S03E10 Transcript: Dr Sarah Vohra on Wellness and Medication Myths

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Gemma Styles [00:00:02] Hello, I'm Gemma and welcome to another episode of Good Influence. This is the podcast where each week you and I meet a guest who will help us pay attention to something we should know about, as well as answer some of your questions. This week, we're talking about well-being and medication myths, daily wellness habits, and how to choose the right ones for you. Navigating social media advice and how to approach. Talking about mental illness medication with the appropriate nuance. So joining me this week is Dr. Sara Vohra, otherwise known online as The Mind Medic. Sara is a consultant psychiatrist with over ten years experience working in the NHS. A speaker and author as well as content creator using her social media platforms to share guidance and tips for all wellbeing, as well as debunking myths and conflicting advice about mental health.

Dr. Sarah Vohra [00:00:53] If you are someone that has a coffee on a morning, maybe to get you exposure to natural daylight, you may decide to open the back doors and sit outside and have your coffee outside. It's more likely that those habits will stick if you start them on top of an existing habit.

Gemma Styles [00:01:07] You use your platforms to share daily wellbeing tips. So starting with the basics, what does mental wellbeing look like to you? Why is that the kind of language you choose to talk about?

Dr. Sarah Vohra [00:01:19] So I think I mean, first foremost, I may consultant, psychiatrist. So I generally assess injury individuals who have mental illness and disorder. And I think what we've noticed, particularly over the last couple of years, I think with the pandemic, is as of being a real focus on mental health and wellbeing. So not necessarily all the severe end of the spectrum that I might see in clinic, but just about encouraging people to look after their minds daily because I think it's been drilled into us that we need to exercise or eat right to look after our physical health. And I think all too often people forgo the stuff that we need to be doing to look after our mental health. And so I think a lot of social media, that wellness space has been taken over by focussing more on our mental health and wellbeing. So the things that we can do that mean that going to support happier, healthier minds in essence, and I think all too often that can feel like it's something that is a luxury or something that you have to pay a lot of money in order to achieve. But actually it's about starting small and doing some really easy, actionable habits that happen the moment you wake up, rightfully to the moment you go to sleep. And it's about making it individual for everyone. So what might be working for me may not necessarily be something that helps you. So I think it is a process of trial and error. So I think utilising my platform to bring a bit of what I bring in from the clinic room to a more mainstream platform and just making it a lot more accessible for people.

Gemma Styles [00:03:01] Yeah, which is great because I feel like everyone, as you say, like it's been an odd couple of years to say the least. I think. Yeah, people are realising that we can tune in a bit more to our own mental health and wellbeing, like you say, rather than you know that meaning. You are suffering from any kind of mental illness. It's about looking after your mind and your self before you ever get to the point of needing someone else's intervention kind of thing.

Dr. Sarah Vohra [00:03:32] Absolutely. And I think that's the thing. A lot of time when I see people in clinic, they will say, I noticed this time last year that things were going down south and I noticed that my concentration was affected or I had less enjoyment in things. And a lot of the time we're so busy that you almost kind of put that to the side. It's not a priority. You may put relationships as a priority. You might have kids, in which case you prioritise them and you get lower and lower down in terms of list of priorities. And it may not be that you seek help until something awful happens, or maybe until you've completely burnt out, but you're not able to operate or function at all. So I think the key really is trying to introduce those habits as early as possible and making it part of a preventative approach to your mental health as opposed to, you know, treating the illness or disorder when it's it's gone so far.

Gemma Styles [00:04:29] Yeah, absolutely. So, I mean, how should we feel ackwards if our mental well-being is good? What's the kind of aim that we're going for? Because I've got a feeling you're going to say it's not feeling 100% happy all of the time.

Dr. Sarah Vohra [00:04:44] Yeah, exactly. And I think that's the key, because I think there can be this notion that being mentally healthy is being free or void of any emotion or negative emotion, rather. But actually it is about feeling a sort of sense of contentment, a balance amongst kind of moments that feel quite difficult and moments that bring you joy. It's not to say that you're not going to have challenging situations in life. Absolutely. There'll be times that challenge you. But actually being able to process those work through them and rather than be at the expense of your mental health. So I think a lot of the time people can get this in this idea that they're trying to achieve 100% happiness. And that is is not the case at all. And I think I have this conversation a lot with individuals where if we have started medication, for instance, if it's that they're so low and so anxious such that they're not able to even engage in therapy because they're not in a place that they can concentrate or be motivated to be able to make the changes that are required in therapy. A lot of the time we may look at medication as a means to support the therapeutic work and as soon as things start to improve and a lot of people refer to it as that sort of fog lifting, we have conversations about what does better look like for you. And again, a lot of the time people won't say, I want to be a different version of what I was before I became unwell. A lot of the time it's just I want to be able to walk out of my front door and not feel this overwhelming sense of anxiety and panic, or I want to be able to make myself a breakfast and not feel like a chore, or I want to be able to spend time with loved ones and not be clock watching and thinking that something awful is going to happen and that I need to return home immediately. So I think it's about recognising that. It's not to say that those difficulties won't be present, but actually feeling more manageable alongside your day to day.

Gemma Styles [00:06:45] Yeah, that's a really interesting way to think about it because I feel like I mean, as someone who talks about this kind of thing a lot, I feel like if I hear the phrase kind of mental wellbeing, I do still think of it as a kind of. Sense of self kind of thing and unlike as a feeling, rather than what actually comes down to, as you say, the really practical things and how our lives are affected by our mental state. Yeah, that's an interesting one. I like that. So we're going to you mentioned medication, which we'll come onto in a little bit because I knew we were going to have going to have a chat about that. But you were also saying about. Some well-being practises, taking into account that not everything works the same way for everyone. What are some of the most basic and I suppose commonly effective wellness practises that we could be doing?

