Anxiety vs. Depression: Which Do I Have (or Both?) with Dr. Karen Jacobs

Podcast Transcript

Nada Youssef:   Hi. Thank you for joining us. I'm your host, Nada Youssef, and today we have Doctor Karen Jacobs, psychiatrist here at Cleveland Clinic, and today we're taking your questions regarding depression and anxiety. So, make sure to send us any questions you may have below, in the comment section. And before we get started, please remember this is for informational purposes only and not intended to replace your own physician's advice. So, thank you so much for being here today.

Karen Jacobs:    My pleasure. Thank you for asking me.

Nada Youssef:   Sure thing. If you want to just introduce yourself to our viewers.

Karen Jacobs:    Absolutely. As Nada said, I'm Karen Jacobs. I've been a psychiatrist here for the past 12 years. I previously was an outpatient psychiatrist who finished her residency at the Cleveland Clinic for 14 years prior to that, so I've had many years in psychiatry. I specialize in outpatient psychiatry, so I see a lot of folks for depression and anxiety, as well as overseeing our adult psychiatry residency program.

Nada Youssef:   Great. Great. Awesome, well, anxiety and depression. First, I want to state some facts, first. Anxiety disorders are the most common mental illness in the United States, affecting 40 million adults in the United States, ages 18 and older, which happens to be 18.1% of the populations every single year. Also, major depression's also one of the common mental illnesses, affecting 16 million adults, which is 6.7% of the population.

Nada Youssef:   Now, I know we group these together, anxiety, depression. Can we talk a little bit about how do they relate to each other, and just because you have one doesn't mean you have the other, correct?

Karen Jacobs:    Absolutely. It does not mean that you might have both at the same time, although they commonly co-occur.

Nada Youssef:   Okay.

Karen Jacobs:    So, they're very different diagnoses. The symptoms are different for each of them, and then there's some cross-symptoms that might occur, between anxiety and depression. So, for instance, one of the things that we're looking at when we are interviewing someone is if they're presenting with a lot of depressive symptoms, but there is a high degree of anxiety as well, we're trying to sort out the chicken and the egg, and trying to figure out which one was first? And did one cause the other?

Nada Youssef:   Sure, sure. Okay. And now, many times, we feel sad or down. How do I know if I'm slipping through depression, versus just having a hard time dealing with a change like a divorce, or anything kind of like a life change? How do we know when you're stepping over that line?

Karen Jacobs:    Well, that's a great question, because all of us have episodes where we get sad, you know? We might miss someone, a good friend that's moving away. We might lose a loved one. We might not have done so well on a test. There's a lot of things that could cause us to feel sad, but these are things that typically are a little more temporary. They don't last that long, and the big differentiation between sadness and depression would be the symptoms are not nearly as severe, they're not as persistent, and they don't tend to interfere with our ability to function on a day-to-day basis. So, it doesn't cross or cut our work life, our home life and our social life.

Nada Youssef:   Sure. Now, I want to ask you about post-partum, just because I had two children, and you know, the first time I had my first child, such a happy moment, but then you go home, you're not sleeping, body changes, and it was like, I wasn't sure if I was having baby blues versus is this a post-partum thing? Do you have any hints or any tips on how to help moms that maybe go through this?

Karen Jacobs:    New moms need to know that there's been a major change that has occurred.

Nada Youssef:   Yes.

Karen Jacobs:    You know, you have gone from carrying these very high levels of hormones for nine months, and then it goes to zero.

Nada Youssef:   Yeah. Sure.

Karen Jacobs:    And all of a sudden. So, there's going to be fluctuations. The difference is, is it a big departure from your typical behavior? Is it starting to really interfere? Are you isolating yourself, somewhat, from the family, from the baby? Are you not connecting? Are you not sleeping at all? And so, if those symptoms get to be a bit more severe, and people are recognizing changes in your behaviors, and it goes beyond two weeks, then you need to start thinking, "Is this something a little more than just the blues?"

Nada Youssef:   Okay, so, two weeks? That's-

Karen Jacobs:    Two weeks.

Nada Youssef:   Okay. That's good to know.

Karen Jacobs:    Right.

