 Hello, Psych2Go viewers. Our guest for today's live stream is Dr. Ola Kenosha, also referred to as Dr. Kay. He is the host of his own amazing YouTube channel, Healthy Gamer, which is a mental health platform that has been viewed by millions of people worldwide. He's also the co-founder of the Healthy Gamer Foundation. Welcome, Dr. Kay. Thank you so much for joining us today. Thank you so much for having us, Michelle. I appreciate it. Of course. So can you start off by telling us a little bit about yourself and your background? Sure. So I grew up in Texas and played a lot of video games, struggled a lot with video game addiction myself, basically failed out of college, went to India to find myself, stated a lot of monasteries and stuff, decided to become a monk, and then seven years later decided that that was not the path for me, went to med school, became a psychiatrist, and then thought that a lot of what we understand about psychiatry needed to kind of be modernized and sort of translated to the digital generation, which is why we started Healthy Gamer. Absolutely. And you're a Harvard train psychiatrist, which is really impressive. Yeah. So I trained and was a faculty at Harvard Medical School. That's correct. Wonderful. So just to start off with the first question, Dr. Kay, how would you define depression and anxiety? Yeah. So it's a great question. So let's start by understanding that depression and anxiety are emotions, right? And so what's happening right now in our society, which is great, is that there's a lot more information and awareness about mental illness. So sometimes people are using those terms to refer to clinical things. So when we kind of talk about a diagnosis of, let's say a mood disorder, like major depressive disorder, a bipolar disorder, oftentimes when people say, I have depression, that's kind of what they're referring to. Similarly, anxiety is just an emotion that everyone experiences. But what we're seeing is that anxiety disorders are on the rise. And what we sort of think about in terms of like, a lot of people will wonder, okay, do I have a diagnosis or not? What we sort of really think about as clinicians is whether it impairs your function. So what's the difference between someone who worries a lot and someone who has an anxiety disorder? Is the amount of worry that you experience interfering with your life in some way, keeping you from doing schoolwork, keeping you from being social, keeping you from like advancing professionally? And if it's really causing a problem, it is a problem. Absolutely. And so like on that, so according to WebMD, the chance of acquiring depression is much higher when an anxiety disorder already exists. About 60% of people with anxiety also have symptoms of depression and vice versa. Dr. Kay, can you explain to our viewers how depression and anxiety go hand in hand? Absolutely. So there are a couple of different angles on this. The first thing that we need to understand is that if you grow up as a teenager with some other psychiatric illness, there is a very high chance you will also be diagnosed with a depressive disorder later in life. So if you have anxiety as a teenager, about two-thirds of people will grow up to also have a mood disorder. That's of the comorbid populations. There's a slight kind of caveat there. And then the same is actually true of ADHD. And the reason for that is that if we kind of think about, okay, what makes us healthy, well-adjusted individuals, it's having a normal adolescence, basically. And what we see in people who grow up with ADHD or have anxiety disorders is that they miss out on a lot of very common experiences that like normal teenagers should have. So your anxiety will keep you from going to parties, will keep you from making friends. You'll worry so much about a test that you won't be able to sleep at night. And the next day you kind of wake up and like, like your mind isn't functioning properly. And then you do poorly on the test anyway, which kind of, you know, causes a vicious cycle. So that's one thing that we sort of know is that if you have an anxiety disorder, your risk of developing depression actually increases. But there's more to it than that. So we also know that both, we look at treatments for mood disorders and anxiety disorders, oftentimes we'll use serotonin boosting medications in both. And so what we kind of know is that when people have quote unquote low serotonin, although their serotonin may not be low, serotonin is like a neurotransmitter that governs like contentment and well-being. And boosting serotonin in both of those illnesses seems to help people like feel better. So there may be common like neurotransmitter stuff kind of going on. And then the other thing that's really common about the two is that oftentimes they'll have like cognitive filters. So what I mean by that is that people with anxiety will ignore reassuring information and will actually be hyper vigilant to scary information. And people with depression will sort of do the same thing where they'll ignore things that would make them feel good and will sort of focus on the things that will kind of make them feel bad. So we know that there's like cognitive biases or cognitive filters in both cases that oftentimes intersect. And in one of your videos, and it was so interesting, you actually mentioned that there's a correlation between depression and high IQ and that people with depression that tend to actually be very logical about it. Yeah. So there's some data that suggests that IQ and depression kind of go hand in hand. There are many cases where that's not the case. But one of the things that's really interesting is that oftentimes people with high IQ suffer in a slightly different way with depression. Because if we think about what depression is, it's basically your mind being turned against you. So whereas your mind normally gives you like reassuring information, gives you reassuring analyses in the mind of someone who's suffering from a mood disorder, their mind is like calculating in the wrong direction. But if we think about IQ, that's like your power to calculate. So what we sometimes see is that people with depression have very high IQ, they can, they can really, it's almost like that IQ is being turned against them. And they're very good at providing evidence and analysis to conclude that they're kind of like screwed in life and there's no point and stuff like that. That makes sense. That really does. So the Herring statistics show that depression exacerbated by anxiety has a much higher suicide rate than depression alone. In one study, 92% of depressed patients who had attempted suicide were also plagued by severe anxiety. Research also shows that when anxiety occurs co-morbidly with depression, the symptoms of both depression and anxiety are more severe compared to when each disorder occurs alone. So Dr. Kay, can you explain why the symptoms are so much more severe when these two disorders occur together? Yeah, absolutely. So there's kind of like a high level answer and a more detailed answer. So on a high level answer, we have to understand that the human body, brain and mind are like one unit. And if you're trying to deal with multiple things at once, your body just doesn't have the capacity to like fight off two different things. So if I'm struggling with, for example, like a skin infection and COVID at the same time, that's like more than my body can handle. Normally dealing with either one is requires my whole body's attention. And we also see that in mental illness where anytime you've got multiple illnesses at play, it's kind of like more than your body or brain or mind can handle. We also know that there are some ways that these things will like intersect. So now getting on to more details where if we kind of think about, okay, like if I'm struggling with a mood disorder, now let's say I've got depression, what are the kinds of things that I would do to protect myself or help myself? I would maybe go find a therapist or go reach out to some people for help or support, reach out to friends. And if we kind of think about if I also have anxiety, well, then like, what's that going to do? It's going to be like, well, maybe the therapist like has better people to see and you don't really need their help and your anxiety is going to prevent you from getting help for your depression. Your anxiety will keep you from reaching out to friends