Just As Well, The Women's Health Podcast - Protecting Your Mental Health in a Pandemic: One Psychiatrist's Prescription

Episode Date: October 8, 2020

Times are tough; made more so by the fact we don’t know exactly when they’re going to get better. But, as policymakers and medical chiefs aim to sort the situation on a zoomed out, macro level, we want to play our small part in helping by offering you sensible, actionable advice on looking after your mind in 2020. Just in time for World Mental Health Day, we’ve got NHS consultant psychiatrist Dr Sarah Vohra on the podcast to discuss the particular challenges this moment presents for our minds - and, crucially, what you can do to mitigate their worst effects. She’s one of Women’s Health’s most trusted authorities on mental health and, as you’ll get from this conversation, has a real knack for turning down the alarm bells and intensity on the topic of mental health and providing really straightforward, clear-eyed advice. Here, she talks Senior Editor Roisín Dervish-O’Kane through the simple habits and routines that are vital for mental health maintenance during a tough time, such as staying disciplined with your self-care and being aware of your limits. Plus, what to do if you are one of the people whose mental health has slipped to the point where you’re not coping and need to seek extra support. You are, very much, not alone - and we hope you find this episode useful. Dr Sarah Vohra is author of The Mind Medic: Your Five Senses Guide To Living A Calmer, Happier Life (£14.99, Penguin Life) Follow Dr Sarah Vohra on Instagram: @themindmedic Follow Roisín Dervish-O'Kane on Instagram: @roisin.dervishokane Folllow Women's Health on Instagram: @womenshealthuk Topics: Discussing the results of Women's Health's Strong Mind survey Why 2020 life is so tough on our minds How to build a daily routine that supports good mental health What to do if your mental health feels unmanageable A PSA about antidepressant medications Like what you’re hearing? We'd love if you could rate and leave us a review on Apple Podcasts, as it really helps other people find the show. Also, remember to subscribe wherever you get your podcasts, so you’ll never miss an episode.  Got a goal in mind? Shoot us a message on Instagram putting ‘Going for Goal’ at the start of your message and our experts could be helping you achieve your health goal in an upcoming episode. Alternatively, you can email us: [e-mail]. Hosted on Acast. See acast.com/privacy for more information. Learn more about your ad choices. Visit megaphone.fm/adchoices

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Let me tell you this. It's got to be consequences. Mayor of Kingstown, new season now streaming on Paramount Plus. Hello, everyone. You are listening to Going for Goal, the weekly women's health podcast. My name's Rocheon DeVichou Kane. I'm senior editor on Women's Health, and this is your weekly chance to plug in and be inspired to work on your health and wellness.

as I'm sure won't have escaped your attention. This week, on Saturday, it's World Mental Health Day. So, big question, where are we at? A cursory glance at the headlines will let you know that the situation isn't great. The Royal College of psychiatrists saw a 43% increase in urgent and emergency cases following lockdown. Research by the O&S reported that almost one in five people in the UK were experiencing some form of depression in June. and the charity Centre for Mental Health has said 10 million people in the UK

could need mental health support after the pandemic ends. We at Women's Health commissioned research to find out how you, much-loved and valued members of the women's health family, were coping during a year like no other. We polled over 2,000 of you and there's no way of sugar-coating it. The results painted a pretty negative picture.

While 10% would have rated your mental health as poor or very poor before the pandemic, that number has now risen to 46%. Times are tough and made more so by the fact we don't know exactly when or how they're going to get better. But as policymakers and medical chiefs aim to sort the situation on a zoomed-down macro level, we want to be able to play our small part in helping by offering you sensible, actionable advice on looking after your mind as we draw to the end of 2020.

And that's exactly what we'll be doing in today's show. A couple of months back, I called up Dr. Selle's. Ravora, an NHS consultant psychiatrist and author of The Mind Medic, Your Five Senses Guide to Leading a Calmer, happier life. Dr. Vora is one of women's health's most trusted authorities on mental health. And as you'll get from this conversation, she has a real knack for turning down the alarm bells and intensity on the topic of mental health and providing really straightforward, word clear-eyed advice. In this conversation, she shares the simple habits and routines that are vital for mental health maintenance during a tough time, like keeping disciplined with your