Dr. Sarah Vohra [00:07:43] So I think the pandemic was perfect for highlighting actually what was really important in terms of mental well-being practises, because if we think about what the COVID pandemic forced us to do, it forced us to be in one place at one time. It limited our ability to go outdoors. It limited our social interactions. It didn't make distinctions between our daytime and our Night-Time routines in the sense that actually, for a lot of people, you know, they wouldn't leave their front door at all. And that exposure to natural daylight. Absolutely crucial for maintaining our natural sleep wake cycles, for instance, and helping support a good night's sleep. So if we kind of think about that, actually, the pandemic kind of shone a light on those practises that we probably did without even realising. So that ability to separate and distinguish between arts time and Night-Time is absolutely crucial because one of the things that our bodies rely on is a loss of daylight and a return of daylight to reset our body's natural sleep wake cycles. So if you're cooped up indoors constantly, actually your body is not necessarily going to get the cue that it needs to indicate when it's ready for sleep to release the appropriate hormones to trigger those pathways for sleep, for instance. So what I would always say is kind of a first mode is that a good night's sleep starts the moment that you wake up in the morning. So as soon as you wake up, making sure that you get outside into natural daylight as early as possible, and again, that is to support the production later of an important hormone called melatonin. So melatonin again, supports a good night's sleep. It triggers the pathway needed for a good night's sleep. The other thing is, I think people forget about how much of an impact the bookends of our day can have on our mental health. So I know that I'm incredibly guilty of it in terms of having my phone by my bedside and I sit and it's my alarm clock. And I think the issue is as soon as I switch my alarm off, I'm then invited into what the rest of the world has to offer. So what what messages have come in overnight? What telephone calls have I missed? Oh, let's have a little quick browse on social media, and that's even before I've got out of bed. And actually, if you think about what that's doing to you, that you're sat in your bed, any pyjamas, you know, you've got an hour, whatever it may be to get ready and started for the day. And instantly you may come across a message from work that sets up that sense of urgency that, okay, you can forgo your shower and your leisurely breakfast because you need to get on this email as soon as possible. Yeah. Or someone on social media has already got up and they've done an hour long yoga workout and they're now sitting down with this many people. And again, instantly that feeds into your lack of inadequacy and guilt for actually having to optimise or utilise my morning in an appropriate way. So I think one of the things that you could do, and I'm always met with a look of horror when I suggest this in clinic, is just get an old fashioned alarm clock. And I think the reason being is that it's not going to then lull you into what else is in store that actually forces you to switch the alarm clock and then immediately get out of bed and to start your morning routine and before reaching for your phone to avoid getting pulled into other people's sense of urgency or other people's priorities. I'd encourage people just to do the things that make you feel better able to tackle the day ahead. So whether or not it's grabbing, allegedly shower or maybe doing a workout or having your breakfast or chatting to a loved one, those things before. And it's not to say that when you do open that email inbox that you're not going to be on high alert or feel worried about it, but at least you know that you're primed for it. You know, it is a very different set up than if you were just sat in your bed and you pyjamas and you suddenly get overwhelmed with all these tasks that you've suddenly got to do and you've not even got out and brush your teeth yet. So I think first and foremost, making sure that invest in alarm clock, if you are someone that is likely to get tempted by what else your phone has to offer, doing the things that you know are going to help you and priming for the day and getting outside for some natural daylight and for some people that may come in their commute to work. And I think the other thing that I think particularly pandemics being poor for is it's blurred the boundaries even more so around our work and our downtime because how many people I see on their commute, checking their emails, firing off things and I think actually technically they probably don't start at that time, but again utilising that. Commute time for something that is a bit more light-hearted or, you know, use it as an opportunity to listen to a podcast, to listen to an audiobook. Again, just priming yourself in the best possible position to be able to deal with the stresses of of day to day life. The other thing that the pandemic shone a light on, and I think a lot of people coming out the other side are really struggling with is that lack of social connexion that was suddenly enforced. And us not just, you know, it's great being able to see people online and virtually, but actually that tactile and, you know, physical presence of having somebody. I think a lot of people have lost the confidence of reintroducing that into their day to day life since the pandemic. So, you know, it's not to the degree that people are, you know, socially anxious or not able to manage those social situations, but almost not having the confidence to to pre-empt them. So what I would encourage people to do is, you know, if it's a Sunday evening or Monday looking at a week ahead and making sure that your social connexions are not just work related and you are optimising and making time for, yes, old friends and families because if they work's particularly stressful, those social connexions are not necessarily going to recharge you or help you to recuperate. They are just going to exacerbate the stress you're already feeling. But there is research that suggests that the people that we surround ourselves with, particularly in times of stress, are hugely important because they can help us make sense of that stress and also reduce the effect it would otherwise have on us. So I can't say enough actually. How important is to prioritise social connexions, even if you're horrendously busy? There is always time if it's ten, 50 minutes, you know, if that's all you can offer. But just having time to see someone outside of work I think is really important. And the other thing is exercise. So again, I think this of over the last ten, 15 years, there's been a real shift in how we view exercise. Initially, it was very much viewed in the way of it being a punishment to sort of an earn and burn mentality. But actually, I'm I'm hopeful that I'd say in the last two or three years, I think the COVID pandemic did shine a light on actually utilising exercise. You know, that one hour that we had to go out and do with freedom wanted everyone to utilise that because actually suddenly the importance of just getting outside again, we've spoken about natural daylight, but just getting outside and moving our bodies can help alleviate stress, can help improve our mood, and it can also help regulate our sleep and appetite. So again, some form of movement and it doesn't have to be movement in the sense of it having to be a hit or something overly strenuous, just something that's going to get your heart pumping. And I think the other thing is screen use in general. So I think a lot of people again are glued to their screens in some form. And I know my husband is absolutely terrible for this. He does this sort of multi-tasking multi-screen tasking where we'll be glued to watching a box set. He'll have his laptop off, he'll have his phone on. And you just think which screen you're actually paying attention to. And and I know, again, I'm guilty of it. I feel like just a bit of online shopping whilst watching the entire box set, but actually screens particularly late at night. And screens are blue light and blue light blocks, the crucial hormone I mentioned earlier, melatonin. And again, melatonin so important for triggering the pathways to help us sleep. So it's really important. I'm not going to be a killjoy and say don't don't watch anything lights at night. But it's about thinking if you are someone that struggles with your sleep and we know that sleep can impact our performance the following day, can make us feel quite tired, it can affect our concentration and even our mood. And if those sounds familiar, there is stuff that you can do and it's about maybe setting yourself a realistic curfew. So if you're someone that doesn't get to bed until half 11 and that for you is a preferable before bedtime, yet 30 minutes beforehand, just making sure that you shut down any screens, you read a book, you know, you maybe get in the bath. So another thing that our bodies need to do in order to get a good night's sleep, is it our bodies into their core temperature? So a bath is a perfect way of kind of speeding that along. So having a bath and then getting inspected your preferred time. So all these simple measures from the start of your day. So again, like I said, that old, old fashioned alarm clock making sure that you prioritise something for yourself rather than getting pulled into the external world that early on exercise social connexions and then thinking about your screen use at the latter end of the day as well.