because, oh, like, you'll have these kinds of thoughts like, why would they want to bother with me? They're out there having fun. And if I go and I'm depressed, like, you know, I'm going to ruin their day. So oftentimes the anxiety gets in the way of the things that would help depression. And it works the other way too, where let's say I have crippling anxiety and I've got really bad social anxiety, but I have trouble getting out of bed in the morning because I'm in the middle of a major depressive episode. So I skip my appointment, miss my appointment, miss work, and then my anxiety kind of piles on top. And it's like, well, I missed a week at work. I'm really worried about going back. So the two can really like intersect in a very unhealthy way. Well, that's like a very interesting insight that like the anxiety gets in the way of actually getting help for something that you need for the depression. So wow. And so then what are some of the mental barriers that keep people stuck in a cycle of depression and anxiety? So this is what's tricky. I mean, I think that oftentimes if we look at these illnesses, part of the nature of the illness is that it keeps us stuck. Excuse me. So if we think about someone who's got, let's say a mood disorder, part of the problem is that when you have a mood disorder, it makes you think about the future in a very negative light, right? So if you've got like a depressive episode, you're going to feel hopeless. And so then if you kind of think about it, what keeps us stuck is like, well, if it's hopeless, like what's the point in getting treatment? So subjectively, you know, there's some thoughts that I've seen patients have over and over and over again. And if people like have these kinds of thoughts, it's interesting because you should definitely get help. So here are just some examples. The first is like, if I get help, it won't work for me. Or sometimes even I've tried to get help and it hasn't worked. Nothing will work. I'm a hopeless kind of case. Or these kinds of thoughts like people have better, there are better patients out there who deserve help more than I do. So these kinds of thoughts will sort of get in the way of us seeking help. And that's kind of the feature of the illness itself. So I kind of think about a mood disorder in some ways is like the HIV of the mind. So if we think about HIV, it attacks our immune cells. So it attacks the part of us that actually fights infection. And depression actually does the same thing. What if we think about when we're normally struggling, what do we do? We reach out for help. We ask for support. But depression makes us think that reaching out for help will be completely useless. And so it attacks our ability to actually get help. So with that being said, how do we defeat these mental barriers? And how does one empower themselves to seek mental health treatment? Yeah, it's a great question. I think we've got to be a little bit careful with our language. So I really appreciate the positivity of your language. But I think using the word defeat, like how do we defeat cancer? You know, we'll use that language too. And one of the things that we've learned from cancer research is that if some people beat cancer, but then if you don't win, does that kind of make you a loser? So I think we've got to be a little bit here. From the approach of empowerment, how do we empower? I'm with you. I'm with you. And that's the challenge, right, is that we use some of these words. I didn't mean to call you out there. But I think we've got to be careful. Because the first is that implies that people with depression aren't empowered in some way, which is kind of interesting, because I think that what we really have to do, and it's kind of weird, but what I found is very useful, and this may be sort of like the background as a monk, is that it's not about defeating depression, it's about actually accepting it and living with it can be just as useful, recognizing that, hey, this is sort of like part of the way that my brain is wired in this moment. And there's a lot of great success stories about people really overcoming depression. So I'm all for empowerment. But I think sometimes, especially if the audience is depressed, that language can make people feel worse. And if you want to talk about the cycle, it's like, okay, if these are the things I should do to empower myself, if people can't do those things, it can actually make people feel worse. So there are absolutely things that we should do to destigmatize and empower people. But I also think there are things that we can, we should really understand that this is just a part of your life right now. And I think a lot of that empowerment actually starts with acceptance. So you really made me see it from a different perspective, because I never thought of it that way, like just accepting it for what it is. Yeah, you know, you're right about that. Absolutely. Yeah, so it's kind of weird, but like there are studies that show that some of these like, there's a lot of evolution in the field of psychotherapy right now. And we're seeing something called third wave therapies. And third wave therapies are basically old types of psychotherapy, plus like mindfulness or Eastern principles. And we're seeing some of these therapies have more effect for a lot of things that we haven't been great at treating. And it's really this acceptance angle, right? So like we live in a society where we want to perfect everything. Like I'm not going to order something from the internet unless it's got five stars. I want to eat at restaurants that have five stars. Absolutely. I want my, you know, my Uber driver or Lyft driver to have five stars. So we're all about optimizing and fixing. Yeah. And sometimes I think we got to take a step back and say like, Hey, this is, this may just be something that I'm struggling with, which sounds kind of depressing, right? And that I may not be able to fix this. But the really fascinating thing is that when you sort of accept, instead of struggle to change things over and over and over again, somehow clinically, it can help people. So I didn't mean to just attack your question though. So like going back to that, I do think that actually conversations like this are really, really important at destigmatizing. I think that people with depression do really struggle with feelings of disempowerment and hopelessness. So helping people kind of get there is really, really important. I think one thing that people can do is that depression and anxiety are both very isolating experiences. So even sharing your experience with other people and then checking in with them afterward, because we make a lot of assumptions that, oh, people wouldn't want to hear this, right? Like because I'm burdening them. So if we talk about that, if we kind of think about that, if I don't share things with people, what I'm actually doing is promoting the stigma because, Hey, we're not going to talk about it. So sometimes what we really want to do is share our experience with other people and you can just check in with them. Hey, what was that like for you? It kind of felt like I was trauma dumping there or like, you know, like, is that, does that weigh on you in a negative way? You can just check in with people. And the really cool thing that we tend to see in our community is that when people share their experiences, what they actually find is that there's a lot of connection and that other people will say, Hey, I've really been struggling with that too. And that bond can really help empower everyone involved and destigmatize things. Absolutely. So essentially, there's a tremendous strength in vulnerability. Absolutely. Right. So vulnerable strength and vulnerability. And that's a great way to put it, Michelle, because being vulnerable requires acceptance. Absolutely. So if you're vulnerable along the way, you're going to sort of automatically accept. And then you're also going to open yourself up to connection, which can be so helpful for people struggling with mood disorders or anxiety disorders. Yeah, a support system is essential. Like, you could never do anything alone in this life, right? So for everything, you just, you need a support system, that foundation. And if you don't have it, you can find it. Yeah. So I love that attitude, Michelle. I think the really scary thing is that we're quickly entering a world where you can do everything on your own. It's bad for