Category: Mental Health Awareness

The Internal Revenue Service, Employee Benefits Security Administration and the Health and Human Services Department have proposed amendments with the aim of bolstering enforcement of the 2008 Mental Health Parity and Addiction Equity Act (MHPAEA). The agencies want to enhance patients’ access to mental health and substance use disorder (MH/SUD) care and close existing loopholes that insurance companies often exploit to deny such care.

How the Mental Health Parity and Addiction Equity Act Could Change

The proposed changes in the rule released by the Departments of Labor and Health and Human Services could have a significant impact on individuals seeking mental health and substance use disorder (MH/SUD) care. Here’s how these changes could affect a person:

1. Improved Access to Care: The proposed rule aims to ensure that individuals have better access to mental health and substance use disorder treatment. By clarifying and strengthening the requirements for parity between mental health benefits and medical/surgical benefits, it becomes more likely that people will receive the care they need.
2. Broader Coverage: The rule mandates that if a health plan provides treatment for a specific MH/SUD condition in one benefit classification (e.g., outpatient, in-network), it must provide treatment in all other benefit classifications. This means that individuals may have a broader range of treatment options and choices within their health plans.
3. Clearer Protections: The rule explicitly recognizes eating disorders and autism spectrum disorder as mental health conditions protected under the parity law. This means individuals with these conditions are more likely to receive insurance coverage for their treatment, potentially reducing the financial burden on them and their families.
4. Data-Driven Improvements: The requirement for plans and issuers to collect and evaluate data on the impact of nonquantitative treatment limitations (NQTLs) can lead to data-driven improvements in care access. If disparities in access are identified, plans will need to take “reasonable action” to address them. This could result in more equitable access to MH/SUD care for individuals.
5. Certainty in Coverage: With the proposed rule, individuals can have more confidence that their health plans will provide meaningful and equitable MH/SUD benefits. This certainty can alleviate concerns about denied claims or limited coverage for mental health and substance use disorder treatment.
6. Addressing Provider Shortages: The proposed rule includes an enforcement safe harbor for plans/issuers facing access disparities due to provider shortages. This may encourage health plans to work towards expanding their provider networks, ultimately improving access for individuals in areas with limited provider options.
7. Impact on Serious Mental Illness: The American Psychiatric Association has urged that meaningful benefits for serious mental illness include access to coordinated care, supported education, and supported employment. If the proposed rule leads to more comprehensive coverage, individuals with serious mental illness may receive the support they need to lead more fulfilling lives.

Key Provisions of the Proposed Rule

• Clarifying that the MHPAEA’s purpose is to ensure that plan participants can access MH/SUD benefits on par with their medical/surgical benefits.
• Mandating that plans/issuers provide meaningful MH/SUD benefits across various benefit classifications.
• Recognizing eating disorders and autism spectrum disorder as mental health conditions protected under MHPAEA.
• Requiring plans/issuers to collect and assess outcome data to address material differences in accessing MH/SUD benefits compared to medical/surgical benefits.
• Demanding plans to demonstrate corrective action if their analyses reveal noncompliance with the parity law.
• Offering an exception for nonquantitative treatment limitations (NQTLs) when professional medical or clinical standards are applied impartially or to prevent fraud, waste, and abuse.
• Proposing an enforcement safe harbor for plans/issuers facing access disparities due to provider shortages, contingent upon reasonable efforts to expand their MH/SUD provider networks.
• Requiring NQTL comparative analyses to be certified by named fiduciaries who have reviewed the analysis.

The American Psychiatric Association expressed support for these measures but raised concerns regarding exceptions to non-quantitative treatment limitations (NQTLs) requirements and the consequences of non-compliance. The association also urged that meaningful benefits for serious mental illness include access to coordinated care, supported education, and supported employment.

Furthermore, the proposed rule seeks to amend regulations implementing the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 and establish new regulations for NQTLs comparative analyses under the Consolidated Appropriations Act, 2021.

These changes aim to prevent plans and issuers from imposing greater limits on MH/SUD benefits compared to medical/surgical benefits, emphasizing data collection and assessment. The rule also sets content requirements for NQTL comparative analyses and details how plans and issuers must share these analyses with relevant departments and authorities.

Additionally, the departments are soliciting input on ways to enhance mental health and substance use disorder coverage through other federal provisions. Finally, HHS proposes amendments to implement the sunset provision for self-funded, non-federal governmental plan elections to opt out of MHPAEA compliance, as adopted in the Consolidated Appropriations Act, 2023. The proposed rule is expected to take effect on January 1, 2025, for group health plans and on January 1, 2026, for individual health plans.

