Dr. Victoria Kelly - Mental Health During COVID-19

Transcript

Voiceover:
Welcome to Prescribed Listening from the University of Toledo Medical Center. Each week, UTMC providers sharing insight into their medical specialty. This week, Dr. Victoria Kelly.

Dr. Victoria Kelly:
Hello everybody. My name is Victoria Kelly, Dr. Kelly. I'm a psychiatrist in the Toledo area. I'm faculty at the University of Toledo College of Medicine and Life Sciences, where my department is psychiatry. I'm the Program Director, Assistant Professor and Vice-Chair for Education. Some of the other things that I do besides patient care is I really, really do enjoy teaching. I'm really happy to have this opportunity to talk to you guys. With COVID and coronavirus and the pandemic, I mean, our lives have just been turned upside down. So again, I appreciate the opportunity to talk to you guys about some of the things that we've learned along the way.

Dr. Victoria Kelly:
I think one of the biggest things that my patients come to me or other colleagues come to me right now is we are all just over it. We are over this pandemic. We're over quarantining. We're over social distancing. We're all burnt out nationwide. That's what the statistics say, especially if you're in any kind of caregiving position, a job or a role. We are all burnt out, so it's really important right now that before we rush off into the summer and the weather's nice, that we really take our time and take a beat, figure out what we learned from this pandemic and how we can move forward so that we're safe about it, so that whatever changes that we implement are sustainable.

Dr. Victoria Kelly:
A lot of times people ask, "How long do I have to wait? What is this next stage of life? When are we ever going to get back to where we were before?" I would challenge people to think about it differently because things happen to us and they change us. That is the nature of life. The normal that we had before all of this, we really need to kind of grieve for it and put it away because forever more, we are changed because of this and society does and that's what the pandemic from the Spanish Flu, Hurricane Katrina and all of these other types of things have taught us, that we learn about ourselves through this process and we grow from it as we move forward.

Dr. Victoria Kelly:
So whenever a patient says, "When can we get back to normal?" I say, "What normal? There is no normal. Every day is what it is and what is most important is that we get out of it, what we intend to and eventually that we are working towards what we want to be doing with our lives." And there's no definitive answer right now for when it'll be "safe" to do things once we read the reach that herd immunity from vaccinations, but by all accounts, it's going to take still a while till maybe, maybe fall 2021. I wanted to focus a little bit on some of the research and data that's come out this year. The American Psychological Association, the CDC, even the Census Bureau, they've all published a lot of good articles recently about our time in the United States and its impact. There's three things that jump out that are absolutely not a surprise to anybody who is going through this, but I think are very important for our health and sanity for the future.

Dr. Victoria Kelly:
Those are weight, alcohol and stress. Let's go through those one by one. The first one I wanted to talk about was weight. If you're like me, when the pandemic first hit, it was a lot of video games or Netflix or board games, crochet, knitting, baking. All of these things really took off as hobbies as we were all hoarding our toilet paper, but really what the data shows is that about 42% of people had weight gain because of this pandemic, with an average weight gain of about 29 pounds. Now, that is important because a weight gain of even 11 pounds increases your risk for diabetes, 24 pounds increases your risk for a stroke and those are real life consequences that can happen because of weight gain. If you're a parent, like I am, you know intuitively that you probably had it worse than a lot of other people and that also correlates with weight gain.

Dr. Victoria Kelly:
I said about two in five people had weight gain, average of 29 pounds, while moms averaged 66% of moms gained weight and about 80% of dads gained weight and about half of us across the nation have been less physically active than you wanted to be. That can have a lot of health implications, both for diabetes and cardiovascular risk. However, from a mood and emotional standpoint, that's a huge impact too. One of the fantastic things about exercise is that it increases something called brain derived neurotrophic factor, or BDNF, which is a wonderful thing that helps fight depression, so that's one of the ways that if you're feeling kind of down block burnt out, it may seem like it is absolutely the last thing you want to do, go out and get some exercise, but it really can help you, help your heart, help your brain.

Dr. Victoria Kelly:
So for people who have struggled with weight during the pandemic, number one, it's probably not a new thing, but number two, really, it's about maintaining getting track of what's going on and then setting up healthy goals for you moving forward. If you also happen to have an eating disorder or otherwise have an unhealthy relationship with food, like binge eating or stress eating and things like that, you really need to take even extra care getting this part of your life back on track. You may want to work with a nutritionist or a structured program to make sure that you're doing it right and not jeopardizing any other aspects of your mental health. But if you want to manage your weight, the first thing is to, first of all, identify what's going on. What are your actual unhealthy habits? What are your triggers to overeat? What are your triggers to make poor food choices?

