Mental Health: Anxiety and Depression

1 in 5 young adults has a diagnosable mental health condition; 50% of these begin by age 14. In this episode, we speak with Gianna, a junior in high school who has lived experience of depression, anxiety and a suicide attempt. She shared her story with us to help start a conversation and bring to light the realities so many of her peers face, but might be too afraid to talk about.

May 1, 2018

Rebecca: Hi everyone, I’m your host, Rebecca, and thanks again for tuning in. Before we get started we wanted to share a few stats:

  • 50% of all mental illness begins by age 14
  • 75% by the age of 24
  • And for this age group, suicide is the second leading cause of death

May is Mental Health Awareness Month. Mental and behavioral health issues affect, in one way shape or form, everyone. And as common as they are, discussion surrounding them still carries an extreme amount of stigma in our society. In honor of mental health awareness month, we pledge to do our part to drive the conversation forward and stop the stigma.

We will be dedicating our next several episodes to mental health because we believe that every month should be mental health awareness month. We will be continuing the conversation beyond May and including the topic of mental health across all of our resources, regardless of condition or topic. Thanks for listening. And we hope you enjoy today’s episode.

Today we’re going to be focusing on a health topic that is extremely important - why? Because it is something that can, and likely does, affect each and every one of us. Whether it is yourself, a friend or a loved one, it is very likely that you have been affected by mental illness in some shape or form. Mental illness does not discriminate and it is very, very common. Much more so than you might be aware: did you know that about 20% of people aged 13 to 18 live with a mental health condition? That’s 1 in 5 people.

Gianna: In my words having mental illness means being strong.


Rebecca: That’s Gianna, she’s a bright, young woman who has lived experience of depression, anxiety and a suicide attempt. She wanted to share her story to help spread the word and bring to light the realities so many of her peers face, but might be too afraid to talk about. I’ll let her introduce herself…

Gianna: Yes, so my name is Gianna. I'm 16 years old; I live in Cupertino, California; I like to draw, read, and write, as well.


Rebecca: Gianna was just 13 years old when she began experiencing symptoms of mental illness. This may seem young to some listeners, but according to the National Alliance on Mental Illness, half of all lifetime cases of mental illness begin by age 14.


Gianna: So I first started experiencing symptoms at the age of, I would say, 13. Towards the end of the eighth grade I noticed I was feeling down. I was being extremely stressed out by the prospect of high school and going to high school. Once the courses started I realized the workload was a lot more than I could handle. I experienced my first panic attack during my freshman year of high school, and then I also had very sad thoughts. I was very tired, very lethargic. I struggled to get out of bed to talk with people and to just show general emotions, for the most part. I kind of became very reclused, and I would stay in my room which was kind of strange for my family, and they didn't really know how to address it. I wasn't as positive or upbeat as I usually was, and this trend continued for most of eighth grade and freshman year.


Rebecca: It may be difficult for someone to try and figure out what’s normal and what’s not when it comes to the feelings Gianna was experiencing. This can be especially difficult for those who are friends with or a family member of a person who is struggling with mental illness. The ways in which symptoms of mental illness manifest themselves can be different from person to person. We asked Gianna, how did you know that your symptoms were in fact symptoms and not normal sadness and fatigue that most people experience at some point?


Gianna: Well, one of the key indicators to me was the fact that, like, it wasn't going away. It wasn't just a bad day, or it wasn't something that was like an outward result of my day. Like, when I would wake up already sad and not ready for what I'm going to have to face, it made me realize even if it's a normal day I'm still not ready for it. And I guess the whole idea that 'I can't do this' kept on going into my head and I was... I just wasn't able to cope with a lot of things. And the fact that it was a recurring trend in my mind that, like, "I'm not good enough...I can't do this" kind of made me think that maybe this isn't just a one day or a one subject thing.


Rebecca: Adolescence is tough, everything is changing - schools, your body, social expectations, and academic expectations. There is suddenly a shift from learning for the sake of learning, to learning for the sake of getting good grades and being accepted to college - as Gianna puts it, “living for the college application rather than living to learn.” Pressure is everywhere. In some communities, this type of pressure may be more apparent than in others.


Gianna: Yeah, I think Cupertino and the Silicon Valley, in general, puts an extreme amount of pressure on their students. Like, when I first moved here when I was three, school was pretty relaxed, but then I started to see the city kind of change before my eyes. There were a lot of immigrants coming in, like my parents that moved here when they were in high school. And so there were a lot of engineers and, of course, if these parents value education they're going to have their kids value education. And it kind of just seemed like competition to go to college and a lot of the times, even in middle school, people are talking about what college they want to go to, what job they want to have, what they're going to do in high school. And it just seemed like living for the college application rather than living to learn.