Do you know which profession has the highest death-by-suicide rate in the United States? The answer might surprise you – farmers. Agricultural workers die by suicide at a rate three and a half times higher than the general population, according to the National Rural Health Association. Between 2000 and 2002, suicide rates increased 46% in non-metro areas compared to a 27% increase in metro areas, according to the Centers for Disease Control and Prevention.

Financial stress, limited access to mental health services, and a reluctance to seek help could be associated with the elevated risk of suicide among farmers, mental health experts say. Iowa farmer and psychologist Mike R. Rosmann, spent decades trying to better understand and address suicide risk in this population.

“Farming has always been a stressful occupation because many of the factors that affect agricultural production are largely beyond the control of the producers,” Rosmann wrote in the journal Behavioral Healthcare. “The emotional well-being of family farmers and ranchers is intimately intertwined with these changes.”

Mental Health Services and Farmers

Access to confidential crisis services and culturally competent mental health care is key to preventing suicide in agricultural populations, Rosmann explained. Josie Rudolphi, a professor of agricultural and biological engineering at the University of Illinois and co-director of the North Central Farm and Ranch Stress Assistance Center, explained that most farmers are independent producers who operate on very thin margins and mental health care is often considered a luxury or an unnecessary expense. Rudolphi said the geographical distribution of farmers is another challenge. They are scattered across the counties and states and not in one centralized workplace like a healthcare facility or university campus that would make mental health education and outreach easier. And their schedules are incredibly varied.

“We still see stigmatization around mental health in these communities, but I think that’s starting to change,” Rudolphi told the University of Illinois News Bureau in 2022. “Stigma seems to be more pervasive among certain demographics. For example, it appears as though it’s more challenging for older generations to talk about mental health issues. And in small communities, people are very conscious of other people knowing what their vehicles look like and not wanting people to recognize their car or truck parked outside a mental health clinic.”

Psychiatric Medical Care treats many current and retired agricultural workers in our different care environments. It is important to not only understand their increased risk, but to also understand interventions that can assist with lowering their risk for suicide.

Stress and Depression Checklist for Farmers

Professors at Colorado State University and the University of Wisconsin created a checklist and guide to help identify stress and depression in farm and ranch families. These signs can be observed by anyone, including friends, extended family members, neighbors, milk haulers, veterinarians, clergy, school personnel, or health and human service workers. 
Signs of stress and depression include:

•Change in routines
The rancher or ranch family stops attending church, drops out of 4-H, Home makers or other groups, or no longer stops in at the local coffee shop or feed mill.   
•Care of livestock declines 
Cattle may not be cared for in the usual way; they may lose condition, appear gaunt or show signs of neglect or physical abuse.

•Increase in illness
Farmers or farm family members may experience more upper respiratory illnesses (colds, flu) or other chronic conditions (aches, pains, persistent cough).         
•Increase in farm or ranch accidents
The risk of farm accidents increases due to fatigue or loss of ability to concentrate; children may be at risk if there isn’t adequate childcare.
•Appearance of farmstead declines
The farm family no longer takes pride in the way farm buildings and grounds appear, or no longer has the time to do maintenance work.        
•Children show signs of stress
Farm and ranch children may act out, decline in academic performance or be increasingly absent from school; they may also show signs of physical abuse or neglect.

Signs of Suicidal Intent

• Anxiety or depression:  Severe, intense feelings of anxiety or depression.
• Withdrawal or isolation:  Withdrawn, alone, lack of friends and supports.
• Feeling Helpless and hopeless:  Sense of complete powerlessness, a hopeless feeling.
• Alcohol abuse:  There is often a link between alcoholism and suicide.
• Previous suicidal attempts:  May have been previous attempts of low to high lethality.
• Suicidal plan:  Frequent or constant thoughts with a specific plan in mind.
• Cries for help:  Making a will, giving possessions away, making statements such as “I’m calling it quits,” or “Maybe my family would be better off without me.”

If you suspect someone is at risk of suicide there are a number of resources available to help. You may start by calling 988, the Suicide and Crisis Lifeline.

A study by the University of Illinois found that 45% of all farmer and rancher suicides in the last 15 years were committed by people aged 65 and older. Our Senior Life Solutions program in Kingsman, KS started using an idea created by the Suspenders for Hope Foundation. Working with a local hospital, they create Suspenders for Hope kits. According to Suspenders for Hope, in the days following a hospitalization or visit to a crisis center for a mental health crisis or suicide attempt, individuals often face stigma and shame and are at higher risk of attempting.

Their aim is to provide Suspenders4Hope kits to patients leaving emergency mental health and detox services equipping them with essential resources to help bridge the lethal gap between crisis services and connecting with outpatient treatment. The kits are designed to increase coping and destigmatize help-seeking. Suspenders4Hope kits include items that instill hope, develop emotion management skills, provide information about crisis resources, peer support, and patient education, and reinforce reasons for living.