self-care and being aware of your limits. But she also discusses what to do if you are one those people whose mental health has slipped to the point where you're not coping and you need to seek extra support. I really do hope you find it useful. Dr Sarah Vora, welcome to going for goal. Hello, thank you for having me. So Sarah, you're a consultant psychiatrist in the NHS, but in your new book, you really showed that you've got this pretty holistic approach to promoting good mental health. How would you kind of sum up your philosophy to treating poor mental health? And how does you arrive at that viewpoint? So I think there's often a misconception that psychiatrists, all we do is prescribe medication. But actually, there is a whole focus on sort of whole body mental health. And actually, you know, it's all well, and good prescribing medication to help with low mood. But actually it's the therapy work alongside that. It's maybe the family work or it may be encouraging people to make small changes

in their day-to-day, their working lives. That really helps optimise how they feel. So I really wants to bring some of the clinic room into a book that was really accessible for people so that they can start to make some small, simple changes to feel calmer and happier. Yeah. And wow. I mean, we've spoken, so Sarah and I have spoken across all platforms very frequently for, I think, the past three years. So we've spoken about mental health a lot and across the full spectrum.

I'm so pleased to have you on the show because I can't think of the time when we have needed sensible, actionable, kind of evidence-based advice more. Would you agree? Absolutely. I think what's really interesting about this time, and certainly what I'm seeing, is that people that would say that they need. normally don't struggle with their mood or they don't normally struggle with anxiety have found over the last few months that they're experiencing these different range of emotions than they're used to. And suddenly, you know, they are aware that perhaps there's more that they could be doing to help optimise how they feel. Because I think there can often be a misconception that mental illness is kind of the severe end of the spectrum. And that's the bit that we tend to hear a lot

about in the media or when we think about professions such as psychiatry. But what I wanted to really sort of hone in on was the fact that we all are affected by a whole spectrum of emotions on a daily basis. And that is normal. But actually at what point does it tip into an area where it starts to affect our every day? So it starts to affect our ability to look after ourselves or our ability to engage with our friends or perhaps even our working lives. And that's what I really want to empower people to do is to think there's things that I can do to help make myself feel less anxious, a bit happier. But at what point do I need to call on other people to help support me? So what you said there about more people experiencing symptoms of mental health,

it really tallies with the results of research that we commissioned at women's health. I'd love to share a few of the findings with you. So 70% of our respondents said their mental health had deteriorated as a result of the pandemic. And while 47% of respondents would describe their mental health as good before the pandemic, only 17 would say theirs is good now and nearly 50% would describe theirs as poor or very poor. What are your thoughts? I think really, really interesting findings. And I suppose all I'd be really interested,

in knowing is how people kind of define those difficulties. So I see it all the time when people come to see me in clinic, they can't always pinpoint why they feel off or why they feel anxious or unhappy. And so one of the tools that I developed was this five-sense idea about trying to pinpoint the life stresses or the reasons why people feel that their mental health has deteriorated, maybe particularly in the lockdown period.

And so I'd ask them a really simple, question, is there anything that you've seen, heard, smelt, felt, or tasted that could possibly provide an explanation? And some people were finding, particularly at the start of lockdown, because they were spending so much time on their screen, so sense of sight, they were finding it difficult to unwind from the working day. There was no clear boundaries from when their day or their working day was finished and the downtime and nighttime routine started. So as a result, they were really wired before bed, they delayed the release of melatonin because of the exposure to blue light, which meant that the onset of sleep just wasn't happening for them.

It may be that people were struggling with criticism from a boss because, you know, one of the things that we've had to adapt to new ways of working, and rather than having a conversation one-on-one with your boss, they might be firing emails at you, left, right and centre, and you may be thinking, oh gosh, they think I'm incompetent, that I can't do my job. And, you know, they were finding actually they were on the receiving end of criticism a lot more. If there are anything like me, I know that, I mean, my kettle's literally just behind me. And my kettle was constantly on the boil.

When I was in all day, I was literally backwards and forward making myself, you know, vats of tea and coffee. And wondering again why I was so wired and couldn't switch off come the end of the day. So very, very quickly, you can kind of pinpoint the things that may contribute to why you're feeling a certain way and then get into the really empowering position of being able to do something about it. Yeah, absolutely. And does this, is that kind of, and we'll come into those suggestions later, I know you've got tons of them and we want to give listeners as much advice as possible because it's quite hard to get 30 minutes with the NHS psychiatrist. So we're going to make the most of you.