Nada Youssef:   Okay. Great. Now, are there warning signs for depression? I have a lot of questions, also, about anxiety. I don't want to mush the two together. But are there warning signs for depression that we should be on the lookout for, whether it's in myself or in a loved one?

Karen Jacobs:    Well, if you see a loved one or someone that you care about starting to withdraw, you know, they're isolating, maybe they're not as talkative as they usually are, maybe they seem to be sad, sometimes they are having more difficulty with concentration, they may not be eating as much, so, you might notice that they're losing weight, you might notice that they're pretty tired. Things that you might have asked your friend or your loved one, you know, "Honey, you know what? Your favorite movie is coming to ..." You know, "The next edition of this movie is coming." "Oh, you know what? I don't really want to go."

Nada Youssef:   I see.

Karen Jacobs:    So, those kinds of things are the kind of warning signs we need to be paying attention to, about those we care about.

Nada Youssef:   Sure. Sure. Now, speaking of a loved one that's going through a major depression, because a lot of times if you have a spouse or a child or anybody that's going through depression, and it's a daily basis that you're dealing with them, how do I keep myself motivated and emotionally healthy and strong for that person, when you're dealing with that negativity all the time? Do you have anything to say for those people?

Karen Jacobs:    That's a very difficult situation to be in, and it can be a protracted situation, depending on what it is that's going on. But one of the things that I would suggest is that if your spouse or loved one, for instance, is not getting help, then you should be seeking some assistance. You should be talking to someone about, "How do I manage living in this situation?" To keep yourself okay. Now of course, we're hoping that that spouse is willing or that loved one is willing to go seek help themselves, and so, there's going to be a period of time where you're going to need to be very patient and loving and kind.

Karen Jacobs:    One of the things that really is distressing for me, as a psychiatrist, is to hear people say is there are folks that have never experienced depression in their lives, families have never experienced depression, they don't get it. They feel that it's a weakness, and they will say the kinds of things that you've heard. They will say, "Pick yourself up by your bootstraps." "Just get going." "If you just got out of bed, if you just did this ..." And those kinds of things are ... The person experiencing a true depression is, "If I could, I would. But I can't."

Nada Youssef:   Sure. Sure. Okay, and now, if the person that's going through depression is resisting help, how do you become a support system for that? That you know you're the one taking all the beating, but they're not going and seeking help. How do you not push them to do something they don't want to do, but you want the best for them?

Karen Jacobs:    I think talking to them very directly about, you know, "I'm hurting that you're hurting, and I'm not sure how much more I can take of this. I'm going to go seek some help for myself. I'm going to go talk to NAMI," National Alliance for Mentally Ill, that has support programs for families of those who have mental illness, or again, as I had mentioned before, having someone that you can talk to yourself. How do you manage? How do you stay healthy? You're going to have to make sure you're getting plenty of sleep, that you're doing all right with this whole process.

Karen Jacobs:    If you can get them ... So, sometimes, they may not want to go talk to a psychiatrist. We tend to, in the media, might be portrayed as scary or intimidating, and I'm hardly that, so I'm hoping that more people would be willing to come out and talk to folks, but going to see their family physician is a great first step. You can always call the family physician and let them know, "You know what, I'm going to be bringing Joe in, and I'm really concerned about his mental health. He seems so depressed. He's withdrawn. He won't talk to the family. Can you help us out with it?" By giving them some kind of forewarning, they may be able to be prompted to ask the questions that will draw Joe out.

Nada Youssef:   Okay. Great. Thank you, that was so great. Okay, now, jumping a little bit to anxiety, so we all go through anxiety episodes, at least I do. What's normal? How do I know my anxiety's off the roof and I should probably be seeking help, versus, this is just normal anxiety?

Karen Jacobs:    Anxiety manifests itself a little bit differently, but there's some similarities to the depression. For instance, I was anxious coming in here and doing something like this with you, and you've been very gracious, so thank you.

Nada Youssef:   Thank you.

Karen Jacobs:    But, that would be normal. You know, being worried about how well you're going to do on a test or going into talk to your boss about your annual review, those are normal things to be anxious about. But, if it starts, again, persisting and crossing against all your life activities, your work, your home life and so forth. So, some of the things you might see would be someone who is, firstly, is really disrupted. They have a lot of muscle tension. They are constantly ... They can't stop thinking about all these worries. They are pervasive. So, they are focusing concentration on their work or at home or anyplace else. They are someplace else, and very troubled by it.