Gemma Styles [00:17:28] Well, I mean, I'm feeling very attacked by some of these examples.

Dr. Sarah Vohra [00:17:32] I'm guilty, too.

Gemma Styles [00:17:34] I mean, this is the thing. It makes me feel better to hear, you know, someone like this is literally what you do for a living. But to hear you say, you know, I'm quite bad for having my phone next to the bed, for example. And I think it's something that we see actually in a lot of different areas. I mean, climate and that kind of activism immediately springs to my mind. But the kind of idea that we see now, where. There's a real perfectionism to it. And if you're not going to do every single thing absolutely perfectly, then what's the point? And I think a lot of maybe sometimes what we see on social media where you'll see different influences and people in certain spaces where it will be, you know, this is what I do in a day. And these are my wellbeing practises and kind of seeing people do every single thing perfectly all throughout their day. That is all guilt geared up towards having, you know, this ideal state of wellbeing, which for people who do do that, you know, more power to you. Great. But. Is it still worth trying to work on things in different areas, even if say so, having my phone late at night is one I'm particularly bad for. And also. Yeah. Working from home, I'd say what you were saying about, you know, daylight and getting out out into the day and breaking up your day to night routine. That's definitely one that I'm not very good at. But how do we, I dunno, find the balance. And kind of get to be okay with. Doing certain practises and still recognising that we don't have to be perfect in all the areas like where where's the best place to begin, would you say?

Dr. Sarah Vohra [00:19:18] I think first you've hit the nail on the head in terms of, you know, it's not about striving for perfection, because I think the problem is as soon as you say absolutely no screen screens, half an hour to an hour before bed, and then there's one evening where, you know, that box that runs a little bit later than you'd anticipated and then think, Oh, that's it, it's over. It's done. I'm not going. I can't do this. It's too much of a difficult change to make. And then you decide to swing the other way and just forget about it altogether. So I think the thing that I always tell individuals that I see is thinking about what is a problem for you at the moment. So I know, for instance, if I turned on to my husband and said, You do need to limit your screen time, he's like, Well, why? Because I'm sleeping fine. And actually I'm performing well the following day. So for him, I'm not going to preach to him that he should come off his screens half knots before bed if it's not an issue for him. And one of this of easy exercises that I try to get people to do and called a day in the life off. And I always use my my seven year old as an example for this. So people will think, actually, what does a seven year old have to feel sad about or unhappy about? But it's just to kind of paint the idea that actually this is an easily translatable exercise. So if we think that she gets up at the crack of dawn, 6 a.m. in the morning, she gets herself dressed ready for the day, she goes downstairs immediately. She she wants a breakfast like on the table. She wants it. Half an hour ago, she watches her favourite TV boxsets and then normally if it's a it's during term time will send her off to school and she's relatively happy and generally we don't hear a peep from the teachers. Now, if I was noticing she wasn't getting up until half seven, eight, I mean, I probably celebrate if I'm honest, because actually that would be a win for me. But for her, that's such an unusual thing for her. You know, she's someone that she's up at the crack of dawn. If I noticed, I was going through her room and she wasn't dressed and she was a bit irritable. She was off her food. She had no interest in watching a favourite TV programme that would kind of lead me to question the key. There's something going on with her either a physical health or mental health, and then you almost become a bit of a detective and think, okay, what's changed? So it may be that we've just come back from a week abroad and actually our body is still trying to adjust to the new pattern being back in the UK. It may be that she'd had a really busy weekend where we're a lot more sociable. She wasn't getting to bed until later, so actually you can then pinpoint the practises that you need to implement. So that's about kind of resetting your bedtime routine, making sure that she's eating well, that she's getting, you know, enough exercise. So what I would say is there's a temptation now that I've kind of shared all these tips and everyone's going to say, right, okay, no. And you kind of try it all at once and then you're not going to know what's made the difference. So I'd probably encourage people just to do that day in the life of exercise and think, okay, is that something that's off or has shifted from my baseline? So am I noticing that I am a bit more irritable, and am I noticing that I'm not getting to bed until late? Okay. Is there a change that I can make there? And I think the key also is sticking at one change long enough to see the benefits through, and it's never going to be a quick fix. And even when we do prescribe a medication for people that I see, it's always going to be in conjunction with other things like therapy and with the lifestyle changes. And again, that's all takes time to see the effects. So I think it is a bit of trial and error. What works for one person is not going to necessarily work for another, and I would just encourage people just to see see things through long enough to to see the benefits from them and also just to reflect on on how those changes are going. If you are seeing the benefits. I think it's important just to take note of those as well.

