Listen to The Matcha Guardians Podcast Season 1 Episode 13 | Why Most People are Seeing a Psychiatrist in 2024

Listen to The Matcha Guardians Podcast Season 1 Episode 13 | Why Most People are Seeing a Psychiatrist in 2024

Why Most People are Seeing a Psychiatrist in 2024

In this episode, we have a candid conversation with Dr. Matthew Mosquera on hope, understanding, and guidance for anyone who suffers from a substance use disorder. We delve into real stories and research around the most prevalent mental health issues he faces with his patients.  Matthew J. Mosquera, MD, is the medical director of the Alcohol, Drugs, and Addiction Inpatient Program at McLean Hospital. He is board-certified in general and addiction psychiatry. His clinical work focuses on the outpatient and inpatient treatment of individuals struggling with substance use disorder and other co-occurring psychiatric disorders.

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TRANSCRIPT FOR SEASON 1, EPISODE 13 | Why Most People are Seeing a Psychiatrist in 2024

Voiceover:

Welcome to the Matcha Guardians Podcast, brought to you by matcha.com. Here we focus on the biggest trending health topics of our time, featuring the greatest and upcoming wellness advocates. Now here are the Matcha Guardians, licensed dietitian, Diana Weil and medical journalist, Elara Hadjipateras.

Diana Weil:

Hello everyone. Welcome back to another episode of The Matcha Guardians.

Elara Hadjipateras:

So, this week we have a very exciting and special guest, an addiction psychiatrist, and also the medical director of Alcohol and Drug inpatient treatment at McLean Hospital in Boston, Massachusetts, Doctor Matthew Mosquera, who also happens to be my brother, if you guys can't see the resemblance, striking resemblance to the eyebrows. Welcome, Matt.

Matthew Mosquera:

Hi everyone, thanks for having me. Elara and Diana, it's a pleasure. You can call me Matt, by the way.

Elara Hadjipateras:

I mean, it's hard for me to put the title of Dr. Mosquera. Can you call him Dr. Mosquera?

Diana Weil:

No. I mean, I could. I could do it.

Elara Hadjipateras:

I mean, Diana has known Matt for years too.

Diana Weil:

If it was important to you, I could do it. But right, I've known you since what? I was 12, 10? Something like that.

Matthew Mosquera:

Yeah, the doctor Matt thing … but I'm a doctor.

Elara Hadjipateras:

You're a doctor. So, you're a doctor who specializes in addiction within mental health. What made you choose that?

Matthew Mosquera:

I'm trained in general psychiatry, so I do focus on all different mental health ailments. But I got subspecialty training in addiction. That was after my residency training. But I guess what led me … where should I start? What led me into medicine first or psychiatry?

Elara Hadjipateras:

Psychiatry within medicine is what I'm interested in knowing.

Matthew Mosquera:

In the world of medicine there there's all sorts of different specialties as everybody knows. And going into it, I knew I wanted to go into something where I could sit down with folks, get to know them, figure out what makes them tick, figure out how to help make them better. Kind of that simple.

And I thought I was going to go into neurology at the start and you do all these different rotations in med school. I rotated neurology, and it wasn't what I thought it was going to be. For a lot of different reasons that probably aren't pertinent here. I wasn't drawn to the field.

You don't get to sit down with folks as much. You don't get that strong deep connection that I was looking for. And it turns out that connection that I was looking for was actually present in psychiatry.

So, when the time came, I did my psychiatry rotation. I absolutely loved it. I did a bunch more throughout med school and then I decided on going to training for psychiatry.

Elara Hadjipateras:

Off the top of my head, one of the things that strikes me with psychiatry when you have sessions with patients is you're able to really get a holistic view. You're spending time with them; you're getting to know them versus a lot of other specialties.

I just think about when I go to my OB-GYN or my general practitioner, I'm spending at most 10 minutes with them and we're just kind of going over vitals and things like that. And they're filling out forms on the computer, but we're not really ever having a conversation. Or if we are, it feels very surface level, very topical.

Matthew Mosquera:

Completely surface level. You don't get to get down to the nitty gritty, which is what drives me. It's kind of what I went into it for in the first place. Yeah, but unfortunately medicine these days is more disease management, kind of churn and burn model. It's kind of personal, which is not what I like. So, hence psychiatry.

Diana Weil:

One of the things I struggled with was what is the difference between a social worker and a therapist and a psychiatry on a day-to-day level?

Matthew Mosquera:

Great question. To be completely honest here, I had no idea the difference between a psychiatrist, psychologist, a social work, PsyD, all these different terms all meant the same thing to me going into it.

So, let's break it down. So, a psychiatrist is a medical doctor who just has a specific training in mental health. So, we can do therapy, we can prescribe meds.

Psychologists can focus on any different element in the world of, I guess, human psychology. Everything from the focus on therapy to research. Everything in between. They can't prescribe, but boy can they do therapy. And they're typically some of the best therapists out there.

Social work, they wear a lot of different hats. I work with social workers here on our inpatient unit and they are an essential part of the team helping to meet with patients, connect with families set up after here, but then they can also do therapy on the side.

And in addition, there's all these different other sort of sub qualifications, like licensed mental health counselor, they can do therapy, life coaches can do therapy. The, I guess, licensure for it is quite broad. There is no specific license to be a therapist. You come at it from a bunch of different angles, which is cool. There's definitely a lot of privilege to it. And some cons as well.

Elara Hadjipateras:

So, within the mental health field of psychiatry, at least within your specialty of addiction, what type of conditions are you often treating with your patients? What are the, I don't know, top three, top four things that you've been seeing a lot over the last year?