Karen Jacobs:    Sometimes, you'll see some physical agitation. You know, they may not be able to sit still. They may be restless. Those kinds of things. So, there's a lot of things to look for in that regard.

Nada Youssef:   Now, if your life becomes naturally more stressful, so, you have natural anxiety that comes with it, is there anything, besides jumping to medication or anything like that, that you think a person can do at home? I don't know, meditation, or counseling? Is there anything else to do besides medication that you can go to?

Karen Jacobs:    Absolutely. So, initially, we wouldn't even want to jump into medication, if you can help it. If it's a moderate to severe anxiety or depression, that's when you might want to introduce the medication, but prior to that, as you mentioned, meditation, exercise, healthy eating, if you are drinking a lot of caffeine or a lot of alcohol, both of those should be reduced. Psychotherapy, extraordinary useful to have someone to talk to.

Nada Youssef:   Okay. Now, a lot of people don't feel comfortable going to a counselor, telling them anything like that. What do you say to those folks? Sorry, my computer fell asleep, so I'm going to go log back in here.

Karen Jacobs:    That's okay.

Nada Youssef:   Yeah, just because, you know, you're telling your personal information to a stranger to you, that never talked to you before, and you're like, "Where do I start?" You know? What do you tell someone like that?

Karen Jacobs:    Someone like that ... It is difficult. You might say, "You know what? Would you feel more comfortable if I went with you." So, if there's a good friend. You know, "And I can sit in there for the first 10 minutes, and if you're getting more comfortable with someone, then I can walk out." They can start with talking with friends, but, you know, when I have folks that say in a session, "Well, I really don't need therapy. I have my friends." There's a big difference between having someone who's professional and can help guide you versus a friend who is a support. We love having support systems-

Nada Youssef:   Good friends. Yes, definitely. Definitely.

Karen Jacobs:    Yes, yes. Yeah, absolutely.

Nada Youssef:   Great. All right. Now, I want to talk a little bit about some of these shows, some of these movies. Let's say Thirteen Reasons Why is a Netflix show that came out, and it really heightened awareness of suicide in a negative and a positive way. And we know that results of a recent study show suicide searches were 19% higher in the days following the Netflix show release. Do you think these type of shows, or even violent video games, or even social media, is affecting our social and especially our children? Have you seen a spike in visits? Has that affected anybody?

Karen Jacobs:    Well, it's a great question, and I do remember the media indicating the high increased rate of suicides, but this is a question that I would probably have my child psychiatry colleagues be able to share their information, share more about this.

Nada Youssef:   Okay. Great. Then, I want to talk a little bit about the risk of suicide. It's very real with these patients. Can we talk a little bit about the warning signs? What to do, what not to do? If there are trigger words that we should probably stay away from, or things that can help?

Karen Jacobs:    Well, one of the things right off the bat that people get a little bit scared about is someone starts to talk a little bit about suicide, or if they're super depressed, and you're wondering. They're afraid to bring up the topic of suicide, because they're fearful that it might push them towards it. That typically is not the case, and it's actually a bit freeing for the person if someone else says to them, "You know, I'm really worried about you, Nada. Have you been having thoughts about wanting to hurt yourself or suicide? Because you've been so down and you've changed your behavior, you're isolating completely, you're drinking a lot more and I'm really worried about the things that you're doing." So, it actually frees them up to feel more open to talk about it.

Karen Jacobs:    But they may start talking about things. They might start talking about ... They're talking about suicide. They're talking about ways to kill themselves. They're looking up things on the internet, how to do these kinds of things. Their behaviors are way different than what they typically are. They're drinking more. You know, one of the things you might want to know is are there guns in the household? We always have to ask about guns in the households, and one of the first things that we ask when we're talking to patients, and they do have guns, is, one, are they locked? Are they loaded? Can we get them out of the house? Is there someone that can take them and keep them for you?