But before, so these findings that we found, which are pretty negative, is this telling with what you are seeing from your patients? I think obviously it's difficult in the sense that a lot of the patients that I see were with me prior to the lockdown period. But certainly because I tend to work with the younger generation, we're finding a lot of young people coming through with anxiety about returning to school and what that might mean. And in other areas, you know, there's lots of parents that have had to juggle, you know,

homeschooling, jobs, people have lost jobs, people have had to grieve during this time. So actually all those findings I don't think are altogether surprising. But I think what's really important is to normalise that. That is actually absolutely normal that if you have experienced loss during this time, whether it's loss of a job, loss of a family member or friend, you know, loss of identity, you know, you've got a working mum that maybe used to commute into the city and is finding that she's trying to work from home as well as being a teacher, as well as being a cleaner, you know, all these kind of identity changes that we go through

or have gone through in the last few months is bound to take its toll. But I think it's thinking about what can you do or what can others, what can you rally other people around you to help support you through so that it doesn't continue to ever weigh at your mental health. Yeah. So what would you say then is the, so the starting point then, if we're getting into, if we're getting into these interventions, at what point should you take action? So I think, you know, we can all take action straight away. So if you're finding, I think just checking in with yourself every morning and every evening and asking yourself how you feel in yourself. So do you?

you feel more anxious, do you feel unhappy? And then taking yourself through that five sense exercise. It's really simple. It takes no longer than five minutes. Just jot down your senses and think about the things that you've seen. So things that you could have seen could have been spending time on your screen or spending too much time on social media. Maybe seeing yourself in the mirror, so body image concerns or the people that you surround yourself with. Sense of hearing can be things like, like I mentioned previously, responding to criticism or struggling to hear compliments or maybe struggling to hear your internal no, which I know that is one of the things, findings that we're finding during this period of time is something called presenteism.

And essentially, that's where people at work, because they're not a bum in the seat in the office, are finding that they're actually working harder almost to prove that actually I am doing something. I'm not flagging at home, but we know that that's going to risk things like burnout. So thinking about whether or not you listen to your internal no. I love that phrase, internal no. Could you explain for listeners what that, like what it is and how you can, how you can get in touch with it? So I think, you know, whenever you are approached with a, you know, question or request to do something, what does your gut say initially? And a lot of the time, I know, or even what does your mind say when you are presented with that request?

And I know for a lot of people, they know, oh, I'm too busy. I can't possibly take anything else on. But that seems to be overpowered by this worry that they're perhaps going to let someone down, or that someone may be angry, or that the opportunity will pass them by and go on to someone else. But we know that if we take on too much, we do risk burnout. we do risk feeling overwhelmed and we can actually end up resenting the person that's got us to say yes in the first place. One of the exercises that I talk about within the book is trying to think of this hypothetical scenario and it does feel very hypothetical at the moment because, you know, with new quarantine restrictions, a lot of us aren't able to go on our holidays abroad, maybe like we used to. But essentially, if I said to you, right, we're going to go on holiday.

I've decided that we're going to go to Greece because we need some sea, sun and sand. And we're going to pack for Greece and we're going to meet at the airport. So we go to the airport. We check our bags in and we've got our ticket in our hand and we're ready to go to our departure gate. And someone stops us in our tracks and says, you don't want to go to Greece. You want to be going here, skiing instead. Chances are we tell them no, because actually we're. We've prepared ourselves to go to Greece.

We've packed the necessary equipment. And we've set in our mind what is important to us, which is actually some escape, some sea, sun and sand. Now I'm going to paint a completely different scenario, which is we need to get away. I don't know where we're going to go. Let's just meet at the airport. We'll pack for every eventuality.

We'll look at the departures board and we'll see what takes our fancy. And the same person approaches us and says, you want to try going here? the chances are we'd be more open to their suggestion because actually we don't really know what's important to us. We haven't prepared for a particular destination. So actually being swayed into saying yes is a more likely outcome. So the differences in the scenarios really are around you being able to identify what's important to you. And I always ask people, think about what's important to you

personally, what's important to you in terms of your social connections, and what's important to you in your working life. And then any question or any propositional request that comes your way, bring it back to those core goals. Because that way, you know, this is not a case of giving you permission to say no to everything that comes your way. But it's allowing you kind of to feel empowered enough to think, well, actually, this is not going to serve me right now or in the future. So I'm actually going to decline the request. You know what's better than the one big thing? Two big things. Exactly.