Gemma Styles [00:23:24] Yeah, definitely. Would you have any advice for people when navigating this kind of wellness advice and content sort of stuff on social media? Because I feel like. I feel like on social media in general you have to be quite mindful, but not everything you come across, even though you know we're in such these algorithm bubbles now and you really get fed stuff that's meant to resonate. Not everything we come across has necessarily been. Been published with us in mind kind of thing. And I think that's something that in my experience being online, people can be quite Bada is kind of coming across some kind of advice or piece of content or something. I'm thinking to themselves, Actually, that doesn't apply to me. That's not for me. I'm going to leave that and move on. Rather than, you know, other pieces might be. Oh, no, that really rings a bell for me. And I think that might be helpful. How do we kind of navigate these spaces and realise? What advice is actually going to be useful for us? Because I feel like in wellness and maybe psychiatry and those kind of things, people are sharing a lot of content is really, really helpful for people. But maybe people don't always know which bits to pick out that apply to them. Does that make any sense?

Dr. Sarah Vohra [00:25:00] No, it does completely. And I think it comes back to I mean, the wellness industry is just inundated by overwhelmed. As soon as you pick up your phone, you're fed. And I think even more so with the change in algorithms, you're fed a lot more things that you feel you ought to try. I was always suggest that people go in there with a an air of cynicism in the sense of just be critical in and look at the advice as an example. We know that the sort of the diet and fitness industry industry have profited off, essentially making inferring that people are that inferring that there's a problem and then being on hand to sell the solution to people. Yeah. So there may be something within a piece of content that you see online where you think, Oh, okay, should I feel like that about my body or should I feel like that about my friendship group? Okay, look at the person that's are they trying to sell me something? I think that can also that can be quite helpful because if you feel that it's a ploy to sell you something, I think you're more likely to take whatever is being served to you with a pinch of salt. And again, obviously, I know people you know, there are businesses online that are in need to be profitable and need to survive. But I think the best pieces of advice question it was this a difficulty for you prior to you seeing the content?

Gemma Styles [00:26:36] That's a very good question.

Dr. Sarah Vohra [00:26:37] And if the answer is no, then look at the content more clearly. Is there a linked link to buy, you know, pay X amount each month? And are they trying to sell you a solution to a problem that actually wasn't actually a problem for you to begin with? I think that can be quite a helpful question to solve. And I think often social media doesn't allow us to stop and think more critically about the information that we're being served. So I think just having that pause and asking yourself quite clearly, was this a problem for me before? If not, do I need do I need to be aware of what the solution is? Probably not. And then move on. And I think also just being able to streamline your feed and following content and creators that resonate with you. You know, you can have the same piece of wellness advice. And actually the way that some one person delivers it might feel quite jarring for you. And actually the way another person delivers it may speak to you more readily. So I think having the confidence to unfollow those accounts that don't speak to you or even worse, that make you feel quite negative or make you feel quite judged. And actually, following creators and content that actually speaks to you, there's a bit more compassion there and actually feels achievable, I think is really important.

Gemma Styles [00:28:00] Yeah, definitely. I think it's is key to remember on social media, you know, we're all very different people, so not everything that people put out is going to be the exact right thing for you. And they might not 100% have specifically you in mind when they make that piece of content. And that's okay because it's not your internet, it's our ID. So feel free to find the stuff that makes you happy. But don't expect everything to make you happy.

Dr. Sarah Vohra [00:28:27] Yeah, absolutely. And I think the other thing that I would also bear in mind is, and this is probably speaking more from with my professional hat on, is that if you're following someone online and they are giving you individual bespoke advice, absolutely steer clear. Because, you know, one of the things we do is sort of have as doctors is that we're regulated by a regulatory body body, and we absolutely should not be giving individual bespoke advice online. So I think often what people will find is that they find a piece of content they like. They reach out to that creator, they'll tell them their life story in however many characters this of DM will allow and they in return that individual will give them a bespoke individual plan with actually no understanding of their backstory, their medical history. So I think, again, a big red flag is if you are asking someone for personal advice and they're able to deliver that without, you know, appropriately assessing you in a in a proper capacity, then that is something to steer clear of as well.

Gemma Styles [00:29:37] Yeah, definitely. And I think that leads us very nicely into. Another little section of chart? I suppose so. You and I connected and decided to record this episode when you replied to a story of mine and it was in a Q&A on Instagram, I responded to somebodies question about anxiety medication, and I'll read the message that you wrote to me just to leaders, and because I think it's a good summation. So you said I think there are a lot of misconceptions around medication that scaremonger people out of something that might be helpful for them. Often it's a case that people present late and in a far worse place with respect to their mental state due to what they've, quote unquote heard about medication on socials. And I think that while we've just been talking about, you know. It's very important that we're not getting specific medical advice about our individual health and situations from social media. Please, bye bye. Mind for the rest of this conversation because we're going to have a chat about medication. But yeah, this does not constitute or substitute your doctor's advice. With all that being said. Let's talk about people talking about mental health medications on social media.

Speaker 3 [00:30:51] Yeah.

Dr. Sarah Vohra [00:30:52] Now, I've said and I think that's when I saw your story, I just felt that it was incredibly balanced and you weren't professing to, you know, knowing it all with respect to the medication or giving any advice necessarily? No. And I think often you will find creatures that will do that. And that's really concerning because I think, you know, in terms of anecdotal experience and, you know, someone can have a really, really ropey experience of being on an antidepressant, for instance, or an anti anxiety medication. And they may feel that they need to be really vocal and warn people about the effects of the without kind of realising who is on the other side of that. So you may have to come to you might have someone who doesn't have any mental illness or disorder generally is mentally healthy and too able. He was able to sort of see that experience for for what it is. But on the other end of the spectrum, you may have someone who's in the grips of a severe anxiety or the grips of a severe clinical depression, and who sees that and thinks there's no hope now? They're probably already feeling rock bottom, and they've probably not even access the support that they need because they feel so hopeless. And actually seeing that sort of content where it feels quite damning about medication and quite negative about someone's own personal experience.

Speaker 3 [00:32:20] Mm hmm.