Dr. Victoria Kelly:
Interestingly, data shows that if people are intoxicated, they make poor food choices. If people are stressed, they make poor food choices. Again, not really earth shattering news here, but once we know what our triggers are, that is the first step to putting something into place so that we can take a little bit of control back. For people who are addicted to things or have problems with substance use or shopping or things like that, what you may also find is that the four typical triggers are hungry, angry, lonely and tired or HALT. We've all probably grazed the fridge when we're feeling a little bored, when really we just need to go to bed or we're procrastinating something. So again, just identifying what your triggers are to overeat or make poor food choices is really going to be a great first step.

Dr. Victoria Kelly:
Otherwise, one of the goals would be to at least maintain. It doesn't take much, about one can of pop and one small bag of chips every day, and you'll gain about five to 10 pounds in a year. It's really easy to gain weight, it's not as easy to lose it. The first step is to not continue to gain weight and so stay active, not overeating and coming up with a realistic plan. There's a mnemonic called SMART. If you're going to try to do anything, and often I talk about this with New Year's resolutions, but if you're going to do anything, do it SMART. Have a goal that is specific, that's what the S stands for. Measurable, Attainable, Realistic and Time-based. If you want to lose weight, instead of saying, "I want to lose weight," you might want to say, "I want to fit and feel healthier by being able to walk 10 minutes without being short of breath," whatever it might be. Measurable, meaning you can time it. This is something that you can check a box and say that you met it.

Dr. Victoria Kelly:
Attainable. Is this realistic? It's one thing if I've been sitting on my couch for the entire pandemic not exercising, just drinking and watching TV, it will be rather unrealistic of me to say, "Oh, I'm going to go run a marathon next week and I'm going to lose 20 pounds next week." That's rather unhealthy. So whatever it is, be purposeful about it and be mindful that we all are trying our best here. I generally recommend to my patients to start small. If they're not active, just start with five minutes a day, do what you can. Once you get into a healthy habit of it, increase it up to tolerance and that'll help you on your way to getting where you want to be with your weight.

Dr. Victoria Kelly:
Another thing to consider is that with healthy habits, they take on average over six weeks of doing something every day for your brain to finally catch up and have that new pattern going on. That's why I say it needs to be sustainable. With New Year's resolutions, by far almost 80% of people give up on a New Year's resolution after the first month and most common one is weight loss. So yes people, we're not dealing with anything new here, but 29 pounds in an average of a year, that is a little bit unique. I think another factor that's contributed is a lot of people would do things socially to lose weight. They'll go to the gym with a buddy, they'll go to places and do things. We got to work with what we have. As we segue into the summer where there's more outdoor activities, it might be a little easier to. All right.

Dr. Victoria Kelly:
The next thing is alcohol. If we look at what the business people say happened in 2020, was that the rates of alcohol purchases skyrocketed in the early months of the pandemic. Everything was kind of snatched up. What this recent data shows from January, 2021, is that overall about one in four adults reported drinking alcohol more during this time in order to cope with stress. Once again, parents had it worse. For parents, about a one in two, so 52% of parents with kids ages five to seven found themselves drinking more. Often the question I get with that is, "Well, what's the harm?" Or, "I just need to wind down," or, "It's been a tough day," and things like that. The first question that comes up is, "All right, what's going on? What are you doing? How often is it? How much is it? Is it causing you any problems?"

Dr. Victoria Kelly:
For moderate drinking, the National Institute of Drug and Alcohol Awareness says for women, it's one drink a day or a binge would be considered three in a day or seven in a week. Anything higher than that would be considered drinking. For men, it's two drinks per day or four in a day would count as a binge or 14 in a week. That's just one parameter is the quantity and frequency because people can still have drink alcohol like that and not have them cause any problems for them and people can drink less than that and still have it cause problems. It's not really necessarily the be all, end all, but it's just one factor to consider. At its core though, alcohol use disorder, what we used to call alcoholism or alcohol dependence, we now call alcohol use disorder because it can be mild, moderate or severe.

