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Major mental illnesses such as schizophrenia or bipolar disorder rarely appear “out of the blue.” Most often family, friends, teachers or individuals themselves begin to recognize small changes or a feeling that “something is not quite right” about their thinking, feelings or behavior before one of these illnesses appears in its full-blown form.

Learning about developing symptoms, or early warning signs, and taking action can help. Early intervention can help reduce the severity of an illness. It may even be possible to delay or prevent a major mental illness altogether.

Signs and Symptoms

If several of the following are occurring, it may useful to follow up with a mental health professional.

• Withdrawal — Recent social withdrawal and loss of interest in others
• Drop in functioning — An unusual drop in functioning, at school, work or social activities, such as quitting sports, failing in school or difficulty performing familiar tasks
• Problems thinking — Problems with concentration, memory or logical thought and speech that are hard to explain
• Increased sensitivity — Heightened sensitivity to sights, sounds, smells or touch; avoidance of over-stimulating situations
• Apathy — Loss of initiative or desire to participate in any activity
• Feeling disconnected — A vague feeling of being disconnected from oneself or one’s surroundings; a sense of unreality
• Illogical thinking — Unusual or exaggerated beliefs about personal powers to understand meanings or influence events; illogical or “magical” thinking typical of childhood in an adult
• Nervousness — Fear or suspiciousness of others or a strong nervous feeling
• Unusual behavior – Odd, uncharacteristic, peculiar behavior
• Sleep or appetite changes — Dramatic sleep and appetite changes or decline in personal care
• Mood changes — Rapid or dramatic shifts in feelings

One or two of these symptoms alone can’t predict a mental illness. But if a person is experiencing several at one time and the symptoms are causing serious problems in the ability to study, work or relate to others, he/she should be seen by a mental health professional. People with suicidal thoughts or intent, or thoughts of harming others, need immediate attention.

Taking Action, Getting Help

More than a decade of research around the world has shown that early intervention can often minimize or delay symptoms, prevent hospitalization and improve prognosis. Even if a person does not yet show clear signs of a diagnosable mental illness, these “red flag” early warning symptoms can be frightening and disruptive.

Encourage the person to:

• Have an evaluation by a mental health or other health care professional.
• Learn about mental illness, including signs and symptoms.
• Receive supportive counseling about daily life and strategies for stress management.
• Be monitored closely for conditions requiring more intensive care.

Each individual’s situation must be assessed carefully and treatment should be individualized. Comprehensive treatment to prevent early symptoms from progressing into serious illness can include ongoing individual and family counseling, vocational and educational support, participation in a multi-family problem-solving group, and medication when appropriate.

Family members are valued partners and should be involved whenever possible. Learning about mental illness and what is happening in the brain can help individuals and families understand the significance of symptoms, how an illness might develop and what can be done to help.

Just as with other medical illnesses, early intervention can make a crucial difference in preventing what could become a serious illness.

People often confuse psychiatrists and psychologists. There are similarities—both psychiatrists and psychologists are trained to help people with mental health problems. But there are also important differences. If you need help with a mental health concern, who should you turn to, a psychiatrist or a psychologist?

Psychiatry is the branch of medicine focused on the diagnosis, treatment and prevention of mental, emotional and behavioral disorders. A psychiatrist is a medical doctor (M.D. or D.O.) who has completed medical school and residency. Psychiatrists also have special training in psychiatry and specialize in mental health, including substance use disorders. Psychiatrists are qualified to assess both the mental and physical aspects of psychological problems. A psychiatrist is able to conduct psychotherapy and prescribe medications and other medical treatments.

Because they are physicians, psychiatrists can order or perform a full range of medical laboratory and psychological tests. Psychiatrists’ education and training equips them to understand the complex relationship between emotional and other medical illnesses and relationships with genetics and family history, to evaluate medical and psychological data, to make a diagnosis, and to work with patients to develop treatment plans.

A psychologist has an advanced degree, usually a Ph.D. or Psy.D., most commonly in clinical psychology. Psychologists often have extensive training in research or clinical practice and in psychological testing and evaluation. Psychologists also complete a 1-2 year internship that gives them exposure to methods of treatment, analytical testing, problem-solving techniques and behavioral therapy. Psychologists treat mental health problems with psychotherapy and other behavioral interventions.