Nada Youssef:   Sure, sure. Now, if someone does mention anything about suicide, or hinting to suicide, can you let our viewers know what is the first thing to do? What is the first step that we should be taking?

Karen Jacobs:    Actually, the first step to do if someone mentions suicide is see if they'll talk a little bit more about it. There is a National Suicide Hotline where they can call or you can call, but if they are very serious about this and it looks like you're not going to be able to do much about it, please, don't take this in your own hands. Call 911 immediately. Let the authorities go ahead and take your loved one to the hospital where they can get the specific help that they need.

Nada Youssef:   Okay. Great. Thank you. All right, well, I'm done with my part. Now I'm going to just go ahead and go to the live questions.

Karen Jacobs:    Okay.

Nada Youssef:   So, I have Lisa. "I have been suffering from both anxiety and depression, and some OCD, for years. Does it ever go away?"

Karen Jacobs:    Great question. For Lisa, I would say, if you have been treated with a combination of medications and therapy, the hope would be that the symptoms and your quality of life have improved over time, and at some point, if things are going just swimmingly, they're going fabulous, then your physician and you can work together and start to wean off some of the medications very slowly, to see how you might do. You take major rest stops to see, are you still doing just as well on this dose versus that dose? But oftentimes these can be lifetime illnesses.

Nada Youssef:   Okay. Great. Thank you. I have [Darryl 00:16:19]. "How much anxiety and depression medication is too much, and are there any natural remedies for depression and anxiety?"

Karen Jacobs:    That's a great question, and I think it's going to be very hard to answer that question in terms of what's too much, without knowing some specifics. People do metabolize medications differently. So, I might have one patient ... I remember years ago, here at the clinic, I had a 6' 2", 240 lb gentlemen, and I had a 5' 2", 130 lb female. They both needed the same dose of medication to get them to the place of diminishing their panic attacks and improving their depression, which was uncanny, but that's ...

Nada Youssef:   That's how it is.

Karen Jacobs:    Yeah.

Nada Youssef:   Great. Paula, "I've just started counseling, but what can I do in between sessions to help manage my depression?"

Karen Jacobs:    Excellent. I'm so glad that you started counseling. That's great. That's a great first step for you. Mindfulness apps are great ways of having something with you all the time, so that you can check those, and during the day you can follow a little exercise that there might be. Again, if you can get into a regular exercise routine, even if that is walking three days a week. Again, as we mentioned earlier, things like alcohol and caffeine, if you can manage those reasonably, those are things that you can all take care of yourself.

Nada Youssef:   Mindfulness apps. Can you tell me a little bit about that?

Karen Jacobs:    There's some free apps that I regularly recommend to my patients. Some of them if you want superior or premium kinds of things, you can start paying for them, but there is one called The Mindfulness App and there's one called Headspace, and there's many others. You can investigate and see which one might work best for you. You know, again, there's not one that fits all sizes.

Nada Youssef:   So, does it give you, like ... It reminds you to breathe? And calm down? Or-

Karen Jacobs:    There's a variety of different things that you can do.

Nada Youssef:   Wow. That's awesome. Great.

Karen Jacobs:    Mm-hmm (affirmative). Yeah.

Nada Youssef:   I didn't know about that.

Karen Jacobs:    Mm-hmm (affirmative).

Nada Youssef:   Let's see, then we've got [Allison 00:18:30]. "What do you do when anxiety happens out of nowhere? When it distracts going out and having fun?"

Karen Jacobs:    Okay. So, the question might be, it sounds like, does it interfere with your ability to go out and have fun? And does it escalate into something we didn't touch on, but might be a panic attack? Or is it social anxiety? And again, if it's social anxiety or regular anxiety, being able to figure out ways to bring down that level of anxiety. And again, here is where you might bring a friend in who knows that you get a little anxious before you go out, and can they help you get past the doorway and into the social event?

Nada Youssef:   Now, speaking of panic attacks, can anybody get a panic attack, depending on some kind of stresses going on in their life? Like anxiety? Or is a panic attack an extreme form of anxiety? What exactly is that?