Gianna: I think high school, overall, can be defined as expectation filled. There's a lot expected of us which we want to deliver, of course; and I think...I wish I could just say, "Oh, maybe it's the parents putting pressure," but even I have internalized ambitions that I want to achieve and grade that I want to get. And I think even if you aren't in a neighborhood like this that's extremely academically challenging, nationwide, of course, kids are taking more challenging courses and they want to live up to these expectations that have been set on them. And it's getting harder and harder to be accepted in the high school environment without having these high scores, for the most part.


Rebecca: The stress that anxiety that builds up through this period of life is troubling and confusing. Understanding what these conditions and being able to identify what’s normal and what’s not should not be. So we met with Dr. Shashank Joshi, a child and adolescent psychiatrist at Stanford, to help explain.


Dr. Joshi: The idea that we go through stress is something that needs to be acknowledged. Stress can actually be helpful for us.


Rebecca: That’s Dr. Joshi, and he’s here to help us understand, from a clinical perspective, a bit more about mental health conditions.


Dr. Joshi: Yes, well, it's great to be with you. I'm Shashank Joshi. I'm a child and adolescent psychiatrist; I'm a Stanford faculty member; I direct school mental health services here, and I run the training program for child and adolescent psychiatrists of the future.


Rebecca: Thank you so much for joining us today! Dr. Joshi, can you talk to us a little bit more about anxiety and depression and how they differ from normal stress and sadness?


Dr. Joshi: When stress gets too much for us to handle and when it starts to impact areas of our life, it can look either like something called anxiety, which is excessive worry that's beyond our ability to control it and it's affecting our life, or depression, where people are feeling sad for more days than not.

Rebecca: And what are some of the signs and symptoms of depression?


Dr. Joshi: Teenagers, in general, may go through mood changes as part of an everyday life, but if we're looking at a one to two week period of time where:

  • Someone is feeling sad more often than not
  • They're losing interest in the things they like to do
  • They no longer can experience pleasure in their normal activities or joy in things they like to do
  • They may find themselves being irritable or frustrated, or having feelings of anger even over small things
  • They might have insomnia, which is difficulty sleeping or not being able to sleep, or excessive sleeping, sometimes called hypersomnia
  • They may have changes in appetite
  • They might have slowed thinking or foggy thinking - so, especially in the classroom where they're not able to concentrate, even small tasks can seem like they require a lot of effort
  • A person might experience feelings of worthlessness or guilt
  • They might fixate on past mistakes or failures
  • They might be crying for no apparent reason
  • They might have unexplained physical problems, especially pain related, like headaches or stomach aches or back aches for no apparent reason
  • And they might even have thoughts of dying and thoughts of suicide
  • And that is not common for most people who are experiencing the everyday ups and downs of mood. But for someone who may be dealing with depression, if it's not treated they may start to think more about an exit strategy.

Rebecca: Can you talk a bit more about normal instances of anxiety and depression vs. abnormal?


Dr. Joshi: We talked a little bit about depression; anxiety is, again, a normal reaction - everyone gets anxious from time to time. And anxiety is a normal reaction to stress and it can actually be beneficial in some situations. But for some people, anxiety can become excessive. And while the person who is suffering it may realize it's excessive they may have difficulty controlling these feelings and it may negatively affect their day to day life.


Rebecca: What are the physical symptoms someone might experience?


Dr. Joshi: Muscle tension or stomach problems or headaches or concentration problems. You might feel restless or tired. You might have difficulty sleeping. You might be irritable and edgy. So these symptoms are also similar to the symptoms in depression and that's how depression and anxiety can go together. Depression and anxiety also affect similar areas of the brain, and so some of the same pathways are affected. So they're not exactly the same, but they are similar.

Rebecca: So we’ve learned how depression and anxiety are similar, yet unique. They are both illnesses that affect the brain. Some of the symptoms of anxiety and depression are similar, because they affect the same areas of the brain, but some are very distinct.

We’d now like to go back to a topic Gianna touched on earlier - school. She talked about the pressure and expectations put on students to perform well and how this cultivates an environment of high stress. Dr. Joshi, what can be done to balance academic success and high stress? Surely putting value on good grades and learning is a positive thing; what can teachers and schools do to ensure they’re not pushing kids past a breaking point?