Among the key differences is that psychiatrists can prescribe medication and generally psychologists cannot. Psychiatrists’ training and practice is more grounded in biology and neurochemistry, whereas a psychologists’ training and practice is generally more focused on behavior. Mental health services provided by both psychiatrists and psychologists are typically covered by insurance. (See Mental Health Parity for more on insurance coverage of mental health services and the law.)

Some people, particularly those with more serious mental health concerns, work with both a psychiatrist and a psychologist as part of their health care team.

In addition to psychiatrists and psychologists, a number of other types of professionals provide various mental health services. Clinical social workers can help individuals and families with mental health problems most often through therapy, counseling, and advocacy. Licensed professional counselors, licensed marriage and family therapists, and certified pastoral counselors can also provide care for mental health concerns.

Primary care doctors are often the first ones people go to with mental health concerns. They often provide basic mental health services or work in consultation or collaboration with psychiatrists or other mental health professionals.

A new study points to differences in priorities between patients and clinicians when deciding on treatment for depression.¹ Patients and clinicians agreed on several top priorities when making a decision about how to treat depression: effectiveness of treatment, side effects, and speed of recovery. However, there were also several differences. Patients placed greater priority on treatment costs and insurance coverage. Providers placed higher priority on explanations of how a treatment should be used and how it works.

The survey, led by researchers from the Dartmouth School Institute of Health Policy and Clinical Practice, included nearly 1,000 U.S. adults who were being treated, were awaiting treatment, or had previously been treated for depression. Researchers also surveyed nearly 250 clinicians, including psychiatrists, primary care doctors, and therapists, who had recently treated patients for depression. Both patients and clinicians were asked to rate the information that they believed was most important when choosing a depression treatment.

The study authors note that while some may people contend that medical decision should be based solely on needs, the cost of treatment does have a direct impact. Costs can impact consumer well-being, financial stability, likelihood of sticking with treatment and, ultimately, health status and outcome.

Patients and providers expressed similar concerns related to side effects of treatment; however, patients included sleep problems and increased stress related to treatment among their high priorities.

The researchers also looked at the level of collaboration in decision making between patients and providers. Substantial previous research has found that shared decision making for people with depression leads to people sticking with treatment longer, being more satisfied with treatment, and having improved outcomes.²

Despite the benefits of shared decision making, a number of obstacles exist for patients and their physicians. ² For example, patients may not see the need to participate or may feel the doctor should be making decisions and some mental health conditions may make it difficult to participate in decision-making. Physicians may feel they don’t have the time to devote to shared decision-making or may feel it is not appropriate in some critical situations.

To learn more about what you can do to improve your treatment for depression, see tips on Working with a Provider and Preparing for Appointments from Mental Health America. Also see more information on Shared Decision Making from the SAMHSA-HRSA Center for Integrated Health Solutions.

There are many misperceptions about mental illness and its treatment that contribute to stigma. People may incorrectly assume that the feelings that accompany anxiety anddepressive disorders can be willed away with the right amount of discipline, or that seeking help for them is a sign of weakness. It’s important to understand that these emotional disorders are not “normal” feelings. This fact is often misunderstood, which can also lead to misunderstandings about the use of medication.

Misinformation about the role that antidepressants or medication play in the treatment of mental illness can deter people with depression or anxiety from using what may be one of their best options for recovery. The term “antidepressant” is somewhat misleading, in that these medications could easily be called anti-anxiety medications and are used to treat many other conditions. Combined treatment, which involves drug therapy, psychotherapy and lifestyle change, has proved most effective in treating depression and anxiety and in lowering relapse rates.

Antidepressants Are Not “Happy Pills”

The purpose of antidepressants is to help a patient’s mood to return to a normal state, not to alter it. Antidepressants do not make you high or work quickly – they work over an extended period of time. These medications are not sedatives, “uppers” or tranquilizers. They are not habit-forming. Generally antidepressant medications have no stimulating effect on people not experiencing depression or anxiety. Most people start to feel better two to four weeks after starting treatment. Full benefits may not be felt for two to three months, or even longer in some patients.