The kit is intended to increase protective factors identified through research (mental healthcare, DBT skills, connectedness, life skills, harm reduction, peer support, self-esteem and sense of purpose, and personal beliefs that discourage substance use and suicide).

Learn more about our Senior Life Solutions program and how it helps older adults in rural communities who are experiencing depression, stress and anxiety.

A new survey funded by the Mental Health Treatment and Research Institute LLC, a tax-exempt subsidiary of The Bowman Family Foundation, sheds more light on the deepening mental health and substance use crisis. Authors of a report which presents the survey’s findings call for urgent action to ensure equitable access to timely and clinically effective care and adequate reimbursement by insurers. The authors state that despite significant strides in recognizing mental health as a vital aspect of overall well-being, in-network health insurance coverage for mental health and substance use treatment remains inadequate, lagging behind coverage for physical health treatment. To shed light on this critical issue, NORC, a non-partisan research institute at the University of Chicago, conducted the patient-experience survey, providing valuable insights into the challenges faced by patients seeking mental health and substance use care.

Urgent Need for Mental Health Services

The survey highlights the pressing need for accessible mental health and substance use care. Patients across the nation are struggling to receive the treatment they require, facing barriers in finding in-network providers who accept new patients. The survey delves into the frequency with which mental health or substance use care is needed but not received, bringing attention to the potential consequences of unmet mental health needs.

As patients encounter difficulties with in-network providers, they often resort to seeking care from out-of-network sources. The survey explores the reasons behind this trend and analyzes the disparities between seeking mental health or substance use care versus physical health care. Understanding these patterns is crucial in devising strategies to enhance access to in-network care for all.

Patients often rely on primary care providers and other physical health providers for mental health or substance use care. However, the survey uncovers concerns regarding the adequacy of care provided by PCPs and physical health professionals for mental health conditions. Addressing these concerns could lead to more integrated and comprehensive care models.

The survey also examines the prevalence of service denials and disparities faced by patients seeking mental health and substance use care. These challenges not only hinder access to treatment but can also exacerbate existing mental health conditions, highlighting the urgent need for policy changes and awareness.

Key Findings

The survey reveals a significant disparity between mental health care and physical health care, emphasizing the urgent need for equitable and timely treatment options.

Limited Access to Mental Health and Substance Use Care: The survey found that 57% of patients seeking mental health or substance use care did not receive any care in at least one case, in contrast to 32% of patients seeking physical health care. The figures were even more alarming for adolescents, with 69% experiencing limited access to mental health and substance use care, compared to only 17% for physical health care. These statistics indicate a critical need to improve access to mental health services for patients of all ages.

Difficulties in Finding In-Network Providers: For those who use health insurance and seek care from in-network mental health or substance use providers, 40% had to contact four or more in-network providers before securing an appointment with a new in-network provider. In comparison, only 14% faced similar challenges when seeking physical health care. This highlights the challenges patients encounter when trying to find appropriate and available mental health care providers within their insurance network.

High Reliance on Out-of-Network Providers: A significant percentage of patients, particularly those in employer-sponsored health plans, sought care from out-of-network mental health or substance use providers. As high as 39% of patients used out-of-network providers for outpatient care, compared to just 15% for physical health care. The financial burden of higher co-pays and deductibles faced by patients using out-of-network providers underscores the urgency to improve in-network coverage for mental health and substance use care.

The Need for Specialized Care: An overwhelming majority of patients who received mental health or substance use care from physical health providers (87% of all ages and 98% of adolescents) felt that they needed additional help from a mental health or substance use specialist. This highlights the importance of integrated care and the crucial role of specialized professionals in addressing mental health and substance use issues effectively.

Collaboration is Key to Improving Behavioral Healthcare

The NORC patient-experience survey sheds much-needed light on the profound disparities in accessing mental health and substance use care in the United States. The findings underscore the pressing need for policymakers, insurers, and healthcare providers to collaborate and implement equitable solutions. By improving in-network insurance coverage, enhancing provider networks, and addressing service denials, we can take a significant step forward in ensuring that mental health and substance use care are on par with physical health treatment. Together, let us strive for a future where all individuals have access to timely and effective care, leading to improved mental well-being and healthier communities.

What Is Lamotrigine and What Does It Treat?

Lamotrigine is a mood stabilizing medication approved for treatment of bipolar disorder (also known as manic depression) and certain types of seizure disorders. It affects neural pathways in the brain. Bipolar disorder involves episodes of depression and/or mania. Lamotrigine may also be helpful when prescribed “off-label” for bipolar depression.