Dr. Victoria Kelly:
That's a chronic relapsing disorder characterized by an impaired ability to stop or control use despite adverse outcomes; social, occupational, or health. It affects about 6% of adults in the United States. There's short-term problems, definitely like memory loss, sleep problems, having blackouts or hangovers, which, as you could tell, could cause immediate consequences like not being able to go to work or do your job or car accidents. There's longer-term problems. It can damage your liver, pancreas, stomach, heart, brain, contribute to cancer, memory loss, cardiovascular risk factors. The other thing is with alcohol use, if you drink a little bit and you're starting to get that euphoria, it definitely kind of turns off the rational parts of your brain, so you're way likely to be more impulsive and perhaps act on things that you wouldn't otherwise do. One of the biggest things for people who have unhealthy relationships with alcohol or have an alcohol use disorder is when it is being used to self-medicate.

Dr. Victoria Kelly:
You're feeling upset about something and instead of talking it through or maybe going for a run to burn steam off or whatever it is, you numb the feelings with alcohol. Now, we may find people who do that in our lives with alcohol or video games or pornography or other unhealthy type activities and that's what is the root of it? What's the relationship with it and what kinds of damage is it causing? The other factors that contribute to a higher risk of actually having a problem with alcohol is if you have low self esteem, if you come from a lower socioeconomic status or if you have a history of abuse or drinking while young or family history and genetic contribution there. If you're starting to feel a little bit like I'm personally attacking you during this time, as you look around and you see all the empty bottles of wine in your recycling bin, please don't do that.

Dr. Victoria Kelly:
Officially to have an alcohol use disorder, you do have to meet criteria for that. That would be two out of 11 symptoms during the past year. Those include drinking more than you intended, you tried to stop drinking, but you couldn't, you spend a lot of time either drinking or recovering from drinking. You feel like you can't relax, you can't fall asleep or maybe you can't get your day started without a drink. You get into situations that increases your chance of getting hurt or bad things happening because of drinking. It causes life problems, whether it's home, school, work, wherever it might be, and you continue to drink despite those problems going on. There's also the physical effects of tolerance, where you have to drink more to get the same effect, or withdrawal, if you stop drinking that you get the shakes, feel more anxiety and you could even have hallucinations and it is considered life-threatening.

Dr. Victoria Kelly:
The tolerance and withdrawal, most people think you have to be physically addicted to alcohol to have a substance use disorder and that is a myth. That's only two out of those potential symptoms. So again, I think the most important thing is recognizing that something is going on. Having insight is the first step. If you even kind of think that you might have a problem, it's probably a good idea to check in with your doctor to get a reality check. You may need some blood work to make sure your liver and other organs are okay. There's a wide variety of treatment options. There's inpatient, outpatient, residential, detox and many community mental health centers, universities, hospitals. There's plenty of different settings to get treatment. Of course, there's 12 step programs like AA and other recovery based organizations that are doing a lot of things online.

Dr. Victoria Kelly:
So even what the social distancing in effect, you can still reach out and connect with someone to get the support that you need to be successful in sobriety. I guess that's the other thing, is your goal going to be sobriety? Was your relationship ever sobriety even before that? So kind of scaling back, taking a mental snapshot of where you were perhaps in 2019 and was that okay? Maybe shoot for that again. If you've decided that the pandemic and everything because of it has opened your eyes to the fact that maybe you had a problem and it just got worse, then you could absolutely use it as a time for change, a potential opportunity for change. There's absolutely no time like the present then to do change. There's no magical day you have to wait for. Any day that you decide to live healthier, you can absolutely start that day.

Dr. Victoria Kelly:
We already talked about weight, alcohol. The last big thing that the pandemic has impacted is stress. Now, the data says four in 10 Americans are experiencing symptoms of anxiety or depression or stress, compared to about one out of 10 before. I don't know about you guys, I feel like this number should be a lot higher, like 10 out of 10, because, I mean, it has really wreaked havoc in everybody's lives. I think the more disturbing, startling and sad thing is about one in four young adults said that they had had thoughts of killing themselves during this pandemic and that's according to the CDC and that's reflected in their data, which shows that the hardest hit with mental health problems because of the pandemic are youth and young adults, women, minorities and people with preexisting mental health issues.