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And as you say, it's so important to have those values, those goals, those, what your body and mind needs kind of front and center. So then you're not pulled in all directions. And this is so important, isn't it, when someone is struggling with their mental health, because like poor mental health, you know, the beginnings of anxiety or depression, that can make you feel even more scrambled. It can make you feel even more unsure. It can make you, you can doubt yourself, right? Absolutely.

And I think, you know, for a lot of people, they put themselves at the bottom of the pile. You know, they look after themselves when everything else and everyone else been looked after. But it's about being able to prioritize what's important for you. And I think that's really key because I want to get people used to thinking, okay, I've got the kids sorted or I've got my other half sorted. Okay, what about me? And rather than if I have time, I'll come back to me. Yeah, totally. And that sense of, I can imagine this is even, I don't have children, it must be so much more pressing for people that do. But I imagine that you, there's almost this risk that work becomes your thing and you kind of feel like okay right I've sorted the kids I've

sorted my other half I've sorted the house and then it's almost like your time left for you is work but of course that isn't time for you absolutely it's so true I feel like you're speaking to you know to me personally because I know that my downtime invariably is me firing up a laptop and doing some work but actually that's probably not downtime in the true sense of the work it's fine if I'm feeling inspired or I'm able to get on and do things and I'm enjoying it. But sometimes there's things that just have to be done. And I know that are things that I'd rather probably not be doing. So I think one of the things that I talk about within the book is around self-care and actually getting used to diarizing appointments with yourself. So in the same way that we have decided

to record a particular date, a particular time, I've honoured that appointment because it was a date in my diary, in the same way, actually think each day allowing yourself 20, 30 minutes, you know, I'm not saying to carve out an entire day, because I know for a lot of people, that's not realistic, but at least being able to set aside 20, 30 minutes off you time and schedule that, whether it's, you know, if you're old school like me and like a pen and paper diary or whether or not you like to just put it in your phone, but to make sure it's in there as an appointment that you can't cancel. And I think at the moment the talk about self-care, I think it's almost, it's a term that it felt buzzy for a while.

And I think sometimes people can roll their eyes at it a little bit and think that it maybe sounds a little bit cliched or a bit self-adulgent. But I think really since the pandemic and this is what is totally borne out in our research, but also in the many other studies that are coming out right now that are pointing towards a second pandemic of mental health issues. I think what this has really shown is that those, the self-care acts, they are not frivolous. They are not bonus. They are not selfish and indulgent. They are, and this is a phrase that we use quite a lot in the show, they are like essential mindset maintenance. They are what you need in order to be able to cope because this time is hard. And if you weren't functioning suboptimally in some way,

that would be quite strange or if you weren't feeling weird, that would probably be quite strange. Would you agree? Absolutely. I think also there's this misconception that self-care has to cost money, that it has to be buying into the latest expensive wellness trend.

It's not that at all. Self-care is something that you do purely for yourself. It's creating moments of calm, moments of happiness, allowing you to break from the rat race of the day or the responsibilities of the day. So for me, I know that my self-care probably comes in a form of setting myself a screen curfew and picking up a book because I know, particularly in the last few months, and I know this is reflective sort of nationally internationally, is that my screen use has skyrocketed. You know, it's just ridiculous actually because I have the app on my phone that tells me how long I've spent on my screen. And again, one of the tools I focus on within the book is things.

about screen use and why we get pulled into our devices in the first place. And I found the easiest way to help really break this down to the patients that I see or to other people is thinking about our screen use in three ways. So firstly, there's a non-negotiable. So us recording, as we are doing, is non-negotiable because in order for you to produce a podcast, we do need to be connected to a screen, connected to some form of technology, that is a non-negotiable. other non-negotiables could be filling in a tax return or maybe texting a friend ahead of a lunch date things that you have to do that rely on the use of a screen.