Dr. Joshi: One of the things that we look at in a school environment is how do schools foster an environment that is positive and supportive. We work with a number of schools that have sometimes been called, you know, they're sort of in an academic arms race because they're high performing and they have teachers who have very high expectations. And actually, we know that parental and teacher expectations being high generally promotes positive development in youth, but when they're unrealistically high or when a student's self worth is based on grades, only, or academic or sports performance, only, because that is their perception - that "my parents only pay attention if I'm talking about me being the best at something" - then over time that can take its toll.

And so part of the job of a school is to try to promote this concept of social/emotional health because we know that teens who are socially and emotionally healthy are going to be happier humans and oh, by the way, they're probably going to do better in school because they're more engaged, and they're more happy, and they don't just see school as a place to get good grades on their way to college. But they also see it as a way to learn how to think about complex things in our society, engage with peers and with teachers, and through that, really in their development as teenagers, think about what they want to do after high school which may or may not be college right away. There were lots of other pathways into adulthood.

Rebecca: So, how are high schoolers in these “academic arms race” schools dealing with and handling the topic of mental health?


Gianna: There's kind of, like, this whole bystander thing, even with mental health. Like, if you'll see someone struggling, you don't want to speak up and maybe talk about it because then people will judge you. Because, in class it'll be joked around, like it's kind of an ongoing joke, and I think whole joking about the stress is a coping mechanism. A lot of kids are like all of us are feeling it, so they joke about it rather than making it a real thing. So for the most part it kind of just became this character at our school, like oh you’re stressed, it's ok we all are. And we'll just joke about it and continue on the day, but a lot of kids don't realize the stress will follow you home and then you're going to be alone and have to deal with it.


Rebecca: Is this kind of a joking about mental illness really a coping mechanism?


Gianna: Yea, it's definitely a coping mechanism because, if I do talk about it seriously people kind of get uncomfortable they don't know how to approach it. And then it's hard for them maybe to admit that it's a real thing. You know, out of sight out of mind; it'll go away if you don't think about it; you'll outgrow it. Because we get told a lot - high school isn't your entire life, and a lot of us understand that, but right now, is what we're experiencing and what we're living through. And some people are struggling to just make it through the day and so to, kind of, just tell them "look ahead years and years," it's hard to understand because if you're living day to day with a mental illness, how are you supposed to be expected to look for years in the future? It's kind of hard because a lot of us maybe have tunnel vision.

Right now my major focus is getting to college and my sister who graduated high school this year and her friends talked to me about how, like, right after graduation (the day after) that they were just panicking because you're like, what now? We've been told and built up to this - a lot of us live week-to-week, assignment-to-assignment - like "let's get through this assignment, we'll make it. Let's get it through this week, we'll make it." And so it's like once you're done and you don't have anything to do and you get to make your own decisions, you're kind of just left with a 'what now?' type of deal. And now that they're, you know, out of their houses and they're going to college, they didn't deal with it in high school, and now my sister is struggling to deal with a lot of the mental health issues she's experienced in high school because she pushed it down and suppressed it. Now she's going to have to deal with it in college alone.

She's kind of like my parents in the sense that she doesn't like talking about it. She doesn't like showing emotions in general because she has pretty much been told her entire life it's kind of weakness. She has low self-esteem for the most part, that's what she really deals with, because she she puts grades as value and she's pretty much been told to be the best one in the family.

At first I thought, you know, competition's okay, but there's a certain level where you shouldn't value others over yourself or you shouldn't look to someone to be your guide, for the most part. Because they'll be a benchmark and it'll be like, as long as you score higher than the student and the class, you are doing fine. I see that a lot, like, I'll get a score on a math test and a student will be like, "I finally scored higher than you!" And so some teachers have banned the whole - you can ask someone what their score was - because the second you get your test you're like, "what did you get?" That's not allowed in some classrooms, because it kind of causes this low self-esteem where like "I'm not good enough because this person is scoring better than me."

Rebecca: Another topic that came up when we spoke with Gianna was social media. With more people than ever owning smart phones and computers, there is always a glowing window through which you can view another person’s life. A recent study showed that 79% of Americans ages 12-24 have used SnapChat, followed closely by Facebook and Instagram at 76 and 73%, respectively.


Gianna: I feel like there might be a little bit of forced positivity on the Internet.A lot of kids that are struggling with something - they won't go to the Internet and show it, of course, so there's this picture that's painted of a perfect lifestyle of just, like, happiness. And I don't really blame them for the most part, because I think most kids would rather be known as the person that goes out/does all these fun and adventurous things rather than the person that's struggling internally with these things.

I don't go on social media as much as a lot of my peers, but I did notice that when I would go out with friends they would take a picture and if you don't post it, it never happened. And that's kind of a thing that kids do; if you go out and you don't take a photo and post it, you didn't go out, really. But, like, my Instagram only two posts; I don't go on social media a lot. It's not very fulfilling to me, as a person. It's just looking at photos, for the most part, Unless you really go out and experience these things yourself or understand that it's materialistic. I don't really see a need for social media.