Matthew Mosquera:

So, different substances like opioids, cocaine, meth, they probably get a lot of the headlines. But by far and away, the most common thing that I treat, that we treat here at McLean in our program is alcohol use disorder. I'll call it use disorder. Getting into that, if you guys want.

Diana Weil:

I do want.

Matthew Mosquera:

In the world of psychiatry, just the world of medicine, I believe that language is important and being precise in it. And sometimes when you just label something as an addiction, there's a lot of stigma attached to that word. When in reality we're treating use disorders.

People use substances for a reason, good and bad. And when that use gets in the way of their daily functioning, then we're going to start calling it a use disorder. As opposed to an addiction. Because It's just addiction. It's doesn't carry as much clinical meaning. So, that's the terminology in the biz right now.

Diana Weil:

Alcohol use disorder. Okay. So, that's what you guys are seeing primarily at the-

Matthew Mosquera:

Whenever it comes to somebody has a problem with a substance, it's a use disorder.

Elara Hadjipateras:

And then you said also on top of that, opioids, methamphetamine. What about a word I've been hearing about lately is ketamine. What is ketamine and where is its role within mental health and possibly being used for treatment instead of using methamphetamines and using cocaine? Like it's actually good to possibly use ketamine?

Matthew Mosquera:

Yeah. So, ketamine is this up and comer, but it's actually been around for quite some time now.

Elara Hadjipateras:

It's a horse tranquilizer. Right?

Matthew Mosquera:

I'll do a whole talk just on ketamine. So, ketamine and we can get as technical as you want or as surface level. So, I'll just kind of give my two cents. So, ketamine was created in the 60s by this pharmacist, Dr. Calvin Stevens.

I just know because I just did a presentation on it by this big pharma group. And it was really a new and improved version of, I kid you not, PCP. And they created a drug that they wanted to be able to give folks pain relief as well as provide anesthesia.

And they kind of nailed it when it came to ketamine. It has an anesthetic agent to put people under. It's really great because it has a short half-life, meaning it comes in and out of the body relatively quick. We understand it's pharmacodynamics: basically how long it lasts and what it does. And it doesn't tank our ability to breathe. So, it's great actually.

And then it also helps us with pain control. It was only kind of recently they started looking into it for more treatment resistant depression and then other avenues like substance use disorders. That's all come of age from 2015 and beyond.

It got FDA approval for treatment resistant depression I think in 2019. There's this nasal spray called S-ketamine. And now in the last — it's really exciting and cool. The last couple years a lot of different research groups have started looking into it for use in treating substance use disorders or some people call it addiction. As far as how it works, that's a whole nother topic.

Diana Weil:

What do you see as the kind of the pros or cons of using ketamine? I mean, it's being kind of touted right now as this amazing miracle drug. But I'm sure that there's also some cons to it. Correct?

Matthew Mosquera:

There's definitely some cons to it. And you can abuse it. It's not one of the more abusable substances out there, but it certainly has abuse potential. And then even if you are using it as prescribed, folks taking it on a regular basis and get what's called the k cramps, like their stomach, it's crampy.

And it can affect the urinary system as well. For the most part, it's relatively safe. That's why I think there is going to be a role for ketamine for years to come in the world of psychiatry, mostly because it works quickly and most of the meds we have, most of the treatments works slowly.

And ketamine is atypical in that the mechanism by which it helps us to improve our mood and be more receptive to behavior change is way faster than most other meds that we do.

Elara Hadjipateras:

But do you have to keep taking ketamine regularly or is this kind of like you just take it once and then you're going to feel better for three months.

Matthew Mosquera:

So, the jury's still out on that. It's a really good question. We don't really know for sure. There hasn't been anyone study to be like, okay, if you have this type of depression, you take it for X amount of time. That's not proven yet.

So, a lot of times if folks get connected to ketamine clinics, if they have super bad depression. They'll get started on it three times a week and then their depression hopefully gets better and then maybe they go on to what's called a maintenance dose and they'll get it, I don’t know, once a week, once every couple weeks.

Each patient is different. So, that schedule's going to be variable. But when it works, it really does work. I just chatted with someone this morning who has really bad depression for the longest time, and she got plugged into a ketamine clinic, has been doing ketamine lozenges, not the norm, but still effective three times a week. And she said it's been life changing.

She’s had her depression lifting. Now she's able to function better than any other SSRI or anti-depression she's tried in the past. So, it was cool, just this morning I shared with someone, a 26-year-old woman.

Elara Hadjipateras:

So, would you say that there's a bit of a correlation between substance use disorders and people struggling with depression? Like there's a strong connection there, people are kind of placating their depression or self-medicating?

Matthew Mosquera:

Yeah, absolutely. So, I think we just said on … the self-medication hypothesis which is kind of self-explanatory. People use substances for a reason. One of the questions I first ask my patients whether it's in the hospital is “What are you using and why do you use it?” The good and the bad.

And people will typically be able to rattle off a few different answers in either camp the pros and cons, what they like and don't like. So, there's a huge overlap between depression and substance use.

Doesn't feel good to not feel good. So, you want to try things, make yourself feel better. And if medications aren't hacking it, if what you try behaviorally isn't hacking it, you're going to maybe try some substances.

Diana Weil:

You mentioned that ketamine clinics for people with really bad depression, this isn't something that you can just go to your local psychiatrist and be like, “Hey, I've heard ketamine can be useful.” How do people get started with ketamine?

Elara Hadjipateras:

Matthew Perry from friends was taking ketamine, wasn't he? I mean, he ended up-

Diana Weil:

Is that what he died from?

Elara Hadjipateras:

I don't know if that's what he died from, but I know that he was regularly going and taking ketamine, right Matt?

