the inattentive symptoms: daydreaming, not able to keep track of the conversation, forgetfulness and those sorts of symptoms, which are not likely to get the attention of the parents. They may be diagnosed more often, however, it is still quite disabling for the kids and adults who have it.

Chrissy Billau:

Now, rates of ADHD diagnoses over the course of the pandemic, I'm talking about lots of things with mental health, but specifically ADHD diagnoses, those are up over the pandemic and it's spiking in women in particular. At first, I was surprised by it, and then not so much, once I read a little more into it. What do you think is behind the enormous uptick in adult women right now getting diagnosed with ADHD?

Dr. Victoria Kelly:

Well, one thing that we very commonly find is, when a kid is diagnosed with ADHD, that the parent goes, "Oh, wait, I was just like that," or, "I am just like that," and then they end up getting a diagnosis. If you think back, what happened to kids during COVID? Virtual school, which was amazingly horrible for most people.

Chrissy Billau:

Yes. I think we can all agree that was a failure. Everybody tried their best, but it didn't work.

Dr. Victoria Kelly:

Yeah. That's one factor. A lot of things slapped people in the face with, "Oh, my goodness, this sure is a problem. Maybe it wasn't a problem before, but now it is." That's one thing to keep in mind.

The other thing is, a lot of people think they have ADHD, but they don't. Worldwide, it's seen in about 5% of kids, anywhere from 3% to 4% of adults, something like that here in the US. And as you can tell, there's a lot more people that have difficulties with their memories than that. Often, the biggest thing is, well, are you trying to do too much?

Chrissy Billau:

Yeah.

Dr. Victoria Kelly:

Do you have too many plates spinning too many things? Do you need five of your own administrative assistants? If you have a hundred screens open on your computer, it's just not going to work right. It's going to work slowly because our brains are not really meant to multitask like that. That's step one. Whenever anyone comes to me and says, "I think I have ADHD," that's one thing to consider, but it really is a lifelong disorder. About a third of kids who were diagnosed will continue to have severe symptoms into adulthood, about a third have the hyperactivity die off, but they're still inattentive and struggle with that, and then a third then do resolve. Yeah, I think it was just an amalgam of things and raising awareness of it even more.

Chrissy Billau:

Now, if you suspect that you have ADHD or you think maybe one of your children, what would be some good and indicators or red flags? And then, who do you need to talk to? Do you go to your pediatrician or your doctor? What do you do?

Dr. Victoria Kelly:

Yeah.

Chrissy Billau:

Yeah. You kind of yell and scream at them. "First of all, get your head out of clouds."

Dr. Victoria Kelly:

Yeah. I would say, first of all, no name calling. Let's start there. At the very least, don't call someone lazy or whatever. A lot of times, the parents will hear, "You just got to stop babying them," or, "You just need to discipline them," and literally, the brain is wired differently and the captain steering the ship is just going where it wants to instead of where it should, from a neuroscience perspective.

Now, the first step is, if there's dysfunction. Most all of the mental health disorders, to be labeled a disorder, it has to cause impairment in functioning. There's a wide range of normal. It's normal, when we are stressed, to not concentrate as well, when we're sad if we haven't had sleep. We've all experienced that. Sleep deprivation, we all get a little delirious. Is it just something due to something like that, or is it actually causing you dysfunction? And for ADHD, it's got to be in at least two different environments, so school and home or work and school or whatever. That's one marker. What are the symptoms? Where do they occur? How long have they been going on? It really should have been present in childhood before age 12 and you have to have six or more symptoms in those two or more settings. And then, again, what I was saying is inattentive, hyperactive or combined type.

With the hyperactive, impulsive symptoms, you can get fidgeting, difficulty remaining seated, being restless, running or climbing on things, difficulty engaging in activities quietly. Sometimes, we might see somebody, it's like, "Oh, my gosh, that person looks like they just have a motor." There's constant foot tapping. Talking excessively, blurting out answers, you can't wait or take turns or interrupts on others. Those are some of the hyperactive symptoms.

And then, the inattentive ones would be making careless mistakes, zoning out, not appearing to listen, having some troubles with organization, losing things, struggling to follow through, avoiding tasks requiring sustained effort. None of us ever do that, right? Everybody does their laundry and dishes and kitty litter right when it's [inaudible 00:23:09]-

Chrissy Billau:

[inaudible 00:23:09] and you put them away right away too.

Dr. Victoria Kelly:

Of course. Yeah.

Chrissy Billau:

It doesn't sit in the basket forever.

Dr. Victoria Kelly:

Yeah. As you can see, we don't want to pathologize normal, you have to have a lot of the symptoms and they have to have been present for a while and cause you dysfunction. Often, that means you get fired because you can't show up for work, you can't complete your tasks or they're kind of sloppy. We often see, in history taking, lots of failed relationships, lots of failed jobs and difficulty with sustaining anything.