Rebecca: Though Gianna might not be the norm and use social media as much as her peers, she did use it to post about a powerful article she wrote for the Huffington Post through Bring Change 2 Mind - we’ll talk about this organization in our next episode. The feedback and reactions Gianna received from these posts were mixed...


Gianna: The Huffington Post article that I released through Let's Bring Change 2 Mind - when I posted the link online for my friends and peers to read it, because it was about Cupertino and how it's changed, a couple of family members got to read it and I got a couple of unsettling texts. A lot of them were like, "Why didn't you tell us? We had no idea!" And a lot of kids at school approached me differently which kind of made me uncomfortable, because when I was at my lowest point, no one could tell and a lot of people couldn't really cope with that idea or the fact that I was struggling with something because they couldn't see it.

It's like they were trying to trivialize what I went through just because they couldn't see it outwardly and how I was maybe showing it and describing it. Some family members texted me that I was selfish for wanting to end my life, and it was kind of weird for me to see this approach to what I was feeling. It seemed like they wanted to rationalize it in their own mind rather than trying to understand what I was going through. And so it seems like if you describe yourself as someone that's happy, fun and nice, people won't try and get to know you better; they'll just accept it and agree with what you say you are.

If you do come out and explain to your friends and peers how you're feeling and they're like, "Oh, I don't see it," And so they dismiss it, there's not really something wrong with you. It's more people have a hard time understanding how you can put on this persona and feel a different way. A lot of peers commented things about how "I'm so glad you said this. Your article is extremely relatable." And people were privately messaging me about how I got help, how I dealt with the stress of school. And so, that kind of made it way better than whatever messages I got from family members, because it made me realize there are a lot of people out there that have the same feelings about school or the same feelings that our home life and society, in general, and it seems like once one person speaks out they're more comfortable with doing it.


Rebecca: Through her own bravery in speaking out about her mental illness, Gianna was able to reach other kids in her school who needed help, but weren’t quite sure how to seek it. It can be so hard to come to terms with the fact that you need help. It can be even harder to realize that one of your friends needs help and to take action. But there is help out there. There are people to turn to, and as Dr. Joshi explains, friends can play an incredible role for someone suffering.


Dr. Joshi: In teenagers, anybody who is feeling like their mood is down for more days than not for a couple of weeks and that they are losing interest in things and they're no longer able to enjoy things that they usually like to do... for teenagers, for example, it might be hanging out with friends - that might be the first thing that starts to take a hit. And so, in our trainings we do with with teenagers with peer leaders and some of the newer suicide prevention approaches where you try to empower the opinion leaders and the stakeholders (who are the student leaders on campus) for signs to look for. Two of them we talk about are sad mood (that's a change for your friend) and loss of interest in things they like to do.

And so we think that, you know, friends have a role to support their friends, to really reach out to them and say "what's been going on?" and to try and understand the experience of that person who might be going through the symptoms. But reaching out to them is probably one of the most important things a friend can do for a peer who might be in distress. And then helping them figure out a strategy for coping with those feelings of sadness, and if those strategies are not helping the person feel better, then the next step is to enlist the help of a trusted adult. It might be a teacher on campus, it might be a counselor, it might be a coach, it might be your own parent. If you're a friend and you feel like you're potentially depressed friend can't reach out to their own parent, you might ask your parent about some strategies that could help get this person to feel better and help them get connected to either a counselor or a therapist.


Rebecca: Are there any other trusted adults that you’d recommend a person go to if he/she needs to seek help?


Dr. Joshi: We also recommend starting with the primary care provider and it might be the most accessible way for a teenager to feel safe in asking for help.

We did a study a few years ago; actually, it was one of my medical students who was the lead on this who is very interested in the interplay of culture and help seeking. We found that particularly for middle schoolers (in this study the sample was 300 8th graders), we found that boys, in particular, are more likely to get help for a mental health problem through their doctor, through a pediatrician, through someone outside the school; whereas girls in that study were more likely to get help from either a teacher, or a counselor, or someone on campus. And so that was the quantitative part of that study and the qualitative part - we asked the kids in focus groups "what is it that explains that?" And girls seem to, because they often develop from a social and emotional angle at an earlier pace than boys, in middle school they've had some time to align with these people on campus (teachers, counselors, coaches) and are more likely to share their feelings and express their feelings and also have developed a vocabulary for being able to do that. It's one of the things that middle school girls feel comfortable doing, whereas middle school boys, not so much for many of them. So they may feel more comfortable taking these kinds of issues outside the school.