Dr. Sarah Vohra [00:32:21] May be the difference between someone reaching out to their doctor and trialling medication for the first time or not. Because, I mean, I think I mean, I've been a psychiatrist now for 2012 over 12 years, and there have been a lot of people and this is even with the changes in terms of social media and how much content in social media has changed in that time. I still see people that present very late because of the misinformation that they see online. You know, I follow this person and they've said that anti-depressants are addictive or that I will feel a lot worse and there's no point. And that has made the difference between me presenting, you know, a few months ago or presenting to you today. And a lot of the time they're in a far worse position than they would have been had they come to me a few months prior. And again, it's not to say that that progress can't be made, but just the idea of someone having suffered for that long. Yeah. And it's not to say that their experience would have been the same as the experience that they saw online. So I think, again, being able to sort of look at that content more critically, to think that is that person's experience. You know, we are all individual. And again, yes, there may be times where medication is a negative experience for some people and isn't the answer for some people. But then we have an awful lot of people where in cases that I've seen, it's literally made the difference between life and death for someone that actually someone can be so hopeless, incredibly suicidal. And actually, medication has enabled them to lift them out of that space in order to engage them with the therapeutic work, which is going to be where the mainstay of the work is going to come from anyway. Yeah. So I've kind of I've got the luxury of seeing the benefits that you can offer. Absolutely. There are times where it really doesn't work for people, but I think being able to think more critically about the things that you see online and just taking it with a pinch of salt.

Gemma Styles [00:34:32] Yeah, definitely. I think it's a really nuanced kind of conversation. Or if it isn't, it should be because I mean, even in my personal experience. So I was very much one of those people you kind of described where I ended up going on anti-depressants and seeking that kind of help far later than I should have done. And it would have been better to do it sooner, which I think was, you know, probably partly to do with whatever kind of stigmas it absorbed and, you know, a lot of other factors as well. So. I agree for sure that, you know, people coming out very negatively against, you know, whole classes of medication can be very damaging and not be helpful for people. However, I think it's also true that we should be able to, you know, kind of hold space for people to talk about their experiences of taking different kind of medications. Because I think you honestly see both sides where. Some people won't have had the experience that they wanted from a medication and therefore, you know, say. Quote, You know, all antidepressants are bad and don't work as as a hyperbolic example. But also, I feel like you will sometimes see. Of the content. And I get that it's people, you know, trying to reclaim and take take power and be empowered in their experience. But kind of saying X, Y, Z medication is the best medication in the world and has made this massive difference for me and. You know, definitely works for this condition and kind of kind of does it both ways. And that's something I've definitely seen more from an ADHD perspective, actually, which isn't a mental illness, is something different, but in terms of the way people talk about medication. And yeah, I just I think it can be harmful both ways. But equally they are really important conversations.

Dr. Sarah Vohra [00:36:37] To how a person and I mindful that I have only spoken about the times where and again it's probably reflective of the experience that I see generally coming through the door, which is what they've perceived on social media to be the case is not always married up with their own individual experience, but I completely agree. I think I think for a lot of people going on medication can sometimes feel I think I'm speaking from the patients. I say there can often be a sense of shame in going on medication at times that I should be able to do this without medication and something that we don't readily come forward about in much the same way is that you would if you were taking medication for a physical ailment, you know, take something simple as you've got a headache, there's almost kind of a broad has anyone got any kind of ill? You've got, you know, this kind of there's no shame in requesting the medication or alerting people to the fact that you are taking medication for it. And I think that there still is that element. So I completely. PJ Actually, what you've said about people sharing them or positive experiences off medication can there can be a sense of kind of community around that. I know that Dr. Alex George has done some work, the first for each month where he gets people to sort of post that pill. And again, I think his his work is about trying to reduce the stigma around taking medication. And I think that for some respect, that can help people feel less alone in in sort of taking medication, which I think is leads on to my other myth and common misconception, this idea that once you're on medication, you have to be on it lifelong. And that is not always the case. You know, actually what we should be doing and what, you know, I certainly do in my practise is once we start the medication and we start to see those improvements, we're already talking about when might be an opportunity to get you off the medication. And again, you know, some people may turn around to me and say, this is working for me. I don't want to come off. Whereas other people may be absolutely desperate for the medication just to do what it needs to do and then be supported in coming off it safely. So as an example, one of the things around antidepressants is that you can come off medication when you've when your doctor has observed, your symptoms have improved and you return to your normal level of functioning. So if you've got someone who's moderately or severely depressed or anxious and their life has completely turned around as a result of the medication that they're going out, assessing their self care as they're sleeping better, the appetites improved. They're no longer suicidal from that moment. Assuming that those changes continue and you continue to observe the progress, your doctor might start talking to you about coming off the medication after at least 6 to 12 months of that progress being consistent.

Speaker 3 [00:39:31] Mm hmm.

Dr. Sarah Vohra [00:39:32] And for a lot of people, that is important, that they have got that sort of finish line and that end goal in mind because they, for whatever reason, may not want to continue making medication, whereas you might have someone that has that period of stability. But then there's the fear that if I come off it, that it's all going to unravel. And so, again, it comes back to there's no one size fits all. There's no approach that we take is a blanket approach we take for everyone is very much guided by conversations between you and your doctor. And it should be a collaborative, a joint a joint decision as to when that is. But I think the key is that and again, I think some of the things I've seen on social media are about people talking about weaning myself off the medication, or I'm just I've decided I don't want to be on medication anymore. I'm taking myself off. And I think those messages can be quite concerning because again, that should be absolutely something that happens with medical supervision, because if you abruptly stop your medication, actually your symptoms can come back far worse and you could be in a much worse place than you were to begin with. So it's not to say that medications mean you have to be on lifelong or that your doctor wants to keep you on it lifelong. If you do want to come off the medication, it's really important that you seek the advice from your doctor and they support you in doing that safely.