And then, your question of what do we do? First part, recognizing it. Second part is, who do you go to?

Often, I do recommend that people start with their primary care physician. There are medical conditions that can mimic the signs and symptoms of ADHD and/or contribute to it and most often, for that, I'd be sleep disorders. I usually talk until I'm blue in the face with my patients who have any and all attention problems. Go to your primary care, get an evaluation, make sure there's nothing else going on. That may be a physical exam, it may be like EKG or heart studies, maybe a sleep study or seeing an ENT about tonsils because it relates to sleeping at night and blood tests, vitamin levels, et cetera. And then, depending on the severity, you can have ADHD of whatever type and it's categorized as mild, moderate and severe. Mild may not need meds, moderate and severe usually does, but what the data show is that the medications are very helpful for all types, whether it's mild, moderate or severe.

I think another big step is, don't think that the meds are going to solve it all. I remember reading this study once that said, "Just giving a stimulant to a kid does not improve their grades." And it's like, "Okay, well, huh?" And they think, "Oh, this medication will just fix it." Well, what happens is, they would still forget to turn in the homework. They would do it. They wouldn't turn it in.

Chrissy Billau:

Yes.

Dr. Victoria Kelly:

You have to have behavioral therapy, to some extent, to help your medications to work fully so that you can have the best recovery and meet your goals in life that you want.

Chrissy Billau:

Yeah, there is no magic pill that's going to fix everything. You've got to [inaudible 00:25:28]-

Dr. Victoria Kelly:

No. Yeah, almost everything in the mental health disorders, it's hand in hand, medications plus a therapy of some kind. Another thing is, people take their meds and they don't take them over the weekends maybe because they're like, "Oh, I don't want to be medicated," or, "Oh, I don't need it." And if you've ever talked to the spouse or partner of someone who has these disorders or you're a parent to a child you notice the behavioral differences when they're on it versus not. And it's like, yeah, attention and concentration's still probably really good for a romantic partner too.

Chrissy Billau:

Yes. You don't just need that at work.

Dr. Victoria Kelly:

And the referrals for couples therapy, right?

Chrissy Billau:

Yes.

Dr. Victoria Kelly:

It might make a difference.

Chrissy Billau:

Yes. My next question, I don't mean it to be funny. It sounds funny, but it's not. How do you deal with just feeling stupid in terms of in your daily life? No matter if you have any mental health issues or not, sometimes, you just don't feel, even though you're smart, you are incredibly smart. I get this question from some of my incredibly successful friends. "I'm so stupid." I was like, "You? Oh, my gosh, walk a day in my brain here, okay?" How do you deal with that?

Dr. Victoria Kelly:

If a patient said that to me, the first thing I would do is say, "Hold up." You see that meme where it goes, "Hold up." Words are important, especially the words that we say about ourselves.

Chrissy Billau:

Yes.

Dr. Victoria Kelly:

The first thing is, somewhere along your life, probably starting in early childhood, you internalized someone calling you stupid, even if nobody actually did, you did. Maybe a coach, a teacher, a parent, a sibling, somebody somewhere attributed your mistake or your behavior to being stupid, which it's not. One thing is about being nice to yourself. If someone made a mistake and they're like, "I don't know why, that's just so stupid." I immediately say, "Hold up. Let's reframe that. How else would you like to say it differently that does not layer negativity on it? It was just a mistake." One thing is, whenever somebody feels like they are less than, which is usually what it means, whatever the scenario, is to just stop and think at some point, you were layering on judgment and negativity that's probably not necessary.

Again, whether it is you're feeling stressed and overwhelmed and you're reaching your fraying point or you feel like you have too much responsibility, too much of that burden on you. Often, what helps is getting a sense of the opposite, of mastery, of doing well of pride. You focus on the positive instead of the negative.

Chrissy Billau:

Well, and it's always the negative that stays with you. You could have done so many great things throughout the day, but that one thing that one person said to you, you you're thinking of that at night.

Dr. Victoria Kelly:

Yeah. That's the beauty of therapy, though, that everybody thinks that they're very special, but they really aren't, is that, seriously though, it's a very common cognitive distortion. Cognition is the way that we think about ourselves in the world and distortion is, it's distorted.

Pretty common ones with anxious disorders like generalized anxiety, like magnification of little problems become big or minimizing the positives or jumping to conclusions, things like that. They're pretty common with anxiety disorders. And then, there's a whole slew of other ones that are pretty common with depressive disorders. So number one, hold up. Number two, take a deep breath. Number three, reframe what you said. And number four, see if you need to do anything different to offload any responsibility, or perhaps even learn what you need to from what happened.

Chrissy Billau:

Thank you for joining us, Dr. Kelly. Tune in next week for part two of this episode where we'll talk about postpartum depression, why kids can be so mean and the secret to happiness.