*Information for this report provided by the National Alliance on Mental Illness.

Download our PDF about Lamotrigine.

Generic name: lamotrigine (la MOE tri jeen)

• Tablets: 25 mg, 100 mg, 150 mg, 200 mg
• Chewable tablets: 5 mg, 25 mg
• Oral disintegrating tablets: 25 mg, 50 mg, 100 mg, 200 mg
• Extended-release tablets: 25 mg, 50 mg, 100 mg, 200 mg, 250 mg, 300 mg

Brand names:

• Lamictal®
  • Tablets: 25 mg, 100 mg, 150 mg, 200 mg
• Lamictal Blue Starter Kit®
  • Tablets: 25 mg
• Lamictal CD®
  • Chewable tablets: 2 mg, 5 mg, 25 mg
• Lamictal ODT®
  • Oral disintegrating tablets: 25 mg, 50 mg, 100 mg, 200 mg
• Lamictal® XR
  • Extended-release tablets: 25mg, 50 mg, 100 mg, 200 mg, 250 mg, 300 mg
• Subvenite®
  • Tablets: 25 mg, 100 mg, 150 mg, 200 mg
• Subvenite Blue Starter Kit®
  • Tablets: 25 mg

Symptoms of depression include:

• Depressed mood – feeling sad, empty, or tearful
• Feeling worthless, guilty, hopeless, or helpless
• Loss of interest or pleasure in normal activities
• Sleep and eat more or less than usual (for most people it is less)
• Low energy, trouble concentrating, or thoughts of death (suicidal thinking)
• Psychomotor agitation (‘nervous energy’)
• Psychomotor retardation (feeling like you are moving in slow motion)

Symptoms of mania include:

• Feeling irritable or “high”
• Having increased self esteem
• Feeling like you don’t need to sleep
• Feeling the need to continue to talk
• Feeling like your thoughts are too quick (racing thoughts)
• Feeling distracted
• Getting involved in activities that are risky or could have bad consequences (e.g., excessive spending)

Lamotrigine may also be helpful when prescribed “off-label” for bipolar depression.

What Is the Most Important Information I Should Know About Lamotrigine?

Bipolar disorder requires long-term treatment. Missing doses of lamotrigine may increase risk for a relapse in mood symptoms.

In order for lamotrigine to work properly, it should be taken every day as ordered.

Are There Specific Concerns About Lamotrigine and Pregnancy?

People living with bipolar disorder who wish to become pregnant face important decisions. It is important to discuss the risks and benefits of treatment.
Lamotrigine has been associated with an increased risk of oral cleft birth defects. There may be precautions to decrease the risk of this effect. Discontinuing similar medications during pregnancy has been associated with a significant increase in symptom relapse.
Regarding breastfeeding, caution is advised since lamotrigine does pass into breast milk.

What Should I Discuss with My Health Care Provider Before Taking Lamotrigine?

• Symptoms of your condition that bother you the most
• If you have thoughts of suicide or harming yourself
• Medications you have taken in the past for your condition, whether they were effective or caused any adverse effects
• If you experience side effects from your medications, discuss them with your provider. Some side effects may pass with time, but others may require changes in the medication.
• Any other psychiatric or medical problems you have
• All other medications you are currently taking (including over the counter products, herbal and nutritional supplements) and any medication allergies you have
• Other non-medication treatment you are receiving, such as talk therapy or substance abuse treatment. Your provider can explain how these different treatments work with the medication.
• If you are pregnant, plan to become pregnant, or are breastfeeding
• If you drink alcohol or use illegal drugs

How Should I Take Lamotrigine?

Lamotrigine is usually taken 1 or 2 times daily with or without food.
Typically, patients begin at a low dose of medication and the dose is increased slowly over several weeks.

The dose usually ranges from 25 mg to 400 mg.

What Happens If I Miss A Dose Of Lamotrigine?

If you miss a dose of lamotrigine, take it as soon as you remember, unless it is closer to the time of your next dose. Discuss this with your health care provider. Do not double your dose or take more than what is prescribed. If you miss more than 3 days of medication, contact your prescriber because he/she may need to adjust your dose.

What Should I Avoid While Taking Lamotrigine?

Avoid drinking alcohol or using illegal drugs while you are taking lamotrigine. They may decrease the benefits (e.g., worsen your condition) and increase adverse effects (e.g., sedation) of the medication.

What Happens If I Overdose with Lamotrigine?

If an overdose occurs call your doctor or 911. You may need urgent medical care.
You may also contact the poison control center at 1-800-222-1222.
A specific treatment to reverse the effects of lamotrigine does not exist.

What Are the Possible Side Effects Of Lamotrigine?