Dr. Victoria Kelly:
If anything, it has the benefit of shining a light on these populations that they need extra support, but you definitely come through the media and you see other reports of many youth who end their lives just because of the social isolation and other factors related to it. It's definitely a problem and depression rates have tripled and especially if you're an essential worker. One in four essential workers have been diagnosed with a mental health disorder over this past year. If you think about all of the different waves of this pandemic, the first wave was the acute illness where everybody was on lockdown and the emergency rooms were overflowing all the time. The second wave, third wave, we're now in about that time. These essential workers, I mean, you guys are amazing and have put up with so much. It's like when you're a Superman or superwoman, you just go, go, go, go, go and at some point you're going to hit that wall and you're going to break.

Dr. Victoria Kelly:
I think the first thing is you got to take care of yourself, especially if you are an essential worker and you got to take care of yourself so that you can be there for your family or whoever and then you can be there for your job. Taking care of yourself, whether that's self care, taking vacations, taking time away or going for a run, probably not binging on chips and drinking alcohol, but whatever you got to do to maintain your healthy coping mechanisms to get through this is going to be good. The data from the pandemics from history show that it's going to take at least three years, really, for us to recover on this emotional side of things. Studies after the swine flu and Ebola show that even up to three years after quarantine, there were higher rates of PTSD, depression, the sense of detachment, which clinically is most often associated with PTSD, post traumatic stress disorder, and then guilt, unexplained, physical symptoms, pain, fatigue, alcohol, substance use disorders, death from violence, child abuse, domestic violence, and then agoraphobia, which comes from the Latin meaning fear of the public square.

Dr. Victoria Kelly:
That's an anxiety disorder where essentially your brain says, "Oh, this is an open space. That's super dangerous." You get panic attacks whenever you're in any kind of an open space, like a public transportation, a shopping center. I think it's funny now. We look at the TV shows and people aren't wearing their masks and we low key freak out. It's like, "Their faces are so naked. I can't even watch the show anymore. It makes me so uncomfortable." Agoraphobia is almost like a consequence of trying to do good and listen. It is important, though, this next phase of life in 2021, as we move into 2022 then also, that we take it slow, but we do continue to move out because it is too dangerous for your mental health to remain stuck in fear mode. That's really what all of last year was. Fear, panic.

Dr. Victoria Kelly:
Looking at the studies from survivors from hurricane Katrina, it took them about 13 years before they felt emotionally recovered from everything that had happened. I mean, it'll happen, it just takes a lot of work and it takes time. The biggest thing is you got to make sure while that time is going on that you're doing what you need to do to take care of yourself and your family. Now, sleep. Let's talk about that. That definitely falls into stress. About two thirds of Americans said that their sleep habits changed. About a third slept more, a third slept less during this pandemic time over the past year. Again, I think it's a common theme here. For if you're a parent you were affected even more. 77% of moms, 87% of dads had sleep changes that they did not want. That's a huge thing.

Dr. Victoria Kelly:
I myself have two kids school age and the transition to virtual school, while also expecting to be a physician, while also expecting to help educate our future physicians and whatnot, I mean, it was impossible. The whole theory of, "I'm going to do the best that I can. I'm going to sleep as much as I can," sleep is absolutely one of the core pillars of health. Without it, your brain just doesn't work. If you have untreated sleep apnea, you are functioning as if you were intoxicated. That's what the data says. Sleep is no joke at all. If you've noticed that your sleep's off from the pandemic, definitely take a look at that, see what's going on. Alcohol, to bring that back into the mix. One drink of alcohol can affect your sleep for three nights, making it not as deep. You don't reach those non-REM stages of sleep that are supposed to be restorative. Yeah. Okay. Fine, it'll make you sleep and help you fall asleep, but it's crappy sleep. What you're left with is feeling tired the next day. I definitely think those two are related, but so take a look at your sleep, see what's going on.

Dr. Victoria Kelly:
Are you still trying to do too much and cram too much into your day, especially if your kids are still in virtual school and you're hybrid or back in real work? There's so many factors. But without sleep, your brain will fall apart. So without a doubt, do what you can to get the sleep under control. Check in with your doctor to see if there's anything else that can go on. With that average amount of weight gain, you might have sleep apnea or some other conditions that can affect sleep too. Other stress-related things that have definitely increased during this time. For example, dentists. They found increases in tooth fractures and pain from teeth grinding. Dermatologists have been treating people more for hair loss. The number of prescriptions that pharmacists have filled for medications related to anxiety, depression, insomnia just skyrocketed last year and documented increased emergency room visits for suicide attempts, overdoses, relapses of psychiatric illness and violence otherwise.