Karen Jacobs:    A panic attack often is an unprovoked kind of situation or act. There doesn't necessarily have to be something right then, although, usually there's going to be something in the recesses, whether it's in something you haven't dealt with, or something, but it can come out of the blue. A panic attack escalates over seconds to minutes, and it's quite intense. Your heart is beating fast, you can't get your breath, you feel like you might die. Then, it goes away. You know, if those are repeated, then I would say, you know, if you have one and you never have another one, you don't need to worry about that, but if you start having those on a regular basis or they get more frequent, that's when you should seek some help.

Nada Youssef:   So it affects breathing and everything?

Karen Jacobs:    It feels like you can't catch your breath.

Nada Youssef:   Okay. Okay.

Karen Jacobs:    And so, the first thing most people do when they have a panic attack is they feel like they're having a physical ailment, whether it's an asthma attack or a heart attack, and they go to the emergency room. It's important just to make sure we rule out medical causes, because what we didn't touch on here was that there's a lot of medical illnesses that can promote both depression and anxiety.

Nada Youssef:   Okay. Do you want to talk a little bit about that?

Karen Jacobs:    Well, one of the first things that we look for as psychiatrists is thyroid disorders, because 1 in 100 persons who presents to us with depression actually has a thyroid disorder.

Nada Youssef:   Really?

Karen Jacobs:    Mm-hmm (affirmative).

Nada Youssef:   Very interesting. Now, thyroid throws off your hormones, correct?

Karen Jacobs:    Mm-hmm (affirmative).

Nada Youssef:   Is that probably the major reason?

Karen Jacobs:    It regulates your metabolism, so it can either go really slow and make you feel lack of energy and can't move and tired, so that you appear as if you're sad and withdrawn, but really, there's nothing there.

Nada Youssef:   Wow.

Karen Jacobs:    But it can be easily treated with replenishing the thyroid hormone.

Nada Youssef:   Sure. Sure. Okay. Good to know. Thank you. Going onto Ray, "Can anxiety cause physical symptoms, such as internal trembling?"

Karen Jacobs:    Yes. Yes, there's a lot of ... There's muscle twitching, there's trembling, there's shaking. There can be a little bit of feeling like you can't catch your breath with anxiety. Also, your heart could race. So there's a lot of physical symptoms that can occur with anxiety.

Nada Youssef:   Sure. Sure. Okay, and Linda's asking, "If someone has generalized anxiety disorder do they feel physically ill with pain every day?" I guess you talked about that a little bit?

Karen Jacobs:    Yeah. Can they feel physically ill? With pain every day. So, they can feel physically ill. I mean, with generalized anxiety, this is something that's exhausting. Most of my folks with anxiety, I will talk to, and they are so tired, because the mental processes it takes to work through all the anxiety just wears you out. So they're typically really fatigued.

Nada Youssef:   Sure, sure. Okay. Then, Jill is asking about, "As a parent, what is a good technique for someone who has a 14-year-old with generalized anxiety disorder, who gets angry when anxious and so defensive?"

Karen Jacobs:    If you're able to have a good talk with that 14-year-old, and say, "You know what, Jenny, I know you're not trying to be upset with me or angry with me right now, but I know this is a symptom of what happens when you get anxious. What can I do that would be most helpful for you when this happens?" So, kind of explaining some of those things is really useful.

Nada Youssef:   Sure. And I'm sure just dealing with a 14-year-old is difficult as it is.

Karen Jacobs:    A 14-year-old is difficult, and you're so right, that with teens depression and anxiety might come out a little differently, and it often comes out in this anger and irritability.

Nada Youssef:   Sure, sure. All right. And then, Julie, "Is there hope to free yourself from bad memories that are always on your mind?"

Karen Jacobs:    Yes. That's a very difficult one. So, if we're talking about something like a post-traumatic stress disorder, where you've had some horrific abuse in the past, and these memories are coming to haunt you, therapy is absolutely necessary. We have medications that also can assist in combination with the therapy. So, one of the things I want to make crystal-clear here is that medication is not necessarily better than psychotherapy. Medication plus psychotherapy is like taking one plus one equals three.

Nada Youssef:   Okay.

Karen Jacobs:    So, it is the best combination that you can ever have.

Nada Youssef:   Sure.

Karen Jacobs:    Yeah. So it's a long road, but it can be done, and I've dealt with many people with PTSD, and they have come a long way and those thoughts have diminished quite a bit.