Matthew Mosquera:

Yeah. So, to start on ketamine prescribed by a physician and not just bought on the street, you have to get connected to a ketamine clinic. Because there are some strict regulatory elements to it where if a clinic wants to administer it, they have to keep under lock and key, record the specifics of how many doses they've given out, et cetera.

So, just your bread-and-butter psychiatrist would have to get certified to be able to provide it. So, yeah, Matthew Perry is a good example. I think he was quoted as saying ketamine really did help, kind of similar to that patient I mentioned earlier.

Unfortunately, he did pass away and my understanding was I think ketamine may have been in his system, but a whole bunch of other different substances. So, ketamine, I will say that if you combine it with other depressants, it's risky. It's not going to make you stop breathing. But some of the other stuff may, I think that may be what happened to him.

Elara Hadjipateras:

So, going back to the questions that you ask patients. You ask them what substances do they use and why do they use it? What are usually some of your follow up questions that you ask?

Matthew Mosquera:

What do you like about it? What do you not like about it? Do you view it as a problem? Invariably folks coming to me, they'll be like, “Yeah, I view it as a problem. No doubt.” And then I'm like, “Okay, what do you want to do about it?”

And I'll leave it in the open. I'll leave some space, some silence and then to get a response, if not, do you want to stop using it? Do you want to cut down on your use? And this is where the term ambivalence comes into play. Almost always, there's some degree of ambivalence.

I remember when I first heard that word, I'm like, “What?” Not sure there was a disconnect, but a big word. I'm like, “How does it really apply here?” But it really just means that folks are sitting on the fence.

Part of them wants to stop, part of them doesn't. And it's like that war playing out internally that I try to tease out. And then we try to lean more on the side that's telling them, hey, I got a problem. I got to do something about this.” Cutting down a minimum or hopefully stopping at least for a period of time.

Diana Weil:

I feel like in the addiction world, there's this kind of this idea that once you're an addict, you are always sort of an addict or you're always in recovery. What are your thoughts on that kind of, maybe even just the terminology around that or just that idea that once you're an addict, it's always something that you're going to struggle with.

Matthew Mosquera:

Yeah. It comes up a lot. Dovetailing into that, kind of topics like stigma and shame come to mind. A lot of what keeps folks from accessing treatment for a substance use disorder is fear of that label you mentioned Diana. And then the shame that comes with it.

So, what do we do about it? And as far as it being a lifelong thing, it kind of depends on the person's mindset. Sure, there are going to be people out there that once you're labeled an addict or a user that's going to stick with them for life.

Other times folks would be like, “Look, I had a substance use disorder. It's now in remission. I got to stay vigilant to chronic condition, but it doesn't define who I am.” So, it depends on what mindset they adopt. But it's central to a lot of the treatment and coming in and out of treatment and interacting with family.

Elara Hadjipateras:

Well, I would say from just personal experience. I went through a phase, I guess that would probably be defined as substance use disorder when I was in college, the era of binge drinking and maybe trying different substances, not taking care of your body for a good amount of years, probably five to seven years.

But at no point in time did I ever think to define myself as having any sort of substance use disorder until after the fact, almost 10 years later. And I just kind of consider that more of that was a phase in my life. I experienced it and I left it there, and now I'm in this new phase of my life.

Matthew Mosquera:

Yeah. It can be hard in the moment to recognize you have an issue with something if you're not experiencing negative consequences. Because then you're like, “What the heck? This is fine. Nothing bad is happening in my life.” But then something may come to the front.

And then hopefully at that point when you recognize that the consequences are there, that it's not really serving you well, that you do seek treatment.

And personally speaking, it's maybe a little bit dark turn, but I'll go into it. So, I had a best friend in high school who Elara was friends with as well, who super high functioning, went to a great college, name’s George. His name was George, some bad foreshadowing there.

But George after college got mixed up in opioids. And I really wish, I know now what I know now then to be able to help him better. But got mixed up in opioids to a pretty severe degree. And I remember this conversation I had with him like, “Hey, what's going on?”

He was so smart. He recognized the negative consequences, like I mentioned that it was wreaking havoc on his life, but it was actually the shame of admitting that he had a problem that kept him getting into treatment earlier.

And he eventually did get into treatment, was able to achieve a couple years of abstinence and then tragically relapsed and passed away. But I'll never forget him and his amazing friend, but also just that conversation we had about the shame about using and getting into treatment.

So, the stigma is huge. It is a topic that gets talked about, but it's like the elephant in the room whenever we're talking about it.

Diana Weil:

I mean, so many people also deal with it. That was one of my questions for you was that now that you're kind of a trained psychiatrist, not kind of, you are a trained psychiatrist, do you feel like you walk around now being like, oh, there are all these people in my life who have maybe issues or substance abuse problems that you didn't recognize before?

Matthew Mosquera:

Hopefully I'm more keen to it. I pick up on things. I guess the things I pick up on are, okay, somebody's using this. They're drinking a bunch of alcohol, or they're smoking a bunch of cigarettes or doing a bunch of cocaine.

Okay, alright, that's happening. I'll recognize it. And then I’ll be like, “Is this really an issue for them?” In all seriousness to any of those, I'll be like, “Is this really having a negative impact on their health?” Of course, with some of the “harder substances,” there’s always an overdose risk.

But I'll always be like, “Is this serving them well? Is this not?” Because the one thing that I've learned throughout my time in training is that our powers as MDs, as physicians are so limited. I do not have a magic wand, magic powers, the meds we have are okay at best. It's really more of the guidance we provide. And being okay when things don't go according to plan.

Elara Hadjipateras:

Now, do you think that people can use substances in a positive way, themselves? So, I think one of the popular things over the last five years, once again, speaking from a little bit of personal experience is psilocybin, magic mushrooms. Doing a little bit of microdose and once in a while taking some magic mushrooms, going out in the woods.