The purpose of antidepressants is not to “make you happy,” nor are they intended to keep you from feeling emotions. The goal of medication and combined treatment is to help you get you back to functioning as your full self. Feeling emotionally numb is a symptom of depression, a symptom that the use of antidepressants is intended to help correct. If the medication is working correctly, a patient with a depressive or anxiety disorder should be able to experience typical levels of joy, sadness, stress and the full range of emotions.

There Is No Shame in Seeking Help

Mental illnesses are illnesses like any physical ailment – they often require combined treatment to improve. Sometimes treatment involves psychotherapy, sometimes it involves medication, and it requires both – along with lifestyle changes – to be most effective. If a person requires medication to manage a mood or anxiety disorder, it is important they do so, just as it is important for a person with asthma to use an inhaler or a person with diabetes to use insulin.

As with any medication, there can be side effects when using antidepressants. Some adverse effects, like sexual dysfunction, can be difficult to talk about, but it’s important to talk with your doctor and treatment team about how you’re reacting to your medication. Doctors weigh many factors in choosing an antidepressant, such as the person’s medical status, prior bouts of depression, prior responses to antidepressants and the presence of symptoms. There is a wide variety of treatment options for depression and anxiety, including a range of medications, and the right balance of medication, psychotherapy and lifestyle changes can differ from person to person.

If you are having trouble with what you think may be a mental health condition, it’s important to speak to your doctor. Early intervention can help reduce the severity of an illness. It may even be possible to delay or prevent a major mental illness altogether.

We hear about people’s experiences with mental illness and we may see how someone behaves as a result of a mental health challenge, and we can empathize. But it’s hard to imagine experiences very different from the way we experience things – of hearing voices in your head, being extremely sensitive to or constantly distracted by sights and sounds, or not being able to read and learn the way most people can. While we can’t truly experience what someone else is going through, we can now go online to get a sense of some of these experiences through online simulations of mental health conditions.

Learning differences and attention issues

Understood.org has developed an extensive series of online simulations, called “Through Your Child’s Eyes,” of a range of learning and attention issues. They include reading, writing, attention and organizing. Understood.org is a collaboration of 15 nonprofits working to support parents of children with learning differences.

The website is designed to give parents and family members a better understanding of what a child with learning differences is experiencing. The site allows you to experience, for example, the frustration when your hand won’t write what your brain is telling it to, or how hard it is to read when you have to decode each word. A range of experiences are presented based on selections you make for a child’s age/grade level and the specific issue (reading, writing, attention, math or organization issues). In each case, you’ll see a short video from a child who has the learning or attention condition, and then you are given an interactive simulation to see how the particular challenge might feel. At the end, an expert provides information on the issue.

Another site provides a glimpse into dyslexia (reading disorder). Developer Victor Widell, created a computer simulation of the way a friend of his described experiencing dyslexia. While individuals’ experiences differ, this simulation gives an idea of the type of challenge faced by some with dyslexia.

Sensory overload

Sensory issues, both being overly sensitive or under-sensitive, are common among many people with autism spectrum disorder. The Interacting with Autism project has developed an animation that gives you a glimpse into the experience of sensory overloadand its impact in everyday life.

There are also several short videos of sensory overload experience at the Autism Speaks website. These depict sensory overload in different settings from different perspectives. One video compares a typical person’s experience walking down the street with the experience of someone with autism spectrum disorder who has increased sensitivity to light and sound. Another video highlights autism advocate Carly Fleischmann, who is non-verbal and on the autism spectrum. This video simulation shows Carly with her family in a crowded coffee shop and the anxiety she experiences.

Hearing voices

Some people with schizophrenia hear voices that are not real (called auditory hallucinations). You can hear a brief simulation of the experience of hearing voices online at the Empowerment Center. The sample is part of a complete training and curriculum package, Hearing Voices That Are Distressing, developed by Patricia Deegan, Ph.D., to train mental health professionals.

Postpartum depression

The National Coalition for Maternal Mental Health has developed a short video on What Postpartum Depression Feels Like, providing a brief glimpse into the thoughts and feelings of a new mom’s experience with the condition. (See recent post on Pregnancy and Depression.)

None of us can know exactly what another person experiences, but these simulations can help us understand and empathize with many mental health challenges.