Rebecca: It seems like this could get tricky if one of your friends feels more comfortable talking to their doctor than an adult at school or a parent, but needs their parent to make an appointment with their doctor or get them to an appointment.


Dr. Joshi: In that case, if you have a friend who's a guy who doesn't really talk about his feelings that might be a time where you as a concerned peer go to someone in school to problem solve and think of a strategy.


Rebecca: Dr. Joshi, what are the key things about being a supportive friend to someone struggling with mental illness that people should keep in mind?


Dr. Joshi: There's two things about being a supportive friend that's really important that I want to highlight: one is, if you think someone you know might be depressed, being a supportive friend is just being the person you are. Be there for them when they need to talk and be someone they know will listen without judgment or criticism. In fact, you don't even have to problem solve, you just have to be there for them, because that outlet might be the most important thing for them at the time. For many teens, they tell us, you know, I want to be close to my parents, I want to tell them about this thing I'm struggling with, but every time I talk to them they're always in there with some solution and they don't really listen. And most teens know it's coming from a good place. Parents are trying to help them to solve the problem, but sometimes they get in there before they really take time to listen. And that's probably the top one, two, or three thing that we get from teenagers - I need someone to listen.

You can let your friend know that you care, that you're concerned about them. You can mention what you've noticed that's made you concerned about how they're doing. You want to give them a sense that you want to know how they're really doing and that you'll take time and, you know, you'll do simple things, like you'll put your phone down and you'll just be interacting one-to-one, just listening. Listen, encourage, you give them information if you need to - there's a number of great social media sites out there now where teens can get help online with a counselor; there are crisis text lines; there are other kinds of phone help lines if people don't feel comfortable actually going to a live person first. You might even go with them to do that first outreach to, say, crisis text line or going to a counselor's office for the first time. You might take them to the counselor's office and just sit outside. That can be very reassuring.

When you first approach him, it's important to be compassionate and to not appear to be judgmental. So be ready for what you're gonna hear. They may be very upset about what might seem like a small thing to you, but to them it could be very big. So the idea that a parent, for example, sometimes might call their teenager dramatic or lazy - that can actually be very detrimental. Telling them to "snap out of it" or telling them "you should be doing this in order to be feeling better. You know, if you would just not sleep so much," or "you know, I told you if you were to study for that test earlier you wouldn't have run into this problem. Now you're not sleeping the night before your test and there's no way you're going to be ready for this test." I mean that's well-meaning parents sometimes saying the wrong thing at the wrong time, wishing for a do over later. So you want to try to avoid those things; avoid being preachy, but instead, invite them to try and tell their story so that you can understand them from their point of view.

Rebecca: As a friend or a loved one of someone who is suffering from mental illness, an unbelievably important message to get across to them:


Dr. Joshi: Letting them know that depression is not their fault. Teenagers often feel like a burden to their friends, to their parents, to the other people who care about them. And it's certainly not a sign of weakness, it's not an inability to cope, it's really a brain condition. It can happen to anyone at any time. It doesn't discriminate based on gender, or cultural background, or parenting practice. It's not a hit on your character or who your friends are, what kind of music you listen to. Depression is a brain based condition. It's a medical condition.


Rebecca: Unfortunately, the misunderstanding and stigma surrounding mental health is still very real in our society. This is ever so evident regarding suicide. Luckily, there are organizations dedicated to eradicating this stigma and educating people on what mental illness really is. In our next episode, we'll hear more from Gianna’s story of how her mental illness lead to a dark place, and how she was able to get back into the light.

For resources and information on mental health and suicide prevention, visit The JED Foundation exists to protect emotional health and prevent suicide for our nation's teens and young adults. To learn how to start a conversation around mental health and stop the stigma, visit Links to these resources can be found in the show notes of this episode.

This podcast and the information provided is not to replace clinical therapy and treatment. If you are in a crisis and need immediate help,

Call 911 or go to the nearest emergency room
Text “START” to 741-741 or Call 1-800-273-TALK (8255), available 24 hours a day, 7 days a week, confidential, free of charge
Go to your local healthcare provider or school’s counseling center (during business hours) or call campus security or the emergency number provided

JUMO OUTRO: Thanks for listening! Interested in hearing something special - or want us to help share your story? Reach out to us, we’d love to hear from you! See you next time!

The health information contained in this Podcast is provided for educational purposes only and is not intended to replace discussions with a health care provider.

In My Words is produced in New York City and distributed worldwide.

In My Words - A Jumo production.