your health for sure. So I think yours is the right way to do it. But we live in a world today where I can get groceries delivered to my house, food delivered to my house. I can find plumbers to come online. I can work online. I can play games online. I can have an online community. So we human beings are the most independent and isolation prone that we've ever been. Well, no, that's absolutely true. And I think that it can sometimes make things worse. Like it makes things more accessible. It makes things easier. But then it's like, okay, I feel alone. Yeah. Yeah, well said. We pay a price for that convenience. You always do, right? Always a trade off. So how can we effectively support someone we know who's suffering from depression and anxiety? So that's such a great question. So I think oftentimes it's tricky because when someone is struggling, we want to try to help them in a meaningful way. And so what a lot of friends or partners or parents or even children will do is try to be someone's therapist. You recognize that this person needs help. And oftentimes they'll lean on you in some way. And oftentimes it's more than someone can handle. So we really struggle about how can I help my friend like feel less suicidal, or how can I help my friend who's so depressed and like has trouble sleeping, is so anxious all the time. And it's great to be a friend. But I think one of the most important things that you can do is help connect that person to some form of mental health treatment. And oftentimes, oftentimes what happens is that we feel like we're kind of passing them off, right? Like, hey, I'm not going to handle that. Like you go talk to a professional. It's like, that's kind of how it can feel to us as friends. We can feel guilty for doing that. But I think even sort of having some really good language around, hey, I can see that you're really struggling. I want to be your friend and I want to be here for you. And at the same time, I really think that maybe you should get evaluated by a professional. And sometimes that can be something as simple as like reviewing profiles with them, like say like, hey, do you want to call this person? Can we call them together? Like what do you think about making an appointment? Is especially with people with anxiety and depression, like they're going to, their mind is going to find excuses for them not to call or not to make an appointment. So sometimes that's one of the most important things that you can do. Yeah. And there's a helpful way of giving like a recommendation as a friend, like what you said, guiding them, like showing them, I'm not passing you off. I care about you. Let's look for, you know, a therapist together. Let me, you know, maybe I, they have a therapist. It's like, you know, here's their number, right? So you're actually helping them because they need, if they're struggling with depression and anxiety, they need to see a mental health professional. Absolutely. Yeah. And I think, I liked what you said there, because I think sometimes the one of the best things that we can do for someone is to acknowledge that we can't help them in the way that they deserve. And we're going to try to help them find the help that they deserve. That's perfect. That's the perfect way of putting it because we all deserve help. Absolutely. Yeah. And so what are some coping strategies that you recommend for those struggling with depression and anxiety? It's a great question. So I'm laughing a lot because I think that oftentimes people who are struggling with depression and anxiety are actually like experts at coping, right? They're maxed out on their coping skills. And so one of the things that honestly my experience with a clinician is like, I get that you're coping and like, yeah, let's do mindfulness so that you can cope more. But honestly, it makes me super sad that like people have to cope so much. Right? And so it's kind of weird, but like I almost want to encourage people to get help because everyone wants to optimize coping strategies. And it's a good thing to do. We know that there's good scientific evidence behind them. But also like sometimes people will avoid going into treatment because they're like, okay, if I like learn one more coping skill, then I'll be able to cope. I'll be able to cope. I'll be able to cope. And what I really want to tell the people who are listening to this is that we're going to talk about coping strategies in a second because I guess my thing to do is not answer Michelle's questions. Right? I'm just kidding. And so I think the one thing to understand is that when you get like really solid in terms of treatment or health with these things, you no longer need to cope. And that's really what the target should be. Coping is a temporary mechanism that should be used temporarily. Now what are some healthy coping skills? I think oftentimes we like talk about the standard stuff like meditation is actually really, really good. We can also do other kinds of things like think about the things that you do that help you feel better, but also don't set you up for getting screwed later. So there are unhealthy coping mechanisms, things like, you know, video games, pornography, alcohol, substances of abuse, all that kind of stuff. And I think social like reaching out to people socially, leaning on people like for social support, there's overwhelming evidence that animals can be incredibly helpful for our mental health. I've worked with so many patients who, what literally keeps them alive, they're thinking about suicide, but like who would take care of their dog or cat. And that's actually a really strong foundation to build on. So I don't know, depending on where you are in life, but like getting a pet is actually not a bad idea. Emotional support animals, right? Absolutely. So the first psychiatric inpatient unit I worked on, it was amazing. They had a miniature horse that would come on to the unit. And like, yeah, it was great. And like I showed up at work one day and there's like a horse in the hallway, which is really weird. I was wondering like, wait, hold on a second, are hallucinations contagious? Like in my city, there's like, there's a horse in the hallway, right? And so I think animals are really great, friends are really great, meditation is great. Oftentimes journaling and stuff is really fantastic. But people don't really know how to journal. So like we made a whole video YouTube video about like, you know, how to journal effectively. I think all those things are fantastic. Exercise has been shown to have excellent, excellent improvements with things like depression and anxiety as well as like things like anti-inflammatory diets, serotonergic diets. So like, remember that your brain and even the neurotransmitters that you produce are tied to what you eat in your gut bacteria. So we know, for example, that people with depression and anxiety have low levels of two bacteria in their gut. And those are the bacteria that actually produce serotonin precursors. So there's almost this, this built in digestion deficiency of some neurotransmitters like serotonin. And it's not a coping skill, but like diet, exercise, meditation, all that stuff is great. Cooking. Oh, cooking is brilliant. Yeah. And you're nourishing yourself and taking care of yourself, self care, right? The power of self care. Absolutely. Yeah. Can you say a little bit more about cooking? Cooking, you know, just like, I guess, rewarding yourself and maybe being creative with it because it kind of takes your mind off of things. So like maybe making cookies and things like that, because it takes your mind off of making something yummy. And then afterwards you eating, you just feel good. I mean, maybe healthy foods as well, not just like cookies and snacks, but like maybe, I don't know. No, I'd stop with the cookies. So I love that. So like, I think Michelle, you demonstrated a lot of really great stuff there. One is that take your mind off things, but not in a way that will hurt you tomorrow. That's the biggest problem is people with depression and anxiety will oftentimes use coping skills that actually dig them deeper into the hole. Like a crutch. The other thing that I find is that when I'm working with patients who have like, you know, mood disorders and anxiety disorders that are kind of out of control, like, I think treat yourself is good. Like, don't actually make something like super healthy. Like if you want to bake