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Regaining One’s Balance:
Not a Solo Act, It Requires Help

“Everybody needs to deal with the issue of balance in their lives for their own mental health.” Raleigh psychiatrist, Dr. Mona Gupta offers this view, ironically, in a phone interview as she shuttles her young daughter around town.

Dr. Gupta

“But see? This is a perfect example,” she says. “We want to keep our families happy and we want to have balance. How do I work and do that at the same time?” Like Dr. Gupta, many adults in mid-life, find themselves caring for both their children and aging parents as well as themselves—earning the nickname the ‘sandwich generation.’ “All that pressure can lead to imbalance,” she says.

Dr. Gupta posits that balance—or the lack of it—is the real reason “most people come to us for help, whether they know it or not, even though they may call it something else. People will come in saying ‘I have trouble sleeping,’ and that they’re trying everything to get a good night’s sleep; but they miss the problem. The real problem may be anxiety or their job or their marriage, or just juggling way too many balls in the air; but it’s coming out as sleep. So, they come in and say that’s the issue.

“I have learned that there’s always an underlying issue that leads to the imbalance, and it could be depression or anxiety or trauma, but usually it’s because everyone is striving for a sense of balance in their lives.” But, she notes, that while maintaining stability is on-going work, it’s not solo work; it requires asking for help. “I think it’s easy to try to make everyone happy and forget yourself,” warns Dr. Gupta. “And I think that’s where a lot of substance use starts.”

When Coping Mechanisms Become a Problem

Not all people strive for balance in constructive ways. “Sometimes one glass or one beer can become two or three,” points out Dr. Gupta, “and the thing that helped to keep you ‘balanced’ becomes the source of a serious problem.”

Whether it’s with alcohol or Xanax or opiates, she says, “substance abuse often starts with people trying different ways to get more energy, to improve concentration, or to deal with their anxiety or insomnia. When you’re talking about somebody with a serious addiction problem, most often they started on that path just as a way to keep their balance, and then it grows on them to the point where they have created another imbalance that’s much more serious. It’s never because they wanted to be addicted, but it happens.”

With substance use, people become mired in a cycle of extreme highs and extreme lows, explains Dr. Gupta. “They may come to believe these rock-bottom lows are depression when in many instances they may simply be withdrawal symptoms from drugs they are taking. Other drugs that contribute to such highs and lows are cocaine and alcohol. Many people use these substances as anti-depressants when in fact they really are depressants. This is also true of marijuana, even as we see some states legalizing its use. I’m not anti-marijuana, but I do think in general that it can lead to lower motivation to simply get up and move and engage in life activities. I think it’s a drug that can lead some people on the path to depression.”

“Balancing” Takes Both Art and Science

Dr. Gupta considers the big-picture view when working with her patients, assessing both broader environmental factors and specific symptoms. For depression, she looks at how long it’s been going on, what stressors underlie it, and which ones are new or long-lasting. “If it’s going to be there for a long time, we may need to treat this so you deal with the stressor better,” she explains. “That could be through medication or through therapy or through coaching, getting added support.”

Medication is one option when patients have severely impaired functioning or major imbalances. In those instances, Dr. Gupta may opt to lead with medication and wean them off later, while she may use other strategies first in different scenarios.

“Perhaps eight out of ten patients who come to see me are having trouble sleeping. Some may stay in bed for long hours because they are so tired, but they are not getting restful sleep. In these cases, I don’t simply say, ‘Here’s a medication that will help.’ Scientifically, that medicine may be very appropriate for the patient to address a chemical imbalance. But I want to understand the cause of the sleep problem. What is going on in their life? Are they exercising? Are they taking care of themselves in other ways? Are they working too much? Are they balancing all parts of their life?

“A misrepresentation of psychiatry is that it’s just antidepressants and medications,” Dr. Gupta asserts, when actually, “a good psychiatrist looks at every aspect and every organ system.”

Chemical Imbalances or Life Imbalances?

There is no question, says Dr. Gupta, “that chemical imbalances play a significant role in mental health challenges. These might include out-of-balance neurotransmitters—such as serotonin, norepinephrine, and dopamine—but hormones are also often the source of such problems.
“Imbalances in reproductive or thyroid hormones in adults who are navigating different life phases, such as menopause, can have a huge impact on mental and emotional health,” she says. “And it’s equally true for adolescents experiencing surging hormones and their attendant emotional roller coaster.”

But, she points out, “life imbalances can be as powerful as biochemical disturbances.” These “life imbalances” include excess stress and trauma—often key factors causing depression and other mood imbalances.
“Difficult, often tragic things happen to perfectly wonderful people,” she says. “I talk with people regularly who are dealing with the aftermath of major losses— increasing my awareness in a very personal way that depression is not simply a chemical issue. It can be and often is connected to the loss of a loved one, enduring a stressful job in an unsettled shaky economy, or simply not finding work, and scrambling just to stay afloat. We’re always striving for balance, and until we achieve some sense of stability we often operate in an anxious, depressed state—often feeling guilty about something.”

Whatever the underlying cause, these imbalances can pile up to a point where they trigger clinical depression, anxiety, or addiction.

Safety First in Restoring Balance

Dr. Gupta emphasizes the importance of starting with safety concerns when dealing with depression. “It’s always my first question: ‘Do you feel safe? Do you feel any thoughts of hurting yourself or others?’ And it sounds like a cliché, but honestly, people really just need to be asked.

“Suicide has gone up so much in our culture and it’s because of all these pressures. And so just by asking someone: ‘Are you thinking about harming yourself?’ I find that most people open up and it’s a discussion—and then you can really help people.”