The like-to-dos are the things that you, you know, as it says on the tin, the things that you like to do. So whether it's watching a box set or listening to the Woman's Health podcast when it does come out or listening to an audiobook. And then finally, there's the not entirely necessaries or the Nens. So those are the times, and I know I'm terrible for it, which is just when you pick up your phone and you're mindlessly scrolling. And after 20 or 30 minutes, you think, what am I actually

looking at? And you've squandered so much time, so much energy on just consuming content. But it's nothing that you like to do. It's just something that you've managed to get yourself pulled into. And that can lead you to procrastinate from work. It might affect the quality of your in real life connections if you and a partner are both sat side by side engrossed in a phone, mindlessly scrolling. So the best way to kind of go about your day I find to help reduce your screen time is thinking every time you reach for your phone or push the lid back on your laptop, ask yourself, is this a non-negotiable? Is the act that I'm going to do absolutely non-negotiable? It absolutely requires me to use a screen. Is it something that I like to do? Or am I going

to actually enter and not entirely necessary? And if it's a not entirely necessary, What I suggest to people is setting a time in your day 30 minutes to an hour of when you can do those not entirely necessary scrolls. So when you find yourself picking up your phone, you think, oh, actually, I'm going to go into the not entirely necessary and it's going to take me away from my work or it's going to take me away from being able to have an in real life connection with my partner or with my child. I'm going to come back to this at 6 o'clock because 6 o'clock is my curfew when I can do the mindless scrolling. and then return to the activity that you're doing. And actually what you'll find is that you'll get more and more adept at picking up that phone and knowing when the screen use will or won't serve you and it won't impact those personal, sort of the attention to self-care

or maybe your working life or social connections in the way that it has done previously. And more than that, we know that screen use can impact sleep if we're exposed to it for too long during the day. Absolutely. So you're, it's almost like then you're making space between that. We're joking before, weren't we, about phones going off in, on when you're watching the news and you have almost like a Pavlovian response. And you go, oh, it's my phone. Like, I must.

Or you see the Instagram app on your phone. Other, you know, photo sharing apps are available. And you go straight to it because that's what you've done. It's almost like you're, I think that's such a good point. It's like you're creating white space almost in your reaction to things. And that seems to really mirror what you were talking about in terms of kind of creating this white space in your day to reflect on, you know, what things have made you feel worse, what things have made you feel better. Like, I think it's something that we are really lacking at the moment when everything is done via a screen and there is just not as much movement and fluid time in the day. Would you say that is a goal then at the moment that for people's mental health?

So if we think about our morning routine, all too often, it's our alarms on our phones that wake us up. And it's not a simple case of just switching off our phone, but actually we are enticed but what else it has to offer. So we check any incoming calls or incoming messages that have come in overnight, any emails that are sat in our inbox. Maybe we're scrolling our social media sites and are confronted with people's sweaty post-workout selfies or their glorious breakfast bowl. and that fuels feelings of inadequacy that we haven't used our time well, perhaps we should have got up earlier. And suddenly our pace, our morning pace, is dictated by what we have seen on our screens. So rather than, you know, using a conventional alarm clock where maybe we get up at a time that we wanted, we do all the things that we know make us feel more us. So for me, I know that I love

to just jump in the shower or maybe just do a workout, jump in the shower, have my breakfast, and then invite the rest of the world in, rather than in that really vulnerable position when you've just woken up to be bombarded and suddenly, you know, an email that could possibly wait until 9am, you feel this sense of urgency that you have to action it straight away. And you've got that cortisol spike because, and this is something I find really interesting as well, like when we're having so much communication over email, your brain's got such negativity bias, doesn't it?

So probably maybe something that your boss fired off in a rush at 6.30pm last night that you read first thing, you're probably going to interpret it as far, I don't know, far shadier or far more stern than it actually is. Absolutely. And if you think about that email that comes through from your boss, you think, oh, they must want an instantaneous reply, because we're all so much more contactable and reachable. And anything that you do that morning suddenly is guilt-ridden

because I haven't actioned that email. So I can't afford to spend longer in the shower than perhaps I would like to. Or I can't have a leisurely coffee because I need to action this email. So the whole morning pace just goes up in the air and is completely dictated by, it's inanimate objects, by your screen, by an email.

So what I would say is dedicate that first 30 minutes to an hour, no screens, do what you need to do to make you feel better prepared to cope with the day ahead. Yeah. And coping with the day ahead in an altered environment where you probably are going to be a bit emotional. You're probably are going to be slightly less resilient. We're in altered circumstances. It's a weird, weird time. Absolutely. And I think I was hearing a lot of. that in the start of lockdown is suddenly people's usual routines just completely upheaved overnight. And again, one of the simple tools that I developed was around this idea of being prepared for the day ahead. So at the start of the day, maybe using your sort of screen-free morning to do this, doing it over your morning coffee, a pen, paper, plan your day. Think about

the things that you want to do that day. R is routine. So even if you don't have a job to go to or even if you're not having to get up to get the kids to school, think about how you can make a clear distinction between your daytime routine and your nighttime routine. So whether it's getting showered and even putting on a fresh pair of active wear or fresh pair of loungeware, but something that sets apart kind of the nighttime coming to an end and the day starting. And actually having that semblance of a routine is so important for things like our moon, our focus throughout the day and also our sleep. E is about exercise and I'm not saying that everyone has to do a 30 minute hit session.