Is that something that can actually be really beneficial that people can handle themselves without having any guidance? Because I do think that that's more common these days than not.

Matthew Mosquera:

Yeah, that's a cool topic, to hear your guys' thoughts on this. But I think the answer is yes. I think there is a world in which you can use substances responsibly where there are no negative consequences in your life.

I mean, after all, substances like nicotine, alcohol are legal, but if you use too much in public, you get arrested. So, there is a happy medium here. And I think the same probably does apply to these newer kids on the block, although they're not new at all, like psilocybin.

Yeah, I think there is a safe way to use it and it'd be great to get the word out as to how you do that more because these things haven't really been taught in med school as far as psilocybin use, ketamine use. So, they're all new and guidance around it would be much appreciated. So, something that we could start teaching med students earlier than later.

Diana Weil:

Do you think there's a push now to start teaching medical students that, have you seen more conversations around it?

Matthew Mosquera:

I think more conversation coming from the med students as opposed to the higher ups. I do some teaching for the med students over at Harvard Medical School and they're just out there seeking for knowledge about all of the up and coming treatments, all maybe the new substances of abuse too, and how they can help folks when those patients land on their doorstep.

So yeah, the students are pushing for it, which is exciting. So, we're trying to work with them to broaden.

Elara Hadjipateras:

Well, yeah, you want to be able to use these different substances, I guess proactively. Versus being on the other side of things where you're using it to treat the severe form of depression. You're using it to treat severe cocaine addiction, things like that.

So, putting in guidelines would be amazing, right?

Matthew Mosquera:

Mm-hmm..

Elara Hadjipateras:

I mean, it's just funny you say that because I didn't even think about that as far as if I Google what's the correct way to use, I don't know, magic mushrooms. There's not really any official body that speaks to that at all. It's just kind of hearsay. It's just kind of person by person, based on experience.

Matthew Mosquera:

Yeah. What dose is a danger dose, what dose can you feel okay with? And what do you have to worry about when you're purchasing these? Because unfortunately they're not legalized. You're invariably purchasing them not from maybe the most reputable sources all the time.

Diana Weil:

I feel like that varies so much like by person too. I have a lot of autoimmune people that I work with or people who have chronic pain and I am so interested in how they can help sort of my nutrition clients with sort of these autoimmune conditions. But I obviously can't just tell someone to go off and find some on the streets and buy magic mushrooms and play around with dose and figure out what works for them.

Matthew Mosquera:

Yeah. Everyone is so different, especially when it comes to substances and like certain substances in particular people respond to so differently, like cannabis comes to mind. If one person can smoke, the same amount of cannabis, it is 10 different other people, it could be like 10 different totally different reactions.

Elara Hadjipateras:

One person gets paranoid, the other person gets really hungry and other person's having a great time.

Matthew Mosquera:

What’s up with that? So, I'm not a cannabis expert but cannabis is more psychoactive than people like to give it credit for. I think what's became more legalized on a national level, we stopped focusing on the potential effects. It hits a bunch of different receptors in the brain that are far more numerous than people realize.

So, it's not as benign as it may have been made out to be. So, to answer your question why, it's also stronger now as far as the THC content, different strains. There's different levels of THC versus CBD versus all the other … I'm blanking here, I suppose all the other psychoactive components to it. So, it's kind of just become this monster in some ways.

Elara Hadjipateras:

So, do you have patients who come in and see you and they're like, “Hey, Dr. Matt or Dr. Mosquera,” I should say, “I am feeling kind of depressed, I'm feeling kind of anxious. I'm thinking about smoking some weed. What should I do?” And you don't necessarily have guidelines to go off of. So, how do you answer a question like that?

Matthew Mosquera:

Yeah, I tell them weed's probably not the way to go, sir or madam, just because we don't know how they're going to respond to it. It's pretty risky. Because of that they are saying it can make them worse. So, to actually increase anxiety or make them paranoid.

Sure, you're going to hear from a ton of folks that say, “Hey, the only thing that treats my anxiety is cannabis.” And I say, “That's great, but have you ever had too much? Or has it ever made you paranoid?” And almost always you're going to hear someone say yes.

So, right there you have something that kind of seems to work sometimes, but then you are playing with fire because then it's also led with these not-so-great reactions. So, I can't really recommend that as a sustainable solution. I get it. Sometimes it does work, but I'm looking for things that work consistently and have less of the downside.

Diana Weil:

Sometimes people will say that weed isn't addictive, that you cannot be addicted to weed. But there are people who for sure in my life that I know that maybe — that are very reliant on it. So, do you feel like can you be addicted to weed?

Matthew Mosquera:

Yeah. That is possible. Yeah. See it a lot.

Elara Hadjipateras:

So, you went over you can't, I guess in good faith recommend weed as a treatment option for people coming in, say battling depression. What are some go-to safe things that you usually recommend?

One of the things that comes to the topic of my mind is people that maybe have addictions become adrenaline junkies. So, you encourage them to work out. Is that something that you often recommend?

Matthew Mosquera:

I can recommend two things that if you do these two things, I guarantee you're going to feel better. This is not rocket science, this is not novel: daily exercise. And I always start off by saying, you don't gotta be a hero, you can just do five minutes a day to start out. Seriously, just five minutes a day. But if you're consistent it's going to go such a long way for you.

So, daily exercise or movement in general of some sort. And then try your best to focus on quality sleep. We could chat for hours and hours about sleep. But those two things first of all, they take effort and time. But if you can put in the effort and time for both of them, you will feel better. I guarantee it, which is amazing. Just have a guarantee that you could do two things and feel better.