Nada Youssef:   Cool. Great. Janet, "How do you treat a mixture of PTSD, major depression, SAD and panic disorder? I have all of those and cannot function very well."

Karen Jacobs:    Well, interestingly, the medications that we use, which in your case it sounds like there's a combination of several things that would be very disabling, are similar. So, we can use the same medication that we would use for anxiety, that we can use for depression, and then we need to couple that with some really good therapy with someone that knows how to manage what you're dealing with. So with ... I think you mentioned OCD? Did you mention OCD?

Nada Youssef:   Yeah. That was one of the very first ones. No, I think said mixture of PTSD, major depression, SAD and panic disorder.

Karen Jacobs:    Oh, okay. All right. So, you need a therapist who knows how to manage those kinds of things, in addition to using the right medications.

Nada Youssef:   Okay. Great. Then, Cheryl, "How do you deal with the stress we feel from sounds such as chewing loudly? My hubby is making me nuts, eating peanuts from a can."

Karen Jacobs:    Go into another room. You know what? That's a tough one, but I would say this-

Nada Youssef:   I mean, that is a phobia, is it not?

Karen Jacobs:    Well, I would say that if that's something that if you're troubled routinely, and people are getting on your nerves with a lot of things, then I would be a little more concerned. If that is something that is just one particular issue, if your hubby can't learn to chew with his mouth closed or go chew in another room, then I would exit.

Nada Youssef:   Yeah. Remove yourself.

Karen Jacobs:    Yes. Yeah.

Nada Youssef:   Okay. Great. Then we have, "Why does it seem that people who have a family, healthy appearance, a good job, good looks, hobbies, et cetera, say that they are depressed?" I guess that could be an opinion.

Karen Jacobs:    Oh, so, if I'm understanding the question correctly, it's someone who wonders how someone who appears to have it all say-

Nada Youssef:   Can be depressed.

Karen Jacobs:    Can say they're depressed. That's because outward appearances are very much separate from what actually goes on.

Nada Youssef:   Yes, yes.

Karen Jacobs:    We see these people in our offices all the time. It's very sad, because, again, they're putting forth so much effort and putting on this beautiful face and looking the part and acting the part, and they have nothing left. So, I have patients that I may ask, you know, "Janet, and how many hours did it take you today to look so beautiful?" Took her five hours before she came in to see me, but she looked the part. You would never know that she was depressed if you saw her out in public, but she has very real illness, and suffers quite a bit.

Nada Youssef:   Sure. And you know, just because someone's depressed, they don't have to look depressed.

Karen Jacobs:    No. They don't have to look depressed, especially to the public. There's such a stigma about depression and mental illness in general that folks don't always want to talk about this or let other people know that they're suffering from this, so they will do their best to appear this way.

Nada Youssef:   Sure. Sure. Can we talk a little bit about that stigma? Because it seems that a lot of people that maybe are going through any kind of mental illness, depression, anxiety, they don't like to talk about it, because of this stigma that's out there. Can you speak to that a little bit?

Karen Jacobs:    Yes. Our professions, over the years, have been trying to do our best. Education, education, education, is one of the biggest ways to kind of diminish some of the stigma. Organizations like NAMI are out there, trying to provide this education. But, probably one of the best ways to help us are when people like Kevin Love comes forward and talks about his panic attacks, and he touched millions of people, because here was someone who they had ... So, again, to all appearances has it all, right?

Nada Youssef:   Sure. Right. Of course, yeah.

Karen Jacobs:    Very talented, very good looking, wealthy, but yet, he was suffering with panic attacks. So, when people who are known in the media can come forth and share their stories, it helps other people know, "Maybe it's okay for me to come forward and do that."

Karen Jacobs:    Sometimes, we have to get them to walk in the door, because they don't know what to expect when they see a specialist like a psychiatrist, and when they find out that it wasn't so bad, we're real people, and we just want to talk and listen and help them, it eases it. But we have to get them in the door.

Nada Youssef:   Sure. Sure. And hopefully, you know, just like you were saying, awareness is huge.

Karen Jacobs:    Awareness.