Gemma Styles [00:40:56] Yeah, definitely. I mean, also, as someone who's been through the wringer over the years, I have come off medication without speaking to a doctor first. And it's a really bad idea. And please learn from my mistake. Don't do that. Please speak to a lot of us. Okay, so let's maybe finish up this section. So if we think about, you know, we're talking about medication and the kind of misconceptions and what might maybe put people off or make people anxious about medication. So imagining that someone is in a position where they've got to the point and have spoken to a doctor about their mental health. The doctor has suggested that maybe some kind of medication might be helpful for them. And then that person feels quite anxious and panicked about that and just doesn't really know whether to say yes or whether to say no. What are maybe some good questions that you should be asking your doctor in that scenario? In terms of what? What do people need to know from their doctors about their medication, whether that's, you know, how long will I be on it? What's the process of coming on and going off sort of thing? What what should people be asking their doctors before they make those individual decisions?

Dr. Sarah Vohra [00:42:07] So I think, first and foremost, have have we tried everything that we could try before? I need to take this medication. So I think often, you know, consultations can be quite time poor. I mean, it depends again, if you've gone to your GP or whether GP's referred you on to someone like myself and first of all, a specialist opinion. But I think first and foremost, one of the things we think about medication is that.

Speaker 3 [00:42:34] It.

Dr. Sarah Vohra [00:42:35] Needs to be the least restrictive. So putting someone on medication is not a decision that we make lightly because it subjects you to side effects. And actually one of the questions we have to ask is, are the side effects more? So is it are the risks of putting this person on medication more than if they weren't on the medication. So for instance, if, say, someone is severely depressed, actually the side effects may be that actually whilst we recognise the side effects, the risk of them not being on this medication, improving that depression is greater. Therefore, we need to make the decision to put them on it. So I think when we kind of see someone in clinic, you know, obviously first and foremost, we'd always offer them some therapeutic work, whatever that may look like, whatever may be suited to their early life experiences or what's going on for them at the moment. So I suppose I would want I hope that in the consultation you'd have a discussion about, well, this is being tried, this, this form of therapy has been tried. And we've noticed that you're really struggling to motivate yourself for the work or you're struggling to focus or you don't have the energy for the therapeutic work. And therefore, that's why we're putting you on the medication to support you, engage in the therapeutic work. So it's making sure that the doctor has kind of exhausted all the other options prior to considering medication. And I think also asking your doctor what is going to be happening alongside the medication. So it may be that you may not be in a position even to start the therapy or the therapeutic work at the point of starting medication, because actually you're still severely depressed, severely anxious. I'm mindful that we're talking mainly about depression and anxiety, but clearly there are other mental health disorders that could be at play for you. But I'm just thinking, referring to the sort of the most common for that person.

Gemma Styles [00:44:28] Yeah.

Dr. Sarah Vohra [00:44:29] So your doctor might say, look, you're not in a position to start any therapeutic work, but we will revisit in a couple of months or so. I think having some idea of what else is going to be offered alongside the medication can be helpful. And the lot of people want to know at what point will I start to feel better? And again, it's about managing those expectations that it's not going to be a quick fix. I mean, there are certain medications that may help with kind of acute anxiety for that moment when you feel quite acutely anxious or agitated. But those are not medications that you would have someone on, you know, as long as you would have silenced depression.

Gemma Styles [00:45:07] Yeah, but.

Dr. Sarah Vohra [00:45:08] Getting a sort of an idea from your doctor as to when do I expect that I will start to feel better for my symptoms and side effects, I think are really, really important just so that someone can make an informed decision. Because, you know, whilst a side effect like feeling sickly or a headache may not be a big deal for one person, someone who's got a history of migraine and or, you know, has issues with respect to feeding sick may actually want to say, look, I know that there's a risk if we don't treat my depression, but at the moment, that doesn't sound like it's one for me. So maybe thinking about other options if the side effect profile that's been presented to you just doesn't doesn't fit with with you. And I think also thinking about is this something that I have to take for a long time, coming back to my earlier point around it not necessarily being lifelong, having some idea from your doctor at what point they would look to withdraw and stop the medication and if that is a possibility as well.

Gemma Styles [00:46:12] Every week my guest and I will be answering your questions. On the first one comes in from Philly, who says, After many years of struggling mentally, I feel great for the first time, but I can't really enjoy the moment because I always think about the bad times that might come again. How can I maintain positivity and enjoy my good mental state at the moment?

Dr. Sarah Vohra [00:46:32] Yeah, that's a really, really common worry for a lot of people. And again, I've got a very simple exercise and it is thinking more broadly about worry in general. And so as we go about our day, if we think about how worry may so utterly consume us to the point that we're not able to enjoy and in this example of. August isn't that she's not able to enjoy the current and the present. So what I would say is when you notice the worry in the end to your mind, ask yourself, is this a problem solving worry or is this a might not worry? So is this a worry that I can readily turn into a problem that I can solve at the moment or at some point and move on from? Or is this something that might not even happen? And that is actually going to consume a lot of time and energy. And what I would say is at this moment, she's probably experiencing might not worry. It might not ever get as bad as it has been previously. And ruminating about that possibility that may not even come about is going to impact sort of your day to day impacts, kind of your ability to enjoy social connexions or to knuckle down with your job or whatever it may be. So I always utilise the notes section of my phone for this that as those worries crop up in your mind, jot down those might not worries until yourself that you can come back to at the book end of the day. And you may ask me actually, but what happens if it's constantly coming in? Just repeat that practise and reinforce it. So every time that worry, if I worry that it's going to get as bad as it was previously, just sit down on your phone and then at the bookends of your day. So I prefer this off last thing in the day. So around half seven, 8:00, give yourself a worry curfew. So that's your opportunity to come back to that list that you've generated of my not worries. So once you come back to that, you can think, well, actually that didn't happen. I've had a really positive day so you kind of can strike off those list of might not worries and I'm thinking so a more tangible example that prior to us recording today I had a might not worry you know I catastrophize we had a bit of a tech issue and I was worried that, well, what happens is not going to go ahead. What will Gemma think of me? Oh, my God. She's not going to invite me back to speak to where you can see how very quickly that worry can run away with you. Yeah, there is actually. Yeah, that's not a worry that I can tend to a problem that I can solve. But actually the worry about trying to get logged on again and to make sure that we can continue with our conversation, I can turn that into problem that I can solve by sourcing another lead and making sure that I'm downloading the right programme. And yeah, can you see that? That can feel quite empowering if you have an ability to turn that worry into a problem. So why did that guess to since do it and anyone that finds themselves utterly consumed by worry is to ask yourself, is this a worry that I can turn into a problem I can solve? If so, solve the problem. And it might be about you outsourcing that support. So it might be about, you know, you recognising that your skill set means that you're not able to solve the problem. So looking to friends and family to support you with that or work colleague and dedicating pockets of time in your day. So for instance, if I come back to my worry list later on in the day, I can say, well, actually I managed to get on the call. And, you know, I think Gemma likes me. I don't think she thought I was, you know, incompetent. Thank you.