Elara Hadjipateras:

Well, one of the things I remember you recommended to me. So, I went through a stage, as I said, a little bit of substance use in my college years. Too much drinking, too much smoking of a couple different substances. And throughout my 20s I was kind of on and off of nicotine.

And I remember one of my favorite pieces of advice that you gave me that stuck with me is that when I have that urge to have a cigarette, let's say it's 11 in the morning, just wait 15 minutes, just kind of delay it and then it will pass.

That urge, that need to have that cigarette in that moment, it will pass if you just kind of push it forward. And that was something that was really helpful for me. The kind of the 15-minute window.

Matthew Mosquera:

If you can wait 15 minutes, great. Sometimes they describe the craving maybe as short as seven minutes if you can wait. And it's like a wave, you ride the wave out and then hopefully get back down to baseline.

And the one thing about cravings of whether it's a substance, whether it's even food, if that substance, that entity is around you, the availability's up and availability drives cravings. So, one of the things I ask people, “Hey, I want to stop drinking. Great, sounds good, let's help you out. Is there alcohol in the home?”

They say yes. I'm like, “You have to remove it or else when you get home your cravings are going to be through the roof and then it's going to be harder to ride out that wave.”

Elara Hadjipateras:

True if it's just sitting right in front of you.

Matthew Mosquera:

Yeah, I'd say near impossible.

Diana Weil:

Another thing I wanted to ask you, Matt, is that I've been seeing a lot of ads for Naloxone and a lot of people suggesting that you carry Naloxone in your first aid kit and one, what is Naloxone and two, do you feel like we should all be carrying Naloxone?

Matthew Mosquera:

Great question. I'm really glad you brought it up. So, Naloxone also known as Narcan. That's the medication name. It's an opioid antagonist and it's what you give to folks who are experiencing an opioid overdose.

So, Naloxone, Narcan saves lives. I highly recommend that everyone go pick some up. There should be a standing prescription at most pharmacies around the country where you can go in, and you do not need a doctor to send a prescription in. It's as if a doctor already did and you just say, “Hey, can I please pick up some Narcan?” And it's almost always covered by insurance. So, at no cost to anyone.

Elara Hadjipateras:

And if you don't have insurance what would the cost be out of pocket?

Matthew Mosquera:

That is a great question. If you don't have insurance, you can also go to, they have naloxone, Narcan giveaways at most hospitals. I would go straight to a hospital then to pick it up, a hospital pharmacy because they will almost always give it to you for free.

Diana Weil:

Cool, thank you. So, kind of switching away from drugs more to just more mental health, how do you feel like people are doing right now just on like — how do you feel-

Elara Hadjipateras:

A general pulse.

Diana Weil:

How do you feel like we're doing as humans?

Matthew Mosquera:

How are we doing? Good, given the circumstances? No, people are struggling. They're struggling with a whole lot of different things or constantly being bombarded by not-so-great news. Whether it's here in our country or internationally. So, it's tough. It's really tough and people are feeling it.

Elara Hadjipateras:

But do you think part of that has to do with the fact that people are a bit more transparent about their feelings? I just think about our parents' generation to us and then I think about our cousins and friends that are about 10 years younger than us and I feel like they're much more open.

Our generation and the generation below us and below them are just a lot more open about their feelings. There's less of that stigma that you talked about, Matt, about being kind of shameful about talking about your mental health and struggling.

Matthew Mosquera:

Yeah.

Elara Hadjipateras:

So, do you think that social media has played an impact on this?

Matthew Mosquera:

Where to start here. So, social media absolutely plays a part here. Just in general, there's these topics that come up a lot. Grit and resilience. So, resilience being the ability to bounce back. And then grit is more like persistence, the ability to kind of push through tough times.

And for whatever reason those are two abilities, let's call them, that are in high demand. You just don't see them as much with some of the younger kids right now. There's a lot of things that play into that.

One of them may be the social media part of it, because I think social media promotes more isolation than community unfortunately. I think especially with the younger users. And with that lack of community, we're kind of having a drop in resilience as well as grit. That’s what I’ve seen.

Diana Weil:

Do you have any general recommendations that you give to parents of people with younger children around social media use?

Matthew Mosquera:

Yes. Yeah. Limit it as much as you can or at least put it off. I get that now our world is that we are connected. You're going to have some social media use at minimum, but as much as you can, resist it. And I think context is everything. I think kids are smarter than we give them credit for. Explaining the reasoning behind it. As far as the downsides and what it may do to them.

Elara Hadjipateras:

Do you have any patients who come in kind of struggling with relationship issues more often than not in the post-COVID environment? I don't know. At least I can speak for myself. I feel like I lost a little bit of my social abilities just being cooped up for two, three years and I had to relearn certain things.

Has that impacted any of your patients? Like they're coming to you and they're like, “Dr. Matt, I cannot date people. I'm struggling to find a relationship. I'm struggling to connect.”

Matthew Mosquera:

Yeah, I think you're seeing that a lot more the struggles out there as far as the one-on-one time. I almost view the social interaction ability as a muscle. You don't use it, you kind of lose it a little bit. It takes some time to come back.

But that's what's amazing about being human is that we can adapt and get it back. But post-COVID, absolutely. To answer your question directly, I think there’s been a lot of challenges and folks have been feeling it and struggling to get back out there.

And someplace during COVID, it took the pressure off some people. And then they lost that ability after coming back and trying to figure out how to make it work again. It's tough.

And then throwing social media where folks are constantly comparing themself to some fake version of someone else and it only furthers our feelings of low self-worth and isolation.