cookies to reach yourself, just bake cookies and like cookies. And I don't think maybe someone's going to prove me wrong, but I've never had a patient who has baked their own sweets and eaten them to access the way that people will like destroy a bag of Oreos. You know, like when you buy like cookies from the store, there's like 800 of them and you just like kind of keep eating them and they're filled with like different kinds of chemicals that will like induce cravings and stuff like that. But when you like bake sweets at home, I think by definition, by definition they're way healthier. And the other really cool thing there is that if you have a dopaminergic surge from eating a cookie after cooking, that will reinforce the behavior of cooking. So if you cook and make something healthy that isn't as tasty, there's actually less behavioral reinforcement. So I would actually, I think you have given me the best coping skill that I've ever heard of for people who are depressed, which is like bake cookies. Because there's a sense of accomplishment after you do it, like I did that and I got up out of bed and I made my own cookies and they're bomb. Yeah, that answer is actually way better than anything I said. So I love it. Thank you. And so that brings me to the audience segment of our interview. We will be answering viewer questions. I'm extremely excited. We have a lot of people in here today, Dr. K. Cool, let's do it. Let's do it. So let's begin. So sorry about that. Just going through it. There's a lot of comments like I love healthy gamer. It's my favorite channel. So someone just asked Adrian asked, what's the most effective way to cope during an anxiety attack? We just talked about coping strategies, but it's a specific question. Yeah. So one thing to understand about anxiety attacks. So I'm going to refer this to like a panic attack, which is actually like clinically something that's a little bit different. But one thing to understand about panic attacks is that we oftentimes think about major depressive disorder, mood disorders, anxiety disorders, panic disorders as mental illnesses. One of the reasons that I think that especially like these illnesses are getting worse worldwide is because we're trying to treat them with one hand tied behind our back. We do not acknowledge the physiologic contribution to things like panic attacks. So it's really confusing for a lot of people as they think of it as a mental problem. But really if you look at panic attacks, there are our survival physiology that goes haywire and is inappropriately activated. So in an acute panic attack, there are a couple of things that you can use to sort of try to get your physiology back under control. So first we've got to understand that a panic attack is an over activation of our sympathetic nervous system, which is our like survival mechanisms. So our body is going to be filled with adrenaline. It's going to be filled with cortisol. Our heart rate is going to be through the roof. Our blood pressure is going to be super high. Our respiratory rate is going to be very high. We're going to be breathing very, very rapidly. So one thing that we know is that respiration or breathing is a two-way street. If you feel a certain way, it will change your breathing. So if I breathe like this, that's like an angry pattern of breathing. And if I keep breathing like that, there are actually studies that show that people were sort of like experimenting with this stuff and researchers would breathe that way and then they would start to feel angry, even if they weren't upset about anything. So your breathing can control your emotions. So that's why we really recommend slow deep breaths and actually exhalation is more important than inhalation. So you really want to extend out that exhalation as much as possible. That's one thing that you can do. And then there are some also like DBT kind of coping techniques that DBT is dialectical behavioral therapy. One of my favorites is something called ice diving. So I'll use this with patients that really struggle. And what you can really do is take some ice and you can like dump it into a sink with cold water or even grab a bucket and dump some ice in there and dunk your face in the ice. This will trigger a mammalian diving reflex which causes your heart rate and your blood pressure and your sympathetic nervous system to kind of calm down. There are also other kinds of like mindfulness techniques you can do. There's always things like medication. But if we're talking about like you know non-pharmacologic means like these are two things that are really important. Absolutely. And so can we talk about unusual manifestations of depression and anxiety? Absolutely. So I'm glad you asked that question Michelle because like I think a lot of times the reason that people don't get help is that they don't realize that they could have some kind of mood disorder. So this is especially true in men. So men have something called normative male alexithymia which I know is mouthful. But alexithymia is like color blindness for our emotions. So as men we're not taught to understand or articulate what we feel. So oftentimes when I'm working with men who struggle with depression or anxiety especially depression what they describe feeling is an overwhelming sense of pressure. So they don't feel sad. We think about depression as sadness but oftentimes it's not it doesn't we don't subjectively experience it as sadness. What we feel like is we're under so much pressure and we're on the verge of breaking. And even though we're trying really really hard we don't think that we're going to make it. So if you really talk to that person what they'll experience is some degree of hopelessness. But that hopelessness looks different. It looks like an overwhelming sense of pressure that I won't be able to fix. Another really common sort of feature of anxiety for example is being really really uncomfortable with uncertainty. So people with anxiety disorders are kind of like warriors and they really can't handle uncertainty. And what tends to happen is anytime there's something that's uncertain sometimes they'll like get like hyper fixated on it and they'll be like they'll even like reach out to other people for reassurance or like are you sure you're going to show up? Have you left yet? When are you going to be here? Are you home? Like where are you? So they'll kind of like badger other people but they really are not the only way they feel secure is when things are certain. And if that's really interfering with your relationships if it's making it very hard for you to kind of do stuff like an overwhelming discomfort with uncertainty is sometimes an anxiety disorder. And is that anxiety rooted in like a sense of loss of control? Absolutely. So that's a great question. So let's like understand this. So sometimes what happens in people with anxiety disorders is that I feel out of control. So like I'm afraid or I'm anxious. So then what do I do to fix it? What I will do is oftentimes try to control my circumstances. If I have an anxiety disorder and I'm like my my partner is out like let's say like my wife is like out for like a girl's night out. And if I've got an uncontrolled anxiety disorder I'm texting her constantly. And the way that I manage my anxiety is through her reassurance. And so what I try to do is I try to shape the situation around me. I try to control the situation so I no longer feel anxious. This is really really devastating for children who have parents with untreated anxiety. So oftentimes parents who are control freaks don't go over to your friend's house. No slumber parties. No going swimming. You could drown. You can't do this. You could this could happen. This could happen. This could happen. And so what they end up doing is control their circumstances to make their feelings go away. That what that actually does though is shapes the way that you live your life. You can't live freely because now you're not going to slumber parties or your parent isn't letting you go to slumber parties. They're not letting you play with your friends. And if you have that anxiety you're closing lots of doors in your life. Yeah. And so that's why what's really tricky is what we find with anxiety disorders is people will pay they'll treat their anxiety by shutting doors in their life down. Right. So I'm going to stop doing stuff so I can help myself feel better. I won't leave the house