Gemma Styles [00:49:59] Very much.

Dr. Sarah Vohra [00:50:01] But do you say actually, rather than getting caught up in that worry in the moment, you simply postponing it to say, right, not now, I'm not going to worry about this at the moment because I can't solve it at the moment. I'll postpone it and I'll come back to it.

Gemma Styles [00:50:14] I love that because I think that's something I actually do. I kind of subconsciously know in such a structured way, but I think I've kind of started doing that a bit whereby if something's happening three weeks away that I'm anxious about and I know that I'm going to be anxious about it because I just unlike I can work through that now, but I know it's going to happen. I will kind of just say to myself, Well, I'll start worrying about it a week before and then just kind of like take it out of my head a bit more for about two weeks maybe. And then I allow myself to start thinking about it and doing the kind of problem solving or just letting it take up more brain space a bit closer to the time. So I quite like, but I feel like I'm half halfway to doing it, so maybe that's something I can work on. Next question is from Barra, who says, I've got a question about medication myths. I've been taking a mood stabiliser for five months and it's definitely stabilised my moods and put some space between me and my thoughts. I'm thinking of going off it because it's got some side effects I don't like, but mostly because I feel like my mind now understands what it's like to be in this state and I could get there on my own. Is this a thing?

Dr. Sarah Vohra [00:51:22] So I think I'm not. Signpost you to your own doctor for advice around this. I think often when you are taking medication like mood stabilisers, absolutely. There will be a point where you feel a sense of, oh, I don't like the word normal, but it's of a degree of normality around your mood and your mental state. But what I would say and again, I can advise because obviously I'm not aware for listeners medical history of mental health history, but what I would urge them to do is to speak to their doctor. And again, it's coming back to that point around those of earlier questions around how long you need to be on the medication. And is there is there the possibility of trialling a taper down and stopping? But those are absolutely things that need to be done alongside medical supervision.

Speaker 3 [00:52:15] Mm hmm.

Gemma Styles [00:52:16] In terms of the kind of broader background thing there and I mean, I don't know if you'll have an answer to this or not, but do you think it is sometimes the case that by being on some kind of mental health medication, that it does allow us to. Allow us to kind of see a new way of thinking. And that's done something you can. Learn from as well as the medication helping you to get to that place.

Dr. Sarah Vohra [00:52:47] So I think it's really difficult when I start medication. You never know whether or not that person may have observed an improvement in their symptoms without the medication having me started, because actually I think there's also almost an assumption that the medication started and the medication has led to all of these really positive changes. But it may have been and I saw earlier referred to as a fog, but that's just the words that my patients often use is kind of that lifting of that fog. That means that the concentrations able to improve such that they're able to read and they gain a lot of enjoyment from reading, for instance, and which is something that I probably couldn't have done without the medications support with. And so I think it's really difficult to say absolutely these benefits that I've gained from the medication entirely. But it may be that the medication has made other areas of your life more accessible and for instance, socialising. So if you're in the grips of depression, actually socialising may be bottom of your list of priorities, but actually the medication may help give you a bit more energy or, you know, reduce your sorrow and improve your mood such that you're able to then socialise and then the socialising then has a positive impact on your mental health. So I think certainly that there's a lot that medication can do. But then I'd be looking to what other things that you introduce alongside the medication as also contributes to your progress.

Gemma Styles [00:54:20] Yeah, that makes complete sense. Okay. So last question from Juliet to who says, I know from my mother that my dad has quite a problem with his brain. He attends a psychiatrist and he has medication. However, he's hiding it from me and my siblings. My question is, how can I let him know that I won't change my mind about him when he's so shy and scared about it?

Dr. Sarah Vohra [00:54:43] So is the question around them wanting to know the risk of them having mental difficulties. It was just around just trying to support.

Gemma Styles [00:54:52] I think it's around trying to support. So then she's aware that her dad is seeing a psychiatrist and is on medication. But won't talk to or is like hides it from his children. On how can she kind of support him which to me I think there's a line now with kind of like privacy. Yeah, letting people do what they want.

Dr. Sarah Vohra [00:55:13] But I think that's the difficulty because I think, if you may, I mean, if you make it aware that you know exactly what's going on, then does that create difficulties between your parents in the sense that then dad feels that he's been betrayed because his confidentiality has been betrayed? But I what I would say is about creating opportunities for you and your dad. So more authentically, that might mean in time he may choose to confide in you. So again, I can't comment in terms of I don't know what this pre-existing relationship was. And is this a fan? I do a lot of work in terms of family therapy as well, and those or family dynamics can also impact on someone's recovery or not. So is this a family that would normally talk about things like mental health and in which case, if they weren't, is it likely that your dad wouldn't have come forward about his mental health had he not been seeing a psychiatrist, for instance? And so I would try to create moments between you and your dad or as a family that are more authentic. It's about spending time together. So more, you know, this whole positive lifestyle changes that we spoke about earlier around socialising, getting outside, maybe go on a walk together that may lend itself further down the line of him feeling it's a safe space to be able to open up to you and you're already then showing your support. Whilst it may not be in a direct way, it's that indirect and that kind of creating a safe space for him perhaps to open up. A He may have a multitude of reasons as to why he doesn't feel able to open up to you. It may be shame. It may be that you just want to burden you those. Those are all barriers that may mean that he doesn't want to. Or it may be that that's not the done thing in your family as well. So I think maybe creating pockets in your week or in the month, if that's more realistic for you, what are you able to do things as a family that may mean that further down the line, that feel that conversation feels more authentic?