Dr. Victoria Kelly:
Think about this too. If you were scheduled for your colonoscopy or mammogram, and a lot of outpatient centers were closed down and they started to open back up, but you're trying to catch up and live life. What the study shows about almost half, 47% of American adults have delayed or canceled healthcare services. That's what they're calling the fourth wave are these higher rates of cancer and other things that if you just maintain your healthcare and catch it early, you get treatments. But without that, things fall by the wayside until it's too late. If you've been postponing that mammogram or those other kinds of routine things, man, get that back on track because if something has happened, you want to catch it as soon as you can. With parents, I've mentioned a few times that overall parent's health have been impacted even more than the average American. The studies show that about 48% of parents said that their stress levels had increased, 62% if your kid was in remote learning and 75% said that they could have used more emotional support. About a quarter were diagnosed with a mental health disorder.

Dr. Victoria Kelly:
So a quarter, that's pretty comparable to what I was saying about essential workers. If you're a parent, take a breath, pat yourself on the back. If you're alive and your kids are alive at this moment in time, we'll call it a win. Kids are amazingly resilient and what they really need from a parent during this is a source of optimism and stability. That's, at this moment, what the general recommendation is in terms of parenting is you want to nurture that optimism for the future. There's, of course, silver linings from the stress of this pandemic. Initially, a lot of it was like, "Oh my gosh, I finally had a family dinner for the first time in four years," or, "I didn't have to take my kid to three different sports teams during the week." An article published out of the British Journal of Psychiatry found that about 88% had experienced what they called post-traumatic growth, meaning they learned something positive even out of it.

Dr. Victoria Kelly:
About 48% found that they appreciated their family more. 22% appreciated that the slowdown had made them reconsider what's important. You can't see people every day. You don't get to engage in the chit-chat, so you actually have to plan and expend energy to really stay connected with the people that you want. For holidays, this had come up too. Most holidays, it's not really the most stress-free time for people. You're around family, there's always emotional baggage. Maybe you feel like you're being talked to like a kid again. It's a mixed bag. One of the benefits actually was that, yes, those who have wonderful, healthy relationships with their families, they found ways to still celebrate.

Dr. Victoria Kelly:
But for those who didn't or it was just a little too much right now because of all the other stuff, it was nice. It was quiet. It was stress-free. You learn about yourself, about what you want for your family and what kind of things are good for your sanity and mental health for the future. That's another thing is any silver lining that you've discovered to keep that moving on. Maybe you don't need to be at work 12 hours a day and maybe just stick with the regular eight or nine. Go home, have that family dinner or whatever it might be. The other thing is with COVID, we all probably know someone who's been affected by, either had it or a family member, and we don't really know what the aftermath of that is going to be... What the aftermath. About one in 10 people will continue to struggle for weeks or months after a COVID infection.

Dr. Victoria Kelly:
Then it becomes kind of like you're managing a chronic condition, so what we don't know is how long that will last for, what the actual functional impairment will be. A lot of times what we're seeing now is that people who have had a COVID infection, they are having symptoms afterwards. Well, it's kind of like a chronic fatigue syndrome, what it used to be known as, so a lot of mental fogging and cognitive difficulties. We're going to be learning a lot more about that. Additionally, if you have been affected personally with COVID. Recent data says that for every one person that dies of COVID, it leaves nine others grieving for their loss. There's definitely a lot of things as we move into this next phase of our life, as we try to slowly figure out what life even is, what our new normal is going to be, that we have to do. We have to identify and actively put a plan in place.

Dr. Victoria Kelly:
If you're feeling stressed, number one, I'd say take a deep breath, slow breath. In terms of deep breathing, the best is to exhale for one beat longer than your inhale. Inhale for one, two, three. Exhale for one, two, three, four. On a neurochemical level, what that does is it resets the oxygen carbon dioxide balance, which can literally decrease sensations of panic. So just kind of take a breath, slow, deep breath. Outside of that, figure out what things can you control versus what things can you not control. The things that you can control are your own safety issues, so continuing to wear masks, socially distance as you should, washing your hands, keeping surfaces wiped down, those sorts of things. You can control that. You can advocate for yourself and your family and your needs. Maintain your self-care regimens.