You know, actually finding something that will just get your heart racing a little bit faster, even if it's going outside, plugging in an audiobook and just, you know, pounding the pavements for 30 minutes. But exercise is so important in terms of the mental health benefits of improving our mood, improving our energy levels and helping improve our sleep. P is about prioritising. So a lot of people feel during this lockdown that they have to be busy, that they've got to get X, Y, and Z done. And come the end of the day,

would find themselves feeling very disappointed that they hadn't achieved, what were quite unrealistic goals in the first place. So setting yourself maybe three goals that you'd like to achieve that day. A is avoiding media and social media notifications. So I know very early on in lockdown, I realised that the daily death count wasn't serving me. It was just ramping up my anxiety.

There's a difference between remaining informed and overconsuming information that such it feels overwhelming. So agree pockets in the day where you're going to check in on the news, but avoid that kind of notifications popping up that are just going to ramp up your anxiety. R is about reaching out to friends, colleagues, you know, family members because human connection is so important. finally eating well and keeping hydrated and also thinking about kind of caffeine consumption if you're someone like me that can be quite vulnerable to its effect. So think about prepare every time you wake up. So pen, paper, plan your day. Our routine establish and maintain as much semblance of routine as possible. E is exercise. P prioritise. A, avoid social media

notifications are reach out to family friends and colleagues and eat well and keep hydrated if you manage to tick that off your list by the end of the day you're doing very very well yeah absolutely it's so important to be disciplined isn't it at the moment it's a real i think people often think taking care of their mental and emotional health is something that maybe sounds a bit oh yeah you think it's a bit soft but actually right now as we've said it's essential and it's and it's hard um so something else that came out pretty strong in our survey was people wanted to know what they should do if they do feel like they're struggling. And you know if they could be at the stage where, you know, they're managing to do all these things and they're still

struggling or it's at the point where they feel so rubbish that they are not able to do that workout. They're not able to. Their symptoms are such that they're not able to put in place these healthy habits. What would be your advice on how they can seek support? So I think first and foremost, I think this was the case early on in lockdown, is people have this assumption that regular health services would just have ground to a halt and everything was very COVID-focused. So the first thing I would absolutely say is go and visit your GP as you would normally. You know, although the consultation will look and feel very different or how you might go about accessing that consultation will be very different. It's still essential that you book that appointment.

So I know that GPs, some of them, may be offering sort of tele-consultations. They may offer you a consultation over the phone and think that it's worth coming to see you in person. And obviously, those consultations will look different. I'm having to wear personal protective equipment when I'm seeing people face to face. So it's just being aware that services haven't changed. there are still services available and to not feel that you're impinging on the health service by reaching out, particularly where your symptoms are affecting your ability to carry out your day-to-day. Yeah. And I should say as well that also we've done quite a lot of research into this. And so often therapists will be sometimes offering discounted sessions.

So even if you think it is more of an emotional issue and maybe you don't feel like you want to go down, the medical route or whatever and you you maybe do have some money to spend but not tons there is there's often that option as well and what about there's been some data hasn't there recently that was suggesting that um prescriptions that mental health medications have have gone up if someone is feeling a bit worried about going on medication or feeling like in some way it makes them a failure for not being able to handle their mental health themselves what would you want them to know It's absolutely not about being a failure. And the thing that I would always say is that medication is only part of the treatment option.

So when I see young people and I prescribe medication, actually the medication is only a tiny part of the overall treatment package that we provide to them. The sort of more longer term changes and the improvement is going to come from things like the therapy work that they're accessing or from family work. So I don't want people to assume that if they're on medication, A, that they have to be on that lifelong. Obviously, individual circumstances may vary. But sometimes medication is used where if someone is so severely depressed or so severely anxious, they are not able to engage in the therapy work in a meaningful way because their concentration's poor. They don't have the motivational energy. They may have more severe symptoms. They may be feeling suicidal and very worthless and health. So actually medication in those circumstances are crucial to really help lift their mood, improve their energy, improve their motivation and concentration, enough to find the therapy work valuable and to be able to take on board the therapy work.