Nada Youssef:   Whether it's a celebrity, Facebook Live or podcasts, read about it, listen to people, because a lot of people are going through this.

Karen Jacobs:    Right. Absolutely.

Nada Youssef:   Sure. And then, I have, I think, India. "Can situation anxiety progress to generalized anxiety?"

Karen Jacobs:    There are times that it could happen, that situational anxiety could expand into generalized, but not for the most part. So if it's just an occasional kind of specific situation, and it's not pervasive, so again, it's not consuming someone every day, all the time, and again, it's not interfering with their work, their home, their social life, then they're probably going to be able to contain it to those specific situations.

Nada Youssef:   Okay. Great. Now, Sharon, "Can you talk about borderline personal disorder?"

Karen Jacobs:    Oh, borderline personality disorder? Probably it would be a great topic, if that's what they're referring to, on another session, because it goes into a whole nother realm of a different area.

Nada Youssef:   Sure. Sure.

Karen Jacobs:    And they do share symptoms of anxiety and depression, so that's very real.

Nada Youssef:   Yeah, so it's all relatable.

Karen Jacobs:    Mm-hmm (affirmative).

Nada Youssef:   Okay. And then, Maggie, "What is the likeliness of a child who has suffered from PTSD to have additional diagnosis of anxiety and depression?"

Karen Jacobs:    Very high. There's a lot of comorbidity that goes along with any of the anxiety and depressive disorders, so it's very likely that they will have something else, as they go along. But if they're a child and you're aware that they suffer from PTSD and they're getting help now, that's fabulous, because they have an opportunity to do well.

Nada Youssef:   Right, right.

Karen Jacobs:    Yeah.

Nada Youssef:   Okay. Great. Now, I know you're an adult psychologist, so we're not going to go too much into children, but are there warning signs? Because, you know, just like she said, 14-year-old that's defensive, kids can act a certain way — I have a seven-year-old that acts like a teenager — is there something, where I'm like, "Man, I think she might not be her normal self?" Is that the same thing you said, as an adult, that doesn't want to go see a movie that they usually love? Is it kind of like the same things, or is it different for children?

Karen Jacobs:    Well, for children ... And again, I'm glad you clarified the fact that I am not a child psychiatrist.

Nada Youssef:   Yes, yes.

Karen Jacobs:    But some of the things that you might see in a child would be changes in the school place. They might refuse to go to school. They may not want to get together with any of their friends. They may sulk in their room. And then, the teenagers tend to get the irritable, angry kind of thing. But younger, they may have the school refusal.

Nada Youssef:   Okay. Okay. Good to know. Okay, I'm going to give you one more question before I let you go. Sharon's asking, "I want to be an advocate for my depression and anxiety, and tell my story. What do I do?" Any thoughts?

Karen Jacobs:    Oh, that's fabulous. Get hold of your local NAMI organization. They often highlight folks who are willing to share it. They also, on occasion — and I won't say they do this with everyone — they have folks speak before the large programs that they hold every year. There's hundreds of people that come to those. But they would love to hear your story. They would love to have more advocates, and if you want to help other peers who are going through this, you can be trained to help some of the support groups through NAMI as well. So, educating one more person or sharing your story can generally help many others. So, that's fantastic.

Nada Youssef:   And one more time before you go, NAMI, is that an abbreviation?

Karen Jacobs:    National Alliance for the Mentally Ill. I am so sorry. National Alliance for the Mentally Ill. We have local chapters here. You can look it up online. They have groups that are generally held across the city, in different neighborhoods, and there are those for families.

Nada Youssef:   Excellent. Thank you.

Karen Jacobs:    You're very welcome.

Nada Youssef:   Thank you so much. Thank you so much for coming in today. You've been great.

Karen Jacobs:    My pleasure.

Nada Youssef:   Thank you.

Karen Jacobs:    Thank you.

Nada Youssef:   For viewers, if you guys are interested in our next Facebook Live, it will be next Wednesday. Our topic will be hair, skin and nails with Doctor Melissa Piliang, so make sure you guys tune in, and for more health tips information, follow us on Twitter, Facebook, Instagram and Snapchat at Cleveland Clinic, one word, and we'll see you again next time.