because who knows what's going to happen out there. I'm going to stay in these four walls. And so what we really actually want to teach these people to do is surrender that control and start to be okay with like, yeah, things could go wrong and you will survive and you'll actually be fine. And then once you do that, it's very liberating and you start kind of like living life. It's like not letting the fear control you. Absolutely. Yeah. And that's probably that you started talking about parents because someone just asked a bumblebee gamer asked, how can toxic parents create anxiety that manifests in you? Great question. So there's tons of really fascinating studies on parents and children with anxiety. So the first thing that's really fascinating is that if you have a parent who has anxiety, the likelihood that the child has anxiety is way higher. Now some of those factors are genetic, but a lot of it is like we internalize the views that our parents have, right? We inherit their political views. We inherit their religious views. We inherit their cultural views. And we also inherit their views of danger of the world. So for an anxious parent, the world is a dangerous place. And this is where like we can kind of inherit that. So we can, a child who grows up in an anxious household will believe that the world is kind of a dangerous place. Now I just realized that the question was actually a little bit different, which is how can toxic parents create anxiety? And this is actually a really, really fascinating topic. So children who grow up in abusive households are very, very anxious. And why is that? Let's understand this is a great question. So if I grow up in a safe household, the world becomes a safe place. So remember that when I'm a child, I'm learning the basics of life. I'm learning how strong gravity is. I'm learning what amount of food I can eat before I throw up. I'm learning like what it feels like to need to use the restroom. So the basic foundation is being laid down. Now let's say I grow up with an alcoholic parent. What that means is on one day, the parent is fine because they're sober. The next day, they're drunk and they're pissed. So what that sort of means is that home becomes an unsafe place. Every time I go home, I don't know which parent I'm getting. So there's no security. There's no safety. And so parents are the people that are supposed to provide us with like a safe space from which we can venture out and explore the world. And if we've got a home base that's safe, then I can afford to like go and explore. But when I have toxic parents, I learned that home is not a safe place and there's no space of stability. If there's no space of stability, the world becomes a dangerous place. If the world becomes a dangerous place, I can't go out and do things. So one of the most terrifying results of a toxic parent is a child who has to be perfect. They're unable to do trial and error. So people will say like, hey, bro, just go out there and just try, man, or just try girl, like just give it a shot. Like what's the worst that could happen? Yeah, people who say that grew up in good households, which is why they can afford to fail. So the weirdest way they feel safe, right? Which is afford to fail. Like it's no big deal. What you don't understand is that up to even 50% of the population grew up in a household where trial and error was like not a good thing. You can't try and fail because if I open my mouth and like my parents are drunk, I'm going to get smacked. Right. And so that's what's really crippling is that what we tend to see is it manifests in all these weird ways, like being perfectionistic, not being able to try things, needing everything to be perfect before you even start. Those are actually really common anxiety manifestations, which I think are really more related to trauma. Absolutely. And you just mentioned perfectionism. And there's a question about that. Mr. Happy asked, how to deal with over perfectionism that makes me feel overwhelmed and I get nothing done. How do I make tasks easier for myself rather than harder or impossible to achieve? Yeah. So it's a great, it's a great, great, great question. So there's, I'm going to start by kind of like leaning into Eastern principles. So there's a, there's a really interesting concept called Garma Farda, which means the fruit of our actions. So in kind of like, if you look at yoga and meditation, what they sort of say is that as a human being, you are not entitled to the fruits of your actions that all you're entitled to as a human being are the actions themselves. And oftentimes, if we sort of think about someone who's perfectionistic, they're shooting for a particular outcome. I need an A, I need a hundred. But the thing is, like, if we stop and think about it, I don't actually control whether I get an A or not, right? The professor could dislike me. I may have not studied something. You know, I may have forgotten something, like there may be a chapter where I wrote something down wrong. So whether I get an A or not is not actually in my control. What's in my control is whether I study or not. So if you really want to overcome perfectionism, there are a couple of things you have to do. The first is to focus on your actions instead of the outcomes. So whether you studied enough is not based on whether you're going to get an A or not. It's really stop and think about, okay, like, what am I here to learn and how much time am I willing to devote? And I'm going to devote that and that's going to be, like, enough, right? Because studying 50 hours may be unreasonable, but maybe I can do, like, 20 hours this week. So it's to really focus on the action instead of the outcome. And this is something that, like, it's kind of a brutal story, but, like, you learn this the hard way in med school, whereas, like, you know, we have a lot of great medicine, like, we can literally, we can remove a heart from someone's body and keep them alive. We can stick a whole different heart into your body. We can replace your lungs. We can replace your kidneys. We can replace all kinds of stuff, your liver. We're basically going to replace limbs. We can replace hips and knees. We, like, literally take a piece out of you and stick someone else's piece in there and make that work and you can live a normal life. Doctors are magicians. Yeah. And we have, we do not control life or death. That is something we learned the hard way in medicine. Because patients die, right? Like when they come to the hospital, like, that's sometimes what happens. So one of the brutal lessons that you learn is that as a doctor, how do I know I do a good job? Like, how can I live with myself? And what you focus on is, did I do the best job that I could? Should I have studied more? Should I have, like, you know, run more tests? Should I have consulted with other people? And so all you can do as a doctor is, like, what you can do. And the rest of it, like, you can't control is based on God or the universe or RNG or, like, whatever you want to call it. And so in that same way, what I encourage people who are perfectionistic to do is to really think about, okay, what can I actually control here? What I can control is my actions and let me focus on the action. Because the last thing that you'll remember for people who are perfectionistic is they get so caught up on the outcome that they can never get started. And so what we really want to do is focus on that action itself. And if you take the right actions over time, you will, generally speaking, get the result that you want. Absolutely. I agree with that. It's just, like, knowing that you did your best. And if you didn't do your best, it's rectifying that. But knowing that you can't control everything, you can only control your actions. That's it. And if you did the best you can, then you should be proud of that. Absolutely. And so that takes me to the next question. Oakley asks, I might be wondering if trauma can increase the probability of having anxiety? 100%. 