So, you know, there is always a role for medication and I don't want anyone to kind of go away thinking if they have been put on medication that it's a sign of failure. I think that is such an important point. I know it's something that I struggled with quite a while from I started taking them in 2015 and it was a real, I really battled with the sense that I wanted to sort out my mental health through exercise and eating well. And I think I did some sessions of CBT and it didn't really make much difference. And I was really disappointed and it felt like it felt like a failure leaning on a medical option.

But actually, and, you know, everyone's experience is different, but I'm just sharing in case it helps anyone else. For me, I found that I was so much more able to engage in those healthy habits. So have the energy, as you say, even to exercise, have the energy to want to reach out with my friends because depression can be so isolating, can't it? It can kind of depression and anxiety. I have a diagnosis of both, so they're kind of rear in tandem. they're such nasty conditions because they almost prevent, so the things that you need to do, they almost are pushing those down.

It's almost like they stand in the way. Do you know what I mean? That's such a great way of describing it. And thank you so much for being so honest because I think that will have been a source of comfort for so many people. And I think the messages around kind of the wellness and well-being space, particularly during lockdown, and particularly on social media platforms,

such as Instagram is around I exercise or I eat well for my mental health and kind of pushing that narrative. So imagine someone who is really struggling with their mental health who's trying those things and it's still not shifting. That can really quite fuel feelings of inadequacy, feelings of failure that actually, you know, everyone seems to be coping well by this exercise workout or eating this particular diet, yet I'm still feeling the way I do. So I think why Instagram can be a great place and at a positive pace for sort of motivating and inspiring content, I think sometimes it does lean towards this idea that anything that goes against the grain is not right or someone is doing something wrong by seeking options outside of that

space. You're right. There's such a, and it's so much about what we talk about at women's health, you know, there is so much that you can do for yourself and your mental health, especially with like kind of maintenance. I think you can. keep your mental health in a good place. Well, many people can keep their mental health in a good place by, you know, taking care of their emotional needs, regular exercise, eating well, investing in their relationships so important. But, you know, at times when your mental health is poor, you might need something else. And as you say, it is so important in this moment not to dismiss when you're struggling because you might think, oh, so many people have

it worse than me. For example, I've still got a job, people are getting laid off. You know, none of my family have caught the virus, but actually your concern and your struggle right now is the most important thing for you. And that is what absolutely, that is what you absolutely need to prioritize. Yeah. And I think it's just about kind of shelving what works for other people. And if, if you're finding that that is not serving you, it's thinking, well, actually maybe this is something that I could come back to when my mum. mood is in a better, better place. Yeah, absolutely. And so on that point, what would you want someone who is struggling right now? What would you, what would you most want them to know?

I suppose it's thinking about, again, as I mentioned earlier, is that we're all going to be experiencing a broad range of emotions. It's a really unsettling time. And that's bound to throw up feelings of inadequacy, feelings of guilt that we should be doing more or less. feelings, feeling of anxiety or low mood or struggling to manage the day to day. But it's at what point does that tip into affecting all areas if you're alive? So your ability to look after yourself, if you've got children, your ability to look after your children or to affecting kind of social connections or your ability to work, I think at that point I'd be asking people that they need to seek support from elsewhere.

And that would often, for the most people, if you're listening from the UK, would be the GP as your first point of contact. Yeah, fantastic. Okay, Dr. Sarah Vora, it was such a pleasure to talk to you. And Dr. Sarah Vora's book, The Mind Medic, is out now and published by Penguin Life. Sarah, thank you so much for coming on going for gold. Thank you for having me. Thank you so much to all of you for listening.

Remember, if you are struggling with any of the issues raised, please, please do remember to seek help. you are very much not alone. We've included some trusted numbers, emails and other resources within the show notes. And remember, we are here to help you improve your health and wellness. So whatever it is, you want our experts to help with, be it skin care, nutrition, fitness or indeed mental health, let us know by either sending us a direct message on Instagram, we're at Women's Health, UK, or shooting us an email on women's health at women's healthmag.com.com. UK, putting going for goal in the subject line. That's all from us. We'll be back as always with another episode next week. Until then, and I really mean it, take care of yourselves. Goodbye.