Dr. Victoria Kelly:
Those are probably the biggest ones. And whatever you do, take it slowly. As you rebuild relationships, talking about how this whole time, one of the silver linings is priorities. It doesn't necessarily mean that people that may have dropped from your life weren't a priority, but it's kind of like if you feel like you're drowning, you're not really thinking about making it to that next island, you're just thinking about literally not drowning. So as you figure out which relationships you do want to rebuild, then reach out, start that process. You also want to look out for opportunities. With the pandemic, there's been so much financial impact with that. So yes, that is absolutely horrible, but it is also potentially an opportunity. Sometimes we get kind of afraid and we get stuck and afraid of change.

Dr. Victoria Kelly:
If you don't have any other option, you can absolutely look at this as an opportunity for change and growth. Let go of what you can't control. You can't control if other people are wearing their mask. You can't control what other people are doing with their families. To some extent, you have to let go of that and reflect on your experience. So again, whatever you did learn about yourself and family, keep that going. For me, we probably played board games. I went through my entire stash of board games, and I have a lot of board games, every single week. We went over all of them. Now, am I going to keep that pace up? No. Did we keep that pace up? No, but it did reaffirm, "You know what? I do enjoy board games." We do make sure about once a month that we play something fun together as a family.

Dr. Victoria Kelly:
Whereas before, I can't even recall the last time, as a family, we had really sat down to do that. If you are having some difficulties, seek help early. Really, that is the key. There's a lot of bad things that can happen, either job loss, decreased productivity, damaged relationships, getting fired from work. I mean, so many things can happen if you are feeling depressed and anxious and not able to handle it. If you're going to seek help, check in with your primary care doctor first. Sometimes there's an evaluation medically to do, to rule out like thyroid issues or other things like that. Counseling, psychotherapy and sometimes psychiatric medications are required if the symptoms are moderate to severe. Of course, if there's any, any, any sort of thoughts of death or dying, taking your life or anybody else's, those would be an emergency and I would say go to emergency room if those kinds of things were coming up.

Dr. Victoria Kelly:
But it's really easy to get care in some ways, it's still hard in others. On the clinician side, on the mental health side, in the world of medicine, I think that the biggest silver lining with all of this is tele-health and it is absolutely accessible now. That has been really good. You have increased access to be able to get some help. Lastly, this will pass. This will absolutely pass. In the meantime, I think what we can do is just learn and grow. We just have to be alive to make it happen. When I talk about optimism for the future, I mean several things by that. In our children, we want to instill in them that life happens and what's important is how we adapt to it and what we learn and grow from it. It's important on that factor for them.

Dr. Victoria Kelly:
For us, it's similar, but as an adult, we know more about ourselves and have more control over things. For many of us, that means work-life balance has been absolutely changed because of the pandemic and it may be higher up on your priority list of when you're working and things like that or the level of support you got from your employer. Those things become way more obvious... have become way more obvious during this pandemic, so just learning from that. As a healthcare provider, whether you're working in an emergency room or in an outpatient clinic, the biggest things to be optimistic there are the fact that, if anything, it has exposed difficulties that we have and that we can learn from and implement better measures for the future. That's probably the biggest area there.

Dr. Victoria Kelly:
In medicine, we're always looking at, if something goes wrong, how can we fix it? What is at the root cause of this? We analyze it and come up with measures so that it doesn't happen again. That plus the the boom of tele-health has been absolutely amazing. Sometimes people may also struggle and realizing the importance of reaching out for help. I mean, FMLA exists for a reason if you need it from your employer. They have shown that untreated depression and anxiety costs productivity at work, so you really got to take care of yourself. If your employer really is invested, then they're going to let you take care of yourself so that you can then take care of the business needs. I think optimism is a necessity. Some people inherently can do it better than others and it requires more work, but little by little, step by step, day by day, I think it's something that we can all move towards.

Dr. Victoria Kelly:
If you're struggling, besides reaching out to your primary care doctor, finding a therapist or AA meetings, things like that, other resources, there's a crisis text line. If you text T-A-L-K, talk, to 741741. There's a disaster distress helpline, 1-800-985-5990. The National Suicide Prevention Lifeline, 1-800-273-8255, and Mental Health America has resources on their website also. There's a lot of ways that you can reach out for help, but please do if you need it.

Voiceover:
Thank you for listening to Prescribed Listening from the University of Toledo Medical Center. To learn more about the provider you heard on today's show, visit UTMC.utoledo.edu. More Prescribed Listening next week from UTMC.