Common side effects of Lamotrigine include:

• Nausea
• Insomnia
• Runny nose
• Non-serious rash
• Headache
• Diarrhea
• Abnormal dreams
• Dizziness or drowsiness
• Fatigue

Rare/serious side effects

A serious, life-threatening skin rash (also known as Stevens–Johnson Syndrome) may occur with the use of lamotrigine. Contact your health care provider immediately if you have any of the following: a skin rash, blistering or peeling of your skin, hives, shortness of breath, or painful sores in your mouth or around your eyes. Extra caution is needed in children and teenagers ages 2-17 receiving lamotrigine. These patients may be at an increased risk of developing this life-threatening rash.

Studies have found that individuals who take antiepileptic medications including lamotrigine have suicidal thoughts or behaviors up to twice as often than individuals who take placebo (inactive medication). These thoughts or behaviors occurred in approximately 1 in 500 patients taking the antiepileptic class of medications. If you experience any thoughts or impulses to hurt yourself, you should contact your doctor immediately.

Aseptic meningitis, a serious inflammation of the protective membrane that covers the brain and spinal cord has been identified as a very rare but serious side effect of lamotrigine. Contact your health care provider immediately if you experience headache, fever, nausea, vomiting, stiff neck, rash, unusual sensitivity to light, muscle pains, chills, confusion, or drowsiness while taking lamotrigine.

Patients with certain underlying cardiac disorders or heart rhythm problems may experience serious arrhythmias or life-threatening effects. Those with structural or functional heart disease should be counseled on risk versus benefits of using this medication.

A rare but life-threatening immune system reaction which can cause serious blood or liver problems has been reported with lamotrigine use. Contact your health care provider immediately if you experience fever, frequent infections, severe muscle pain, swelling of the face, eyes, lips, or tongue, swollen lymph glands, unusual bruising or bleeding, weakness, fatigue, or yellowing of the skin or white part of your eyes. Onset usually occurs within the first several weeks after starting therapy. Patients with HLH symptoms should be evaluated promptly; discontinuation and conversion to alternate therapy may be required.

Seizures may occur if a patient taking lamotrigine suddenly stops taking it.

Are There Any Risks for Taking Lamotrigine For Long Periods Of Time?

To date, there are no known problems associated with long term use of lamotrigine. It is a safe and effective medication when used as directed.
It is important to note that some of the side effects listed above (particularly rash and suicidal thoughts) may continue to occur or worsen if you continue taking the medication. It is important to follow up with a provider routinely and to contact a provider immediately if you notice any skin rash or changes in mood or behavior.

What Other Medications May Interact with Lamotrigine?

The following medications may increase the level and effects of lamotrigine:

• Valproate/divalproex (Depakote®)

The following medications may decrease the level and effect of lamotrigine:

• Anticonvulsants such as phenytoin (Dilantin®), carbamazepine (Tegretol®/Carbatrol®/Equetro®), phenobarbital, and primidone (Mysoline®)
• Oral contraceptives (birth control pills)
• Rifampin (Rifadin®), ritonavir (Norvir®)

Lamotrigine may increase the level and effects of:

• Clozapine (Clozaril®, FazaClo®)

How Long Does It Take for Lamotrigine to Work?

It will typically take several weeks to see an improvement in symptoms.
Mood stabilizer treatment is generally needed lifelong for persons with bipolar disorder.

FDA Black Box Warnings

Serious Skin Reactions

Serious and sometimes fatal skin reactions have been reported with lamotrigine use. Since it is not always possible to predict which rashes will prove to be serious or life threatening, it is important to talk to your doctor at the first sign of a rash while taking lamotrigine.

home for many of us at PMC, and for one of our team members, it is part of her reason for working in the mental health field. 

Recently, she shared her story, and with her permission, we would like to share it with you. Her vulnerability and dedication to spreading education and awareness of the warning signs and impacts are to be commended. 

Read her story below: 

In 2012, I was expecting my first child. My large, close, loving family only amplified my excitement about becoming a mother. I felt particularly grateful that my grandparents were still alive to meet their great-grandchildren. I never expected that one phone call would change all of that. I had just spoken to my grandfather a week earlier, ending our call with him telling me he would see me soon. 

However, a week later, he died by suicide, leaving my family and me with questions we couldn’t answer and indescribable grief. The aftermath of losing my grandfather was like trying to assemble a puzzle without having all the pieces. No explanation would fill the gaping hole left behind by his absence from our family. As I struggled to come to terms with my new reality, I found myself researching and trying to learn as much as possible about mental health and suicide. 