Diana Weil:

With how people are struggling right now in terms of social connections and news, and I mean just everything that's going on right now, how do you make the decision to medicate someone or medication versus kind of lifestyle management? And do you feel pressure that when people come to you that they're looking for medication and you have to offer a prescription?

Matthew Mosquera:

Sometimes yeah, sometimes patients will be more straightforward than you would expect. Like, “Hey, I'm coming to you for X substance or X medication,” and you have to break it down, slow down a bit.

But by and large I don't like to throw medications at patients. We’ll start a medication, if they're really struggling and different interventions behaviorally, dietary supplements, herbal supplements haven't worked, then maybe I'll go to a med.

And whenever I start a medication or recommend anything, let's be very intentional about it. Like, we are going to start X to treat this, we're going to try this behavioral modification to target that symptom.

I think if you could be pointed like that, you put yourself in a better position to lose less in the shuffle because a lot of folks have all different meds on board that don't even know why a medication was started after a few years because it wasn't delivered intentionally.

Elara Hadjipateras:

And then how often are you checking in with the patients, say that you put on medications? Are you seeing them weekly? No? it's just different?

Matthew Mosquera:

When you start a med, you typically want to see someone somewhat regularly, weekly, every other week, at least once every three weeks. And then once they've achieved hopefully some level of stability, you can stretch those visits out.

Elara Hadjipateras:

How does someone go about if they want to preventatively, get ahead of any substance use disorders, how often should they be seeing a psychiatrist just to kind of keep their mental health, even if they're feeling pretty okay, they're content. How do we stay content? How often maybe should they be talking to a third-party or a professional? Should it be once a month? Should it be twice a month? Do you have any recommendation to that?

Matthew Mosquera:

Yeah, that comes up sometimes. Some people will say everyone should have a therapist. I agree with part of that, and I disagree with part of it. When you're going through a crisis, especially after the fact, sometimes during the fact, you know it. We all go through tough times in our lives. Loss of a loved one. Something happening at work that's super tragic. Getting fired from a job.

These are crises that meeting with a mental professional can really help us to navigate way better than we could on our own. So yes, for those folks.

But if you're a cruising altitude and you haven't had a curve ball thrown at you for a little bit and you're feeling okay, you do not necessarily have to meet with a therapist.

Sure, a check-in every once in a while, it could help you, but is it really needed? Maybe not. But some patients, some folks like that for peace of mind. So, that's my take on therapy. Once again, I like to be kind of pointed like, okay, I'm going to see this person for X because I've got these challenges in my life.

It's going to make the treatment more valuable. It's going to make your job and the treatment as the patient because patients are part of the treatment team, easier as well as therapist job easier. When you have that stated goal.

Diana Weil:

How do you know if you should go see a therapist or a psychiatrist? Let's say you're struggling, life has gotten hard, you're going through a divorce, you lost jobs, something like that. How do you pick a therapist or psychiatrist?

Matthew Mosquera:

How do you pick? Well, I'm biased, so always go in to see a psychiatrist. But no. In all seriousness, sometimes psychiatrists are hard to come by. But if you think like, ooh, this is bad where I may need to get put on meds as well as therapy, I would suggest then going to see a psychiatrist.

But if you're only able to meet with the therapist, someone who can't prescribe necessarily, does not have the ability based on licensure, you can start with them and then get plugged in with a psychiatrist afterwards.

Elara Hadjipateras:

Do you have any recommendations as far as how someone should look for a psychiatrist? Is there like psychiatrist.com, find a psychiatrist near you? What's the best way to find a psychiatrist that's going to work for you?

Matthew Mosquera:

There is a website called Psychology Today where you can search by your area code, your insurance or private pay and punch in the exact what you're looking for. That's a pretty effective way. I've met with therapists myself and that's how I've been connected to some in the past.

Other times you can go through your primary care, and I think unlike everyone not having a therapist, I think everyone should have a primary care physician, it’s a plug for them and they can plug you over with hopefully with psychiatrist within your healthcare network.

Elara Hadjipateras:

And after how many therapy sessions do you feel like you can kind of know — because I do think it's a personal thing. You have to have a bit of a connection. You have to have a bit of a trust factor with a psychiatrist, with a therapist that you're working with. After one session are you going to know like, “Oh, maybe this person isn't for me,” and you kind of have to shop around.

Matthew Mosquera:

Yeah. You do have to shop around.

Elara Hadjipateras:

There has to be some shopping around, period. At least in my personal experience, it's not always a one hit wonder.

Matthew Mosquera:

Yeah. This is where we'll get real. So, I was going through a little bit of life crisis, man, when was this? This was a couple years ago. On the heels of some relationship struggles myself with some, I hate to use the word, but toxic situation where I was struggling and trying to wrap my head around what was going on.

And at the same time some struggles in my parents' relationship. So, it was a lot to sort through, it kind of hit me all at once. So, I mean, I got to see a therapist. So, like I mentioned before, I reached out on the Psychology Today website, got myself plugged in, simultaneously I found someone and that was virtual, then I found someone in person that I could meet with, and I didn't like either of these people.

The first therapist virtually we were meeting with him, he was well intentioned. He had a couple tidbits, but he would turn the camera off and start eating.

Diana Weil:

No, that's not okay.

Elara Hadjipateras:

That's bad.

Matthew Mosquera:

Would respond to the doorbell all the time in session. I think he'll even feed his cat at points. It was like, I just happened to be in a session, and he was there. So, it did not pan out and that was after — I gave him even three sessions. But it was consistent.

Diana Weil:

That is wild.

Matthew Mosquera:

I tried calling him out on it. It was just, this is … so, I'm like, you know what? Maybe not the best fit. Plus, it was virtual, and I think I prefer if you're able to in person therapy, which leads me to therapist number two.