110%. Absolutely. Even I know that. There's tons of research around that. I think the really tricky thing is that sometimes, I would say that trauma is sort of like the great chameleon of mental illness. Because it can look like all kinds of things. There are patients that I've had where, like, you know, they come in with like a diagnosis of an anxiety disorder. They've had anxiety for 10 years. It hasn't really gotten better. And when we really do trauma-informed psychotherapy is when we really start to see progress. And trauma can also manifest as things like ADHD because it impairs your concentration. So people have difficulty paying attention. The reason they have difficulty paying attention is because they're actually dissociating, which is more of a trauma response. And so when you dissociate, you kind of mentally check out, you forget things. And so trauma is really tricky because it can look like ADHD. It can look like chronic depression. It can look like anxiety. Absolutely. And then Citi asked, I have a problem of recreating past scenarios in my mind. Is this a sign of depression or anxiety? Yeah. So I also see that I can't accept the situation as it is and regret my decision. Current and then how to overcome. Yes. Yeah. So that's a great question. So let's understand something like fundamental about depression and anxiety. So this is going to sound kind of like weird. It's a little bit of a hyperbole, but it's kind of true. So if you are in the present, it is very difficult or I would even arguably even say impossible to have, to be depressed or anxious if you are fully in the present. And let's like understand what I mean by that. Okay. So we think about depression. Depression is characterized by regret. And if I'm filled with regret, my mind is not in the present. It's in the past. If I think about anxiety, what is anxiety? Anxiety is the mind in the future. I'm worrying about something that hasn't happened yet, but in both cases, I'm literally not in the present. Now, some people may say I have anxiety about past events, but if you really tunnel down into that, what you're going to find is that it's actually like something bad happened and you're afraid of what's going to happen next, but you still sort of, you're still kind of thinking about the past or the future. Like in either case, you're like in the past or the future. So if you have trouble chewing over past scenarios, what that is is actually a circuit of your brain that's kind of gotten a little bit haywire. So we have the circuit in our brain that does something called counterfactual thinking. And this is a great circuit in the brain. So anytime we make a mistake, our brain has the ability to go back in time and think about what we could have done differently. So don't think about the facts as they happened, but go against the facts and hypothesize how to live our life differently. That's good. That's like how we learn how to solve problems, right? So we don't make the same mistake twice. What could I've done differently? What tends to happen in depression is that that part of our brain gets out of control and we get kind of stuck in the past and in regret. And then we get so caught up in like thinking about how to change it or fix it that we stop living in the present. And so we get, one example is like if I got upset about the one that got away, let's say I had a crush in high school and she got away, right? And then if I'm living in the past, I'm not living my life in the present. I don't realize that there are actually other people that I could be meeting other relationships I could be forming. And this is also why we sort of understand that mindfulness is both an evidence-based treatment for depression and anxiety. And how is that? It's because it fixes this time problem. What it really does is help us come to the present. And so if you're really like stuck in the past, or if you're stuck like with regret, recognize that as long as your mind is living in the past, you're going to, that's what's going to happen. So practice spending time in the present and literally bring your mind to the present. You can drink water mindfully, you can bake, right? And you can really like eat that cookie and don't worry about what it's going to do for you tomorrow and like swimsuit season is coming up. That's anxieties for the future. And really just enjoy the present as much as you can. Absolutely. I definitely agree with that. And it's a matter of self-reflection, right? Like it takes that emotional intelligence and self-reflection to just be like mindful and not kind of go overboard with the past scenarios, right? Yeah, absolutely. It's hard, though, because I think that what happens is the mind gets out of control, right? Which is why we kind of get stuck. But you're right. That self-reflection is a really good way to digest emotions. Absolutely. And then Gunblazer asked, can anxiety disorders create or bring about more disorders or mental illnesses? Yeah. So generally speaking, the answer is yes, but those tend to be pretty specific. So it's not like anxiety will lead to all kinds of different stuff. But what we do know is that if you get diagnosed with an anxiety disorder early on in life, that that will impair your developing years. And oftentimes what we see is missed milestones. So you don't form friends, you may not start engaging in romantic relationships, your anxiety may prevent you from like applying for an internship or something like that. And so as you miss those milestones, that can sort of grow into depression over time. The good news is that oftentimes we think once we miss a milestone that I can't go back in time. And I hear this a lot from people who are like socially anxious and didn't date. And they kind of think, well, now I'm 30 and I didn't ever go on dates in high school and I never had a girlfriend or boyfriend in college. And now it's like too late for me. The good news is that you can basically go back and fix all those milestones. I was going to interject. I think that sometimes people have anxiety about like dating and not having experience because they're afraid of telling people, especially if they start dating someone and they're asked, well, what were your past relationships like that brings about anxiety? Like, well, I haven't had one. Are they going to think I'm a loser? Are they are they going to think I'm weird? So I think that's kind of what happens as well. Absolutely. Right. So like so the anxiety will manifest all sorts of ways. Right. And that's the real problem. That's why it's so paralyzing because if I have no relationship experience and my anxiety tells me or depression tells me, this person will reject me because I'm inexperienced. And then I never go out with them in the first place, which means I stay stuck in no dating experience. Right. It just makes it worse. Yeah. And so this is where that acceptance comes in. Right. So what people they're trying to do is they're trying to fix the problem. They're like, I should have dated. And so this is where you just accept that you just, you just didn't date. And like, I know it's kind of weird, but sometimes when I work with people, like they find language is very helpful. And if people ask me, you know, if you had what were your past relationships like, you can say like, you know, I just, I've never actually been in a full fledged relationship before. And they may be surprised by that. And I know this is where if we're anxious, oftentimes what we want to do is like justify or explain ourselves. Yeah. But what you can really do is just say, Hey, like, you know, I just haven't, I haven't really found a solid relationship. They may, if they want to ask why they can ask why, you know, like you can, you can even invite them. You can say you're welcome to ask questions about that. If you're curious, I just haven't had a good opportunity to really date. And if they judge you, they're the wrong person. Right. Presumably. Yeah. Like, if they're judging you and criticizing you, then they're doing you a favor and you need to meet someone who is accepting, accepting and kind, you know, absolutely. Absolutely. I think the real devastating thing is that if they judge you, it makes it so much harder to try it. Right. Because you mustered up all that energy and you went out there and you put yourself out there just like everyone who's like, just put yourself out there, bro. And you did that. And you kind of got punished for it. And that's what I think one of the biggest challenges that I see people with both depression and anxiety do, is that they don't judge other people negatively enough. I know it's kind of weird. Yeah. But in that scenario, if you struggle with depression and anxiety, you think that you're the loser. You never stop to think that like, why is this person so judgmental? Like on a person? Yeah. They don't have