Before losing my grandfather, I had no idea older adults were at a higher risk for suicide. I wasn’t aware that age-related health issues such as loneliness and loss of independence were risk factors. My newfound knowledge wouldn’t bring back my grandfather, but it did encourage me to educate others on suicide’s warning signs and risk factors. 

My young cousin was a victim of suicide a year after my grandfather died. It was another shock to my system. Leaving me with yet another puzzle, I could not finish and a roller coaster of unmanageable emotions. Losing two people I loved to suicide changed me. It changed who I am as a person, how I look at life, and especially how I look at mental health. 

Shortly after losing my cousin, I began working at PMC. My work has played a huge role in my healing journey. This is not just a job for me; it is an opportunity to continue my loved ones’ legacies in my daily work. It teaches me the risk factors for suicide and how I can help break down the stigmas surrounding mental health. Through this work, I continue to heal. Suicide happens in silence. Suicide happens when we avoid uncomfortable conversations. Suicide occurs when we let mental health stigmas prevent us from reaching out for help. Suicide is preventable, but not without education, awareness, and the courage to bring change.

We know many across the globe can relate to Sydney’s story. 

To them, we would like to say we see you and are not alone. To those who may be struggling, please know there is help. I encourage you to reach out for the help you need and deserve. To those who are worried about a loved one, please speak up. Have hard conversations, break the silence, and encourage them to seek help. If you are struggling with thoughts of suicide, you are not alone. 

If you are in emotional distress, here are some resources for immediate help:

• Call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24 hours a day, seven days a week. Or use the Lifeline Chat. Services are free and confidential.
• The Suicide & Crisis Lifeline in the U.S. has a Spanish language phone line at 1-888-628-9454 (toll-free).

About PMC   

Psychiatric Medical Care (PMC) works to improve access to behavioral healthcare in communities like yours. Our founder and Chief Medical Officer, James A. Greene, M.D., developed PMC with the sole mission of improving the function and quality of life for patients living in underserved communities. If you would like to learn more about Psychiatric Medical Care, or if you are interested in joining our team, please email us at [email protected], call or explore our numerous opportunities online.

It is Sunday night, and you gaze out the window at the dark sky illuminated by a full moon. Suddenly, you gasp in terror. Monday is just a few hours away, and they are back! The SUNDAY SCARIES! [cue the black and white spooky backdrop and a thunderclap sound effect!]

While our introduction may have been a little dramatic, we know that most of us have experienced some version of the Sunday Scaries. With the spooky season upon us, we thought, what better time than now to share some tips on how to keep those Sunday Scaries from creeping in on your peaceful Sunday? 

Many people experience anxiety and fear on Sundays, hence the term Sunday Scaries. According to a study by LinkedIn in 2022, out of 3,000 workers surveyed in the U.S., 80% experience this Sunday evening discomfort.

You may have looked forward to Friday all week only to find your weekend state of mind cut short. Many people experience a feeling of doom that shows up the evening before another week begins. “A form of anticipatory anxiety, the Sunday Scaries involves nervousness and dread about something that hasn’t happened yet: the week ahead,” (Healthline, 2020).

Dr. Susanne Cooperman, neuropsychologist and a psychoanalyst at NYU Langone Health, says, “This (the Sunday Scaries) is anticipatory anxiety–not stress now. It is the anticipation of what will come and puts people in fight or flight mode. The adrenal glands sit on top of the kidneys and release adrenaline and cortisol. These stress hormones flood your system, creating a stress reaction that feels like real anxiety.”

“Anticipatory anxiety can range from a passing nervousness to a debilitating sense of dread. With anticipatory anxiety, you might spend a lot of time imagining worst-case scenarios. Over-focusing on these unwanted outcomes can also increase your frustration and hopelessness,” (Healthline, 2020).

Healthline.com says that one might notice anticipatory anxiety symptoms such as:

• Difficulty concentrating
• Emotional numbness
• Jumpiness or restlessness
• Loss of interest in your usual hobbies
• Muscle tension and pain
• Nausea and appetite loss
• Sleep problems
• Trouble managing emotions and mood

The real question is, how do we combat the Sunday Scaries – with cloves of garlic? Or a circle of salt? Of course not! 

In “What Are the ‘Sunday Scaries’?” (Cleveland Clinic, 2021), Psychologist Susan Albers, PsyD, gives ten tips on how to combat these spooky feelings:

Change your mindset  

On Sunday nights, be mindful of your thoughts. Positive statements such as “I can do this” or “This is nothing new” can replace negative thoughts such as “I don’t want to go to work tomorrow.” 

Create a Sunday night routine 

Following a routine gives you something to look forward to and helps you transition from the weekend to the work week. Watch a special Sunday evening show or prepare your favorite meal. A consistent routine is essential to our physical and mental well-being. 