So, meeting with the therapist in person and a little bit older. There's nothing wrong with that. Hopefully wiser, but actually she was hard of hearing. So, I'm sitting with her across the room, and I found myself, she could not hear me. She kept saying, “I need you to speak louder,” to the point that I was like screaming what was going on across the room just so she could hear it.

It was wild. So, that didn't work out. Again, I gave what, two, three sessions and found her to be a great listener, but I'm not sure how much she heard. So, then I moved on.

It wasn't until I found a therapist via, one day I'm like, “Why don't I just check my health insurance, see if there's something there.” I was able to connect to a CBT therapist, a cognitive behavioral therapist via my insurance portal. There was a lot of different companies out there. I happened to go to this company called Lyra, got connected to a therapist, met with her for 10 sessions. It was fantastic.

Elara Hadjipateras:

Was she around the same age as you? Because I always wonder do you want your psychiatrist to be someone who I guess could put themselves in your shoes or you could see themselves putting themselves in your shoes and it's relatable, so you trust the advice a little bit more?

Matthew Mosquera:

Yeah, she was around my age. I think that certainly helped, especially what I was going through with my own romantic relationship disaster and yeah, it definitely helped to get perspective and she just had a better handle on modern romance and modern relationships. Yeah, nothing the other two didn't, but they did not generate confidence.

Diana Weil:

Switching gears here a little bit, I'm really curious your take on ADHD and sort of the prescription of Adderall and all. I also know that I think that Adderall is in short supply right now. There's like a lot going on with people not being able to get Adderall.

I also feel like there's never been more conversation around ADHD and some people feel like it's being over diagnosed, some people feel like it's being under diagnosed. What's kind of your take on that?

Matthew Mosquera:

Yeah, it's a good question. It keeps coming up over and over again and everything is in short supply. There's a theory that for the longest time ADHD was underdiagnosed and now we're finally catching up to appropriate diagnostic numbers, let's say.

I guess I kind of believe that halfway, it seems as though a lot of folks are struggling to focus, to maintain attention that have low mood. And as far as strength of medications that we have in our arsenal, as psychiatrists, as mental health providers, as doctors, stimulants are up there as far as bang for your buck.

They do have side effects, but as far as something that you're going to give to someone and they're going to feel the effect right after and it's going to be a pretty profound change in just their disposition, stimulants are strong, straight up.

So, nowadays everyone's looking for substances, treatment, medications to work quickly. And I think stimulants offer that more than other treatments. I think we're now entering … this is a longwinded way of saying; I think now we're kind of edging towards over diagnosing.

Elara Hadjipateras:

Over diagnosing and over prescribing. I just think back to friends I've had that have been prescribed Adderall since they were teenagers and I think that it's had an impact from a mental health standpoint. They just feel a bit more muted than say they were since they've been on these drugs for at least a decade.

Are there any studies that have looked into this potential impact of just being on these drugs for too long? Can you just maybe go on it a little bit or just use it when you're really having trouble concentrating? Does it have to be every single day?

Matthew Mosquera:

I wish there was. To my knowledge, which albeit is not completely comprehensive. I know what I know, and I know what I don't know, I am not aware of any longitudinal study looking at the long-term effects of stimulants on your health.

I think you're getting at something big Elara that I think there is a lot of negative consequences. Case in point, we recommend patients to take what's called stimulant holidays. So, obviously it’s not great if you're recommending that they take holidays when they don't need it. You don't recommend that for blood pressure medication.

So yeah, it strains the heart. It can make you more irritable, it can affect your sleep, when you take it really matters. So, it's not for everyone. There are a lot of side effects that are way more intense than people realize.

Diana Weil:

It also seems like, and please correct me if I'm wrong, that I feel like for other mental health issues like anxiety or depression, there's a go-to of sleep, stress, community, all that kind of stuff. And for ADHD it seems like the big push is like just take medication rather than what are things that we can do to kind of support you outside of medication. Is that true or is that just kind of the idea or perception behind it?

Matthew Mosquera:

It's definitely the reality. There are behavioral interventions that you can provide to folks with ADHD that can really help with organization, help with task management, help with just getting things done in general that just don't get emphasized because that's way easier just to prescribe a medication and to hope for the best and it's less work for the patient.

So, for all those reasons, we are now in this situation where all these meds are out of stock at pharmacies.

Elara Hadjipateras:

That’s wild. I think that for ADHD in my personal experience, I think I have a little bit of attention deficit at times and consistently working out really helps me. Going back to your whole recommendation of breaking a sweat every day and then also getting some good quality sleep to help reset for the following day is very helpful, across the board in terms of just regulating your mental health.

Are there any other tips besides the get good quality sleep, break a sweat, that you'd say you'd recommend to kind of keep your mental health barometer nice and even keeled?

Matthew Mosquera:

Actually, yeah. One thing, when things are going well, a lot of times visits will be quicker when I check in with folks, which is fine. And when they are going well, I'll encourage a client, that patient to take a snapshot like, “Okay, I'm glad things are going well. I'm glad you're feeling a lot better. And you're chugging along.

Take a snapshot of what is working right now. What is your recipe? What is your blueprint?” Because something's going to happen. Unfortunately, it's another guarantee that I say like, I guarantee that life's going to throw you some bullshit at some point. How are you going to deal with it?

And then we can think back even to, so like March 13th, you were feeling great. What was working? Let's go back to that. So, staying attuned to what works for you and trying to get back to that when things deviate.

Elara Hadjipateras:

Yeah. I’ve become a big fan lately, as you know, I had a baby two and a half months ago, so sleep is hard to come by. Stress is running higher than it was six months ago. What's helped me on a day-to-day basis to kind of maintain my baseline is taking moments and thinking about what I'm grateful for. So, practicing gratitude has been a huge thing for me.