Gemma Styles [00:57:22] Yeah, I felt similarly, I think in terms of when I read that question, I thought it was so nice because you can tell there's so much kind of supportive energy behind. And you know, Julie has a doesn't doesn't want her dad to think that he couldn't tell her. But equally on the flip side. Nobody ever owes you an explanation of what's going on, like in their own medical kind of dealings, if you like. So as much as you would be supportive. And that is amazing and great and brilliant. Your dad still is entitled to his privacy and he gets to decide whether he tells you about it or not. So, I mean, I agree with you in terms of if you can, in the small ways, kind of create an atmosphere where people know that you'll be supportive. That's great, but don't take it as an insult or, you know, people thinking you won't understand or people thinking you won't be supportive, don't kind of make it about you in terms of whether they want to talk to you or not.

Dr. Sarah Vohra [00:58:28] And I think also in this situation, it is a bit more nuanced in the sense that it sounds like her dad's already seeing the most appropriate professional and he is getting that support. But I suppose if it was a different scenario that was being presented where you were worried about your dad, he wasn't seeking support and his mental health was deteriorating. That's a different situation entirely, and I would suggest then that lends itself to having a conversation with him. So I kind of don't want people to think it's, you know, if you're really concerned about someone that you should never approach them. And again, one of the tools that I use to have a conversation more confident conversations is something called face fear. So about it's having face to face conversations, being attentive, so listening to that other person's not interjecting and you bringing your own agenda, actually listening to what they've got to say. Staying calm. So rather than kind of getting tearful or maybe angry with them and forcing them to open up, actually trying to keep your emotions in check. So to convey this idea that it is a safe space for them to open up and is about encouragement, and then the fear aspect is coming back to our day in the life of exercise that we spoke to earlier. What are the facts? What have you noticed that shifted from the norm? So I've noticed you're not getting out of bed until later. You're a lot more irritable than normal. You don't want to sit down and eat dinner with us all. So what are the facts that you've noticed and is explained? So put those into context. Don't roll off a list of things that you've noticed without kind of because that can get someone's back up. So actually say, look, you know, you're normally someone that's straight out of bed in the morning. You're normally the person that insists that we all sit around the table together. So put those concerns into context and a and I's agreed action and review. So it may be that first conversation never amounts to anything but a maybe agreeing to look I am really worried about you and I know you're saying things are fine, but how about we come back to this in a day, a couple of days, and we do another check in? Or how about we start going to the gym together? Well, how about we do a walk in a few, few days time and and try and clear the air? And I think often there may be a situation where someone's gone through a Break-Up, in which case the change in mental state and how they feel can be understandable and attributed to that, in which case you'd notice a an improvement. So what I'd say is and we've answered this of the guests and listeners question already, but I think if you are someone who's concerned about someone else's mental health and you have those same worries about kind of prying or them not opening up to you, I think face fear can be quite a useful starting point to have this or more confident, structured conversation.

Gemma Styles [01:01:10] If you want to know about opportunities to send in questions for upcoming guests, then follow us on Instagram or Twitter at good influence. Yes. Or you can email the podcast at Good Influence podcast gmail.com. Before you go, I've got three things I ask every guest. That's if listeners want to find out more about what we've been talking about. Could you please recommend us? Something to read, something to listen to, and something to watch?

Dr. Sarah Vohra [01:01:35] So I think something to read. And I think this leads quite nicely on to because I've thrown a load of habits out there that actually may for quite overwhelming in terms of people not knowing where to start with them. So a book that I read last year was Atomic Habits, and I felt like I was a bit late to the party with that one. So it's Atomic Habits by James Clare, and I just found the book just really actionable, very sensible advice. And one of the things he talks about within the book is something called habit stacking. So I think this idea of just staying in a habit out of the blue is something that we're not necessarily likely to commit to. So what the one of the things that he talks about is actually putting a new habit and stacking on top of an existing one. So as an example, if you are someone that has a coffee on a morning, maybe to get you exposure to natural daylight, you may decide to open the back doors and sit outside and have your coffee outside as as an example. And it's more it's more likely that those habits will stick if you stack them on top of an existing habit. So I can't recommend that book enough. I really yeah. A really great read. So something to listen to. So I'll do a bit of a plug in the sense that I've written a couple of books and my most recent book, The Mind Magic, came out a couple of years ago and I did an audiobook for that, so a lot. Of the advice that I've given around here. If you are someone that likes to listen to staff, maybe it's only commutes. The audio books say the mine medick. That's on all good audiobook platforms and something to watch. So I generally I'm not on TikTok all that often, but someone that I do like to follow on that is Dr. Judy Smith, who I know you've had on the podcast previously, and we do.

Gemma Styles [01:03:24] Love Dr..

Dr. Sarah Vohra [01:03:25] Judy, just fantastic in terms of her ability to sort of create really simple, actionable videos from seemingly quite difficult constructs. And I think, yeah, it's a real skill and I could watch her videos all day. So if you're someone that doesn't really know where to start and you prefer to be able to watch sort of tips and tricks, I think she's in a perfect place to start.

Gemma Styles [01:03:55] Thank you so much for listening. And thank you, sir, for joining me. If you enjoyed the episode, I'd love you to subscribe to the podcast on whichever platform you're using and if you've got an extra minute, you can leave a rating on a review as well. Your reviews make a big difference and help other people find the podcast. See you next.

Speaker 3 [01:04:10] Week.