Create a to-do list for Monday

Creating a to-do list can help you release stress and organize your thoughts. Before heading to bed, try making a list and prioritizing your tasks. You will go to sleep feeling mentally prepared to conquer Monday.

Get moving

Movement is a natural antidepressant. Movement releases mood-lifting endorphins. Go for a Sunday afternoon walk or dance to your favorite song in your living room. Give your brain a boost of feel-good chemicals!

Get some sleep

Getting enough sleep is good for your body and your mental health. Establish a bedtime routine: choose a bedtime that allows you 7-9 hours of sleep, shut off screens an hour before bedtime, take a warm bath, or enjoy a cup of herbal tea. Quality sleep on Sunday night is one step closer to a positive Monday morning. 

Listen to the message

Analyze your anxiety. Ask yourself, “Why am I feeling scared or anxious? What is my body trying to tell me?” When you understand the “why” behind your Sunday Scaries, you may be able to work through your fears and beat the Sunday Scaries for good!  

Switch on the “off” sign

Set boundaries for your weekend. Avoid doing work. Allow yourself time to recharge and unplug mentally and physically. Give yourself the downtime you deserve.

Treat yourself to Monday morning rewards 

Treat yourself on Monday morning. Choose a fun activity to enjoy during your morning commute. Stop for a cup of coffee, listen to an entertaining podcast, or sing along to your hype playlist. Enjoying yourself will create positive vibes on your Monday mornings!

Visualize a better Monday 

Meditating or visualizing yourself having a calm workday can improve your mindset and increase your confidence to take on the day!

Work on some Sunday projects  

Engage in mindless tasks to transition your thoughts from relaxation to work mode. Try prepping meals for the coming week, doing laundry, or finishing that project you started months ago. Focus your mind on activities that are captivating but not stressful. 

So next time you feel those anxious thoughts starting to creep in, try a few of the tips above to help you conquer those Sunday Scaries. 

Remember, many people get the Sunday Scaries. You are not alone. If the Sunday Scaries negatively affect your quality of life, we encourage you to reach out to your mental health provider. They may be able to help you understand what is causing your anxiety and how to treat it. 

About PMC   

Psychiatric Medical Care (PMC) works to improve access to behavioral healthcare in communities like yours. Our founder and Chief Medical Officer, James A. Greene, M.D., developed PMC with the sole mission of improving the function and quality of life for patients living in underserved communities. If you would like to learn more about Psychiatric Medical Care, or if you are interested in joining our team, please email us at [email protected], call or explore our numerous opportunities online.

“Gratitude unlocks the fullness of life. It turns what we have into enough and more. It turns denial into acceptance, chaos to order, and confusion into clarity. It can turn a meal into a feast, a house into a home, a stranger into a friend. Gratitude makes sense of our past, brings peace for today, and creates a vision for tomorrow” (Beattie, 1990) 

According to John Hopkins Medicine, there is a direct correlation between a positive attitude and your mental health. Research shows that positivity can even improve your physical health. However, a positive attitude is not just thinking happy thoughts. It takes effort and determination to remain positive, especially in today’s world. 

A positive attitude is formed by the choices we make daily and how we react to situations and others around us. When we brush off disappointment or rude comments, we maintain a positive attitude. Our attitude is also influenced by how well we ignore negative self-talk and accept our current circumstances. There are other ways that people embrace a positive attitude and those include being thankful or practicing gratitude. 

However, what many do not realize is that being thankful and practicing gratitude are quite different things. We all grew up being told to be grateful and to say “Thank You” when someone did something kind for us. It became easy to use these terms interchangeably, but what we have learned is that thankfulness and gratitude are not synonyms. 

Thankfulness is a Reaction 

It is your birthday, and you are eight years old. You really want a new bike, but your parents have told you that a bike is too expensive. Imagine your surprise, when you wake up and there is a red bicycle sitting in your living room. You look over to see your grandmother smiling. Your mom says, “Say, ‘Thank You.’” You rush over and give your grandmother a great big hug. You are thankful, and the moment is a happy one! 

When something good or exciting happens, it is easy to be thankful. We appreciate the warm feelings that come with gifts or happy news. Thankfulness involves how we feel in the moment, and like all feelings, eventually, it fades. Thankfulness is a temporary emotional response to a temporary circumstance. 

It is important to express thankfulness when something good happens. Being thankful is not inherently bad. It is part of showing appreciation to others or for your good fortune. We are thankful when we get a new job or meet a new friend. However, thankfulness is not enough to keep us in a positive mindset. Setbacks and things that we are most certainly not thankful for will always interfere with our thankfulness. Because of this, we must rely on other ways to maintain a positive attitude. One such way is by expressing gratitude. 

