Ask the Expert: Managing Stress

Dr. Mark Melden, DO, a psychiatrist affiliated with Sharp HealthCare, answers questions about managing stress.

I think I need to see a psychiatrist but I feel ashamed. What should I do?
If you’re feeling bad I think you owe it to yourself to start feeling better. And I think that you do. You shouldn’t let the idea of going to a psychiatrist and making you feel like you’re going to a psychiatrist is a bad thing. I think what you should look at is how you’re gonna feel better.

Stress is inevitable, but when does it become problematic?
If your stress lasts for more than two weeks with ongoing thoughts of constant thinking about what you have to do or worrying and you’re feeling like you can’t relax, you’re not sleeping well, you’re not able to concentrate all that well, these are signs that you need help.

What are some physical symptoms I should watch for?
It’s adrenaline going through your body. And what happens is that you start to get sweaty. You get headaches. Your interest levels start decreasing. You start feeling like you can’t get out of bed. There are some simple things that you can look for in terms of how you’re feeling stress. You can listen to your body. 

Why is excessive stress an issue?
If you’re not waking up refreshed, your body’s under stress, there are things going on that you cannot overcome. If your stress is not impairing your ability to function then it’s probably not at the level that needs to be treated psychiatrically or psychologically. Oftentimes, people think that if you see a psychiatrist because you’re stressed or depressed you must have some sort of mental weakness and I don’t believe that to be the case at all. It has nothing to do with how strong you are and it doesn’t have anything to do with mental weakness. It has to do with how much pressure you’re under and how long you’ve been under it.

What should I do if feeling stressed out and feel like I need to be treated?
What I see usually is that a person will be stressed out…they’ll go to the primary care first with headaches, feeling a malaise, just tiredness, getting sick more often times over the year than not. They’ll come down with physical complaints and they’ll see the primary care doctor. The primary care doctor will treat them, targeting their symptoms and it’s not getting better. And then they come to a psychiatrist because we are trained to look at dysfunction and see if the stress level meets the criteria for medication.

What if my stress levels don't meet the criteria for medication?
If it doesn’t they will be referred to a psychologist where they can do talk therapy and try to get their mind relieved. I tend to be a big proponent of other methods of stress relief such as exercise, yoga, other things that people can do to make their bodies relax and help their minds relax at the same time. Oftentimes, more than not, a person who is stressed out can go to a psychologist or take an alternative way to decrease their stress and that will always be my first step.

What if I do need medication?
If medication is required the best person to go to is a psychiatrist because we handle these kinds of medications on a day in, day out basis. When you’re stressed there’s not quite enough chemicals in your brain to be able to handle the stress and we give medication to help increase those levels, such as serotonin. Usually between six and nine months is what I’m looking at as a medication course and then weaning them off the medication to see how they hold it together. There are people who get stressed out chronically that might need the medication the rest of their life but that’s not always the case. But there are people who need medication the rest of their life.

What else should I know about managing my stress levels?
People can have heart attacks, hypertension, high blood pressure, stroke, even cancer can be related to stress. Diabetes, mood disorders like depression, people eating because they’re stressed out. They become obese. People use drugs. They self-medicate. If your stress if going on for more than two weeks on an everyday basis and you’re feeling stressed out, get help. If you’re feeling bad I think you owe it to yourself to start trying to feel better.

For More Information
To learn more about Sharp's mental health services or to find a Sharp-affiliated doctor, search for a San Diego psychiatrist or call 1-800-82-SHARP (1-800-827-4277), Monday through Friday, 8 am to 6 pm. To find general information about mental health, visit Mental Health Disorders in Adult Health or read the Mental Health News archive.