a right. That's actually their problem. Yeah. It's a, it's a you problem. Yeah. There's even old psychoanalytic literature from Freud that when we stop being angry at other people, we turn that anger inward and it becomes depression. So one of the most fascinating treatments for depression is to actually direct that anger where it rightly belongs, which is outside of you and towards someone else. So it's kind of weird, but sometimes in psychotherapy, some of the most important breakthroughs I've had with patients with depression is allowing them to be pissed at people in their life who actually let them down instead of the patient blaming themselves, which is usually what happens. Yeah. So like sitting on that feeling of like, you know what? It's not all my fault and being kind to yourself and forgiving yourself because it isn't all your fault. How can you be at fault for everything that's gone wrong in your life? Like that's not possible. Yeah. No, I mean, but some people believe it, right? They shouldn't, but they do. So Moon asks, does OCD have anything to do with anxiety and depression? I'm going to go ahead and say not really, except there everything is going to be like yes or no. So generally speaking, I don't think about OCD as being directly related to anxiety or depression. Now the same thing is true probably of OCD as like anxiety and ADHD in the sense that if you get diagnosed with OCD and it interferes with your life a lot and goes untreated, you may grow into a mood disorder like depression. The second thing that we do know is that high dose serotonergic medication. So the same like antidepressant, anti-anxiety medication at high doses can really help people with OCD. So there's probably something similar in the brain going on. The biggest thing that I would say connects OCD and depression and anxiety in my clinical experience is a lot of people who think they're super anxious actually have OCD. Or people who think they're depressed because they have all these negative thoughts, that can actually be OCD. So OCD is, it really has a lot of intrusive thoughts. So if you think about, I'm worried about this all the time, like let's say I'm worried about getting sick from everyone and I don't want to touch anything and I'm constantly washing my hands. If you talk to that person, how do you feel? They feel worried, they're concerned with uncertainty, but that really has more of an OCD flavor. So one reason why I think it's really important to not just self-diagnose yourself on the internet is that you can sort of like have OCD and it can really look like depression or anxiety. Because it's complex, you know, that's why you shouldn't diagnose yourself. Absolutely. It can be both depression, anxiety and OCD. So that's the importance of mental health treatment. Absolutely. And then Emulf asks, how do you feel about going no contact with toxic parents after achieving independence? That's a parent question. I'm gonna answer this in a very frustrating way possible, which is not to really answer the question. So Emulf, my answer to you, my friend it doesn't matter how I feel, the question is, how do you feel? Right? So I think this is a situation where I think it's okay to set boundaries with toxic parents and oftentimes in parent-child relationships, when we set boundaries, we feel guilty. And this is where what I kind of recommend to people who are struggling with this is that no contact for now does not necessarily mean no contact forever. And the basic problem with toxic parents is that they do not allow you to heal. Right? So what I kind of think about is let's say I've got a boat that's got holes in it and I'm taking on water and it's totally fine to get out of the ocean and go to a port and get yourself patched up before you go back in. And that's kind of the approach that I tell people to take is like if the toxicity is too much for you to handle and they've done some amount of damage, dealing with toxic parents requires you to be stable. And so sometimes a period of no contact or no contact for the rest of your life, but let's start with now, right? Like we don't have to think about the future. So it's okay to set a no contact and tell your parents, hey, like I need like a year to really focus on myself and like get myself stable. I'm not saying it's forever. I acknowledge that this is probably hurtful to you, but I really need this for my health. And I'm happy to revisit in a year. And part of the problem is that y'all don't respect my boundaries. And so if you guys can't respect this decision, then like I'm going to need to extend it longer. Absolutely. It's not like black and white. It's like you can just take a pause. Yeah, absolutely. And I think the reason that people go so much into black and white is because if you've got toxic invasive parents, any shades of gray, they will like invade. So that's why people like try to go no contact. What I'd say is go no contact, but no contact doesn't have to be forever. Absolutely. And then T3Dragon asks, I'm dealing with nerve damage for 15 years. I've researched my issues with family who are doctors. Other doctors I've seen ignore what I know when I correct them on my issues, the depression worsens when doctors belittle what I know. How do I deal with this? So that's super tricky. I mean, I think that unfortunately a lot of patients have the experience that doctors don't listen to them. I think that this is where you've got to be super careful about two things. The first is that oftentimes doctors are arrogant. And so honestly, the right answer is to keep looking for doctors until you find someone who's able to listen to you. The second problem is that sometimes we have our own cognitive bias that shapes the way that we hear what doctors are saying. And so we have to be a little bit careful about if doctors are belittling your issues. That could absolutely be true. But is there any gray zone there where they're sort of taking you seriously and not belittling at least a piece of it? And then I think the third thing that you can really do is talk to your doctors about the way that you feel. This is the most important thing. And you can say, hey, I feel like you're not taking my complaint seriously. Because oftentimes it's kind of tricky. But if we have rare cases that doctors don't know how to treat, we can almost trigger a defensive reaction within the doctor where they're like, yeah, if I can't find anything, I don't know what's wrong with you. So that can be kind of tricky. But I'd say definitely talk to your doctors about the way that you feel and if you feel like misheard or belittled. And hopefully that'll help. And I mean, I feel like it would be deeply upsetting for someone because it feels terrible to be invalidated by this professional. Because you look up to them and if the professional is invalidating you, you feel like, okay, well then, yeah, it's upsetting. Yeah. The last thing I would say is that I've kind of learned the hard way that if a patient tells me something that I do not think is true, it is not good for me or the patient to not believe them. And this is where, because if we really think about, we know a lot in medicine, but I would bet money that if I went a thousand years in the future, we would know 10 times as much as we know today. We're actually at our infancy of competence as doctors. And so if there's a patient who is telling you, hey, something is like off, because if we think about some of these new diagnoses like IBS, POTS, fibromyalgia, chronic fatigue syndrome, complex regional pain syndrome, they're all of these new diagnoses that for many, many years doctors thought were like all in a patient's head. But we now know that all of this stuff has like some real physiology to it. And so I'd strongly encourage you to look for a doctor who will take your concerns seriously. It doesn't mean that they can actually fix it because we may not have all the answers. But there's a big difference between I don't know how to help you and what you have is not real. Yeah. Someone who's willing to discuss, try to understand and they're empathetic. I think that's key in any profession. You need a professional to be empathetic. Yeah. And I think that like I said, I've learned kind of the hard way that if a patient says, hey, there's something wrong with me, like I trust them. And I may not have a medical explanation, but there are two reasons for that. One is that our instruments