Gratitude is a Chosen State of Being 

Where thankfulness is an emotion, gratitude is an attitude of appreciation under any circumstance. Gratitude involves being thankful, but it is more than that. Gratitude means expressing thankfulness and being appreciative of life daily even when nothing exciting happens. 

When you are late for work, your coffee spills in the car, and you realize your socks are two different colors, gratitude is the smile on your face as you reach your destination. Gratitude is your decision that the day is a good day even when evidence points to the opposite. You do not need something good to happen to have gratitude, and when bad things happen, your gratitude does not falter. You know that sad things are just a part of life, and you are happy with the life you lead. 

By choosing to cultivate gratitude in your life, you are actively improving your health and well-being. A study from the University of California Berkeley states, “Research suggests that gratitude may be associated with many benefits for individuals, including better physical and psychological health, increased happiness and life satisfaction, decreased materialism, and more.” 

Gratitude is about being content physically and mentally with the state of your life. You may not always be happy, but you can still practice gratitude. In fact, the same study from Berkely asserts that practicing gratitude is not only good for you but for your relationships as well. 

The study states that “Gratitude is also important to forming and maintaining social relationships.” When you engage with someone and express gratitude for them, they are in turn more likely to express gratitude in return. The expression of gratitude is what helps us form new relationships and strengthen our current ones. Studies have shown the positive effect of relationships on our emotional well-being, and it is one more added benefit of practicing gratitude. 

The Differences Between Gratitude and Thankfulness 

So how do you know if you are operating from a spirit of gratitude? As already mentioned, gratitude is an important part of keeping a healthy psychological outlook, but it is closely related to thankfulness. So, what are the differences? 

• Thankfulness fades-Gratitude remains: Gratitude often begins as thankfulness, but the difference happens when you keep your focus on everything that remains as thankfulness fades. Gratitude will stay with you. 
• Gratitude deepens our inner connections-Thankfulness is external: We feel thankful when something happens externally. When we practice gratitude, we rely on our inner voice to stay positive and remain appreciative in all circumstances. 
• Thankfulness is about the present interaction-Gratitude improves the long-term relationship: You may feel thankful to someone at the moment, but gratitude is an ongoing showing of appreciation in your relationships. Practicing gratitude in your relationships will bring you closer to the ones you love. 

Although gratitude and thankfulness are closely related, gratitude provides you with a longer-lasting feeling of satisfaction and improved well-being. Practicing gratitude is proven to offer many benefits to individuals. 

Ways to Practice Gratitude 

There is no right or wrong way to practice gratitude. Gratitude should be an internal expression of your own thankfulness, but many people find physical acts of gratitude increase and maintain their happiness on a long-term basis. 

Below are some suggestions for your own gratitude practice. According to John Hopkins, by choosing a gratitude practice, you are ensuring resilience when times are bad. You are maintaining a positive attitude, and you are lessening your risk of depression. 

1. Start a gratitude journal. Your gratitude journal can be as simple or elaborate as you please. It can be digital on your laptop, or you can buy a notebook to share your thoughts and feelings. If you hate writing, you can use a voice recording app on your phone to speak in your journal. Most people begin a gratitude journal by writing three things they are grateful for daily. If you want to write more, you can. The key is to find a way to be consistent with the journaling. 
2. Begin a meditation practice. Mindfulness and gratitude go hand in hand. Finding time to meditate for even a brief period daily can have a tremendous effect on your well-being. As you meditate, you can silently list the things you are grateful for or you can simply repeat a mantra like, “I am grateful for all that I am and all that I have.” Hate sitting still? Take a walk and use that time to think about your gratitude list. 
3. Sign up to volunteer. Giving your time to help others is a fantastic way to show gratitude. Find an organization that interests you and see what volunteer opportunities they offer. When we help others, we are reminded of all that we have and instantly feel grateful. 
4. Spend time with loved ones. Spending time with your loved ones often is an effective way to remain grateful. Having close friends and family helps us feel supported and loved. By pursuing your relationships and creating memories, you will create a list of gratitude memories to draw on when you need a pick me up. 
5. Give away to others. Find things in your home that you no longer use and donate them to a charity in need. We all have items that lie around the house and cause clutter. Clear out the clutter and brighten someone else’s day with a donation. When we realize all that, we have, it is impossible not to maintain an attitude of gratitude. 

Expressing gratitude is beneficial in many ways. Thankfulness is also an important value to cultivate. Together, they make the world a kinder and happier place. To maintain good mental and physical health, consider cultivating your own gratitude practice using the above suggestions. Share the idea of gratitude with your friends and loved ones. Remember, your attitude is always within your control-make it a grateful one!