Matthew Mosquera:

So, you're taking a page out of the positive psychology book, which I think is awesome. Focusing on the positives and really working towards a mindset shift.

Diana Weil:

Matt, do you have any books that you recommend to people? Any favorite books for people maybe listening who if they're wanting to improve mental health that maybe don't have the resources to go to therapy?

Matthew Mosquera:

Yes. I'm not sure why this one was coming to mind, but I'll mention it. Thich Nhat Hanh, have you ever heard this? This book on anger is tremendous. Everyone gets angry. And typically, there's something beneath anger when we feel it. And this book helps you to get at that. I just found it pretty eye-opening.

Elara Hadjipateras:

I think that my brother-in-law read that book. And I have to say, I noticed a bit of a difference in him afterwards.

Matthew Mosquera:

That's really good. I also like not maybe books, but if you all like podcasts. I love Arthur Brooks. He is a I think a PhD researcher at Harvard … the Atlantic. He has a great column and yeah, I recommend to everyone.

One of his points that I actually use a lot with patients, I'm not sure if it was him. I'm not discrediting it. I guess just in the idea of happiness. Because happiness comes up a lot. Meet with a doc because you're not happy.

I always encourage folks, and I got this from one of the blogs, that happiness is to have a mindset shift that it's more of a direction, not an end point. If you can make that simple shift, it'll go a long way. Because emotions, sadness, happiness are totally normal. If you were happy all the time, that'd be super weird. So, if you just trend towards it with some blips, you're going to be way better off.

Diana Weil:

I love that perspective. So, kind of wrapping up here, I don't know if Elara prepped you or not?

Elara Hadjipateras:

No. We're hitting him blind. I didn't give him any-

Matthew Mosquera:

I don’t know what's coming.

Elara Hadjipateras:

Yeah, he does know it's coming.

Diana Weil:

Always ask our guests two questions. The first question is, what is a lesson that you have had to learn the hard way?

Matthew Mosquera:

What am I going to go with? I have a couple that are coming to mind.

Diana Weil:

You can hit us with a few.

Elara Hadjipateras:

Some people give us a few.

Matthew Mosquera:

First one, everything is temporary, which is good and bad. You're going through a tough time, a shit time. It's temporary, hopefully. Everything's temporary, so it has to be. But if you're going through a good time, it's temporary.

Along the same lines, relationships change and that's okay. It’s the nature of them. So, that has helped me to push through some challenging instances.

Another life lesson, a lot of these are related. Another one, when people show you who they are, take note, don't ignore it. I think it is great. I tend to have a positive view of people. I'll give people a lot of chances, but if they show you who they are through their actions more than their words, take note.

Elara Hadjipateras:

That's a good one.

Diana Weil:

That's a hard one.

Elara Hadjipateras:

That could be a whole topic in itself as far as a podcast. How to actually be able to read someone's sense of self and who they actually are. And people that are able to mask that.

Matthew Mosquera:

Because you're trying to have an open mind. I think, it's great to have an open mind. At the same time when the reality is right there, pay attention. People can change. You can give them a chance to change, but once again, you're going to pay attention to that change through what they show you.

Elara Hadjipateras:

Actions, actions speak louder than words.

Matthew Mosquera:

There you go.

Elara Hadjipateras:

So, now, kind of other side, flipping the coin. What is a mantra? For Nike, for example it's just do it. What's a mantra? Some piece of advice that you've come across from a family member or friend that right now is really helping you?

Matthew Mosquera:

This is kind of a lame one, but I talk to myself a lot. Focus on what you can control and not sit outside of your control. Sometimes I get overwhelmed, but it helps me to minimize that to a certain degree. Because you can't do everything. Your powers are limited, so just do what you can do.

Diana Weil:

I don't think that's lame. And I think that that's like a really … I was just reading something about being afraid of… Elara, the stage that you're in about the sleepless newborn nights. And the advice was that there's nothing that you can do about it right now. And to just enjoy. And when it comes, it'll come.

And I feel like that you can apply that to any moment that you're in, in life. And it's a really important lesson.

Elara Hadjipateras:

Yeah. There's only so much you can control and you can drive yourself crazy trying to figure everything out around you, but at the end of the day, you're only driving your car. Not everybody else’s on the road. Well, this has been a really fun conversation, Dr. Matt.

Matthew Mosquera:

Thanks for having me, guys.

Diana Weil:

Do you call him Dr. Matt at family dinners?

Elara Hadjipateras:

No. No. I just, it felt right in this moment.

Matthew Mosquera:

I get that from a few people. I have some friends that call me that, kind of cheeky.

Elara Hadjipateras:

Dr. Matt. So, Doctor Matt, if people maybe wanted to see you or work with you in say, a therapy capacity or with work, how could they find you?

Matthew Mosquera:

I am in the process of creating my own website for that. You can find me on that website for providers that I mentioned called psychologytoday.com. Just search my name, plug it in there.

Elara Hadjipateras:

Where are you able to see patients from as far as states? 

Matthew Mosquera:

I'm able to see patients, I'm licensed in Massachusetts and in New York, and soon to be others in an outpatient setting. So, let me know. I'm also at McLean Hospital, not going anywhere, here most days, all day. No, it's good. I love it.

Diana Weil:

Awesome, Matt. Well, thank you very much. If anyone has questions, drop them in the comments and we will all see you guys next time.

Voiceover:

Sip, savor, and live well with new episodes of The Matcha Guardians every Wednesday. Follow our cha for free on Apple, Spotify, YouTube, or wherever you're listening right now. Leave your questions and comments below. Find us on Instagram at the Matcha Guardians or click on matcha.com.