aren't perfect. So we may develop some new test or understand some new biomarker or be able to do some kind of gene testing that will help us discover what is wrong with you. We just can't do that right now. But that doesn't mean that what you have isn't real. Absolutely. And then ESMB asks, how can we understand and overcome generational trauma? That's a great question. I think that's a question that it's kind of hard to answer in brief. And what I would kind of say is, let me think about that one for a second. So I think the biggest thing about generational trauma is that we get, we inherit a view of the world or a way of connecting with the world that is shaped by our trauma. So we live in a reality that is a little bit different from hopefully what a healthy reality is. And so I think that generational trauma is really something where a good psychotherapist is like the best way to do it. I think it can sometimes be very helpful to talk to the generations above you and try to understand what their experience of life was like. So one example is like, you know, I'll have patients who have had parents who are really, really harsh and were like, the only things you can study is like, you have to be a STEM major like science, technology, engineering, mathematics, like medicine, whatever. No arts, no creativity, no music. And that can be really hurtful for people. But I think one thing that's really useful is to talk to your parents a little bit about where does this view come from and what was your upbringing like or even talk to your parents and what was their upbringing like? That can help you gain some context and understanding. But honestly, if the generational trauma is like super bad, like psychotherapies the way to go, like your parents may not be able to help you with that because they live with that trauma and they carry it too. And maybe like a mental health therapist can be like a mediator mediator between the two, right? Like if you go to therapy, yeah, can be, but I think that should be driven by the patient. Yeah, I've heard and seen too many cases of parents, I mean, sorry, therapists trying to be matchmakers between kids and their parents when there's like a lot of toxicity there. So I think you've got to be super careful about pushing for that as a therapist. So if the patient wants it, then by all means, I'm happy to help, but that should be really dictated by them. And then our last audience question by the tool, can school worsen depression and anxiety? 100%, 110%, 120%. Yes. Right? So I think any stressor can worsen depression and anxiety. And I think the other really challenging thing is that we assume that school like everyone does school. So I should be able to handle it. But the people's experiences in school are like really, really different. Right? There's some people who are like captain of the football team and like prom king. And then there are kids like myself who are like bullied every day or a year younger than all my colleagues. So like I suck at sports. And, and you know, there are people who hit puberty later and people who get puberty earlier. And so it takes some time to really figure out like where you are in life, especially in school, but we don't really treat ourselves that way. What we do in school is we compare all the time. I should be this, I should be this, I should be this. So we think about school as like a uniform intervention, but it's actually like a completely different world. It's completely alien, depending on what your school experience is like. And one can absolutely worsen depression and anxiety. And I think those like labels are like harmful, like you're a jock, you're a cheerleader. I was called a nerd like all the time every day. And those labels that can be like a little, it's obviously upsetting. Yeah. Cause you know, I think being a nerd is a good thing now, but at the time, right? Yeah. Absolutely. So thank you for the audience questions, everyone. And then I have a question about men's mental health awareness month to actually this month is meant to health awareness month. Excuse me. What do you think is the importance of men's mental health in terms of just having them seek treatment and speaking up about their issues? Yeah. So that's a great question. So I think a lot of men, we are taught and conditioned to tolerate pain. Yep. So what a lot of men will do. So one of the theories why men commit suicide at about four times as often as women is it was one of the interesting theories is that we are taught to tolerate so much pain that at some point, like the pain, like we never bend, we just break. So men will like be depressed, depressed, depressed and they won't seek treatment. They won't kind of get better until they reach their breaking point. And then they just kind of crack. So I think the one message that I think it's really important to understand is that yeah, it's kind of manly to be tough, right? But the real question that I would ask the men in the audience is whether you're supposed to be tough or not supposed to be tough or whether you're manly or not manly. The real question is do you want to continue living this way? So if you're struggling, if you're suffering a lot of pain, I'm not saying it's strength or weakness or forget about all that crap. Really ask yourself what kind of life do you want? And also as men, we are conditioned that what we want is not as important as the value we provide. So as men, we are providers, we are protectors. And so like, I've worked with so many depressed and suicidal men who are just bearing the burden of like other people's lives. And we don't really think about what we want in our life, right? So as a man, like I'm supposed to sacrifice myself for the sake of the betterment of the people around me. And I think the most difficult question that we tend to not ask ourselves is what do I want? And if you're tired of living your life under a ton of pressure or feeling overwhelmed or kind of thinking like this actually sucks for me, but like I can't do anything about it, I would strongly encourage you to get help. Because the overwhelming experience I've had working with male patients is that you don't have to live a life like this. You can actually fulfill the responsibilities that you want. It can actually be very, very healthy to set down responsibilities that people thrust upon you that you did not choose to accept. And that you can live a happy and fulfilling life. You may just need a little bit of help getting there, but you absolutely deserve it. And it's dismantling the barriers of toxic masculinity. Absolutely. So I think that like all those features or features of toxic masculinity, the tolerance for pain, the expectation of sacrifice, devaluing your own desires compared to the people around you, all features of toxic masculinity. And then my last question for you, Dr. Kay, how can we eliminate the stigma around mental health? I don't know if we can eliminate it, but what I would say is that the biggest problem with mental health is that it has lived in the shadows. So mental health and mental illness has lived in the shadows for way too long. So I'm like Indian by ethnicity and even culturally like being Indian, it's still like really in the shadows where like no one, everyone will hear about heart attacks or cancer and people will call and visit in support. But if anyone has a mental struggle, it's like behind closed doors, don't let anyone know. And so I think like, you know, light is one of the best disinfectants. Light is also incredibly good for like the human body. And I think the biggest thing that we need to do is to share our experiences and then connect with each other over those experiences because mental health, there's even a very strong theoretical belief that mental health is the only organ of the body. Our mind is the only more organ of the body that for its health requires connection with other human beings. It's the only thing that we cannot fix on our own. So our heart kind of takes care of itself, immune kind of take immune system takes care of itself. The mind is the only thing that may require other people to be healthy. Absolutely. Well, a big thank you to Dr. K for joining us today. It's been a pleasure and a huge thank you to our amazing intelligent viewers for being here today. Until next time, guys. Have a great day. Thank you so much, Michelle. You too. Of course. I'm stepping out. Is that cool?