Amanda Wilde (Host): This is MAIMO Med Talk. I'm your host, Amanda Wilde. Joining me today is Dessiree Morgan, Vice President of Nursing for the Department of Psychiatry at Maimonides Medical Center. She'll help us understand depression prevention and treatment, and how Maimonides is supporting mental health awareness. Dessiree, really appreciate you being here to share your expertise. Welcome.

Desserie Morgan, MSN, RN, PMHN, NE-BC: Thank you so much for having me. I'm very excited.

Host: Are there some general early signs of depression that we should be aware of?

Desserie Morgan, MSN, RN, PMHN, NE-BC: So, relatively speaking, I think, the holidays can amplify what's already there. Stress, grief, loneliness, financial pressures. Predominantly, early on, if you're somebody who struggles with or lives with some depressive symptoms, you're going to notice, there are mood changes, maybe appetite changes, changes in habits, things you used to love to do, really depending on the age of the person who's experiencing these symptoms.

If we're talking about children, the children might show more signs of either aggression or maybe even more clinginess. Some inattentiveness at school, irritability, which is very different than the adult who might be having some signs of depression, which will be more withdrawn, sadness, more of the textbook stuff that we're used to hearing about, with depressive symptoms.

Host: So depression does affect different individuals differently.

Desserie Morgan, MSN, RN, PMHN, NE-BC: Absolutely.

Host: And are some people just naturally more depression leaning than other's?

Desserie Morgan, MSN, RN, PMHN, NE-BC: There's two schools of thought. There's the idea that people can be more predisposed to it, depending on their genealogy. You know, is it inherited? Is this something that is runs in their family?

Or is this something that is situational? Are they experiencing a lot of grief and loss and is this something that is going to subside over time? So, it really would depend on the person individually, what they're actually dealing with.

Host: When would you say it's appropriate for someone to seek professional help for depression?

Desserie Morgan, MSN, RN, PMHN, NE-BC: As soon as you're starting to feel any kind of changes in your mood. When you can sense something early, you can disrupt it. When you can disrupt something, you can change it. So I think the earlier that you notice something is going on either within yourself or with a loved one, that's the time to act. You're not going to wait until something's completely exacerbated to act.

Host: So disruption can be a strategy. Are there other strategies individuals can use to prevent depression, both for themselves and their communities?

Desserie Morgan, MSN, RN, PMHN, NE-BC: Absolutely. So, depression isolates, so you want to build connection. These are strategies that you can use. You can plan for triggers before they happen. If you're somebody that lives with depression and you know that this is something that you have struggled with in the past; you are pretty familiar with your own triggers, right? So I'm going to speak specifically about the holidays because that's really what we're going to be up against right now. It can be very stress inducing. Stress is going to be one of the major triggers for somebody who deals with depression, the grief, the loneliness, financial pressures, all of these things.

You have to protect your mental health and you have to plan. You already know that this is something that you can foresee, you know this is going to exacerbate over the holidays. Assume that you're automatically going to need to have some protective factors in place. The goal obviously isn't to force the happiness.

You want to stay grounded and make sure that you have support. So you want to structure your days, protect yourself by basically making actionable steps. Make sure that you have a routine. Make sure that you are sleeping enough. That's easier said than done, obviously, but you want to set a sleep routine.

Any clinician will tell you try to have a sleep routine. But if you are truly, focused on, your own triggers and you are in a place where you know that if I don't sleep six to eight hours, I'm going to wind up falling back into the having those bad thoughts, it's going to be darker for me.

I'm going to wind up going down that rabbit hole. Start setting timers, get off your phone an hour earlier. Whatever it is you need to do, set those routines and stick to them. After a couple of days, it becomes a habit and you start to see that those symptoms will start to lessen, hopefully. Start eating regularly, move daily, get out into the sunlight, plan for those triggers before they happen.

Host: Those are great things the person experiencing the feeling can do. How can family and friends support someone who may be experiencing depression?

Desserie Morgan, MSN, RN, PMHN, NE-BC: So again, we're going to talk about ages. If it's your child, let's say this is a teen that lives with depression. Stay close, stay connected, and stay in conversation. Let them know that what they're looking at at on social media, those are highlight reels. So that's not real.

That's not real life. So there's a lot of comparison that happens that just lends itself to more feelings of inadequacy, more feelings of loneliness and isolation. And let's face it, like kids, even adults, a lot of us are addicted to our phones. And we think that what we're seeing on social media is real life.

And then there, there becomes this comparison to that which makes us feel less than. That just lends itself to feeling even more depressed and checked out. It's important to have that conversation to say that's a highlight reel. That's not real life. So have those conversations, check in regularly, gauge where that person is, and don't be afraid to have the conversation and say the words, how are you feeling on a scale of one to 10 right now? How heavy is your your pain? And that's somebody who you know is feeling, has experienced depression. If this is a new thing, and you're seeing a change in their behavior; again, a lot of people are afraid to put an idea in someone's head to say, are you depressed? Are you having thoughts to hurt yourself?

A lot of people are afraid to have that conversation and they feel that they're putting the thoughts in their head. That's not the case. We need to open up and have those conversations. So the best way to help someone is to just sit with them and say, I am here. I'm not sure what's going on, but I notice a difference and I'm here to help if you need anything. But I'm checking in because I care.

 And that's one way, but if you know, now you're dealing with an adult say that, has depression and you're noticing that it's sort of obvious that they're, they're not doing well right now and it's becoming clear that they might need more help.

 Stay close, check in with them. Or this could be, you know, a grief holiday. This could be a day where it's approaching something that happened in their life that you know that they're going to struggle getting through. Check in, make it routine. I'm going to call you Sunday at six o'clock. I want to go for a walk with you.

Just be there so that they have an outlet. They have somebody to talk to. I'm not saying to be the caregiver for them, but to at least be a connection for them because that is what is missing. And like the older adult, the loneliness that they can feel, after the holiday parties, all of that is gone.

They go home to an empty house that used to be filled with kids and husbands. That's where the risk is when they start feeling lonely. And lonely is not a personality. Lonely is a health issue and we have to start looking at it like that. It is something that we can fix, make those connections.

Tell them to join a senior center or help them join that senior center. Those are some of the things we can help with our family, friends, and community. Be the referral source if you can, or point them in the right direction. If you see somebody struggling and you know that there are things that they can be doing to maybe curb that loneliness so that it doesn't seem so isolating. That's the worst part. That's where it feels really, dark.

Host: So staying connected is really important throughout any bout of depression.

Desserie Morgan, MSN, RN, PMHN, NE-BC: Absolutely. Connectiveness is protective. Like really, as long as somebody doesn't feel alone. That message that they get, that they're not alone, I think is what we need to drive home to everybody, regardless where they are in their illness.

Host: On the medical side, Dessiree, you've been in this field for 20 years or more. What role does psychiatric nursing play in supporting individuals with depression?

Desserie Morgan, MSN, RN, PMHN, NE-BC: There's many roles, obviously the clinical one where we give the medications and we run the groups. But the real role, the one that I think is the most important role, is the empathy, the caring, the just lending your ear, your heart, sitting down next to somebody and hearing them and kind of being in that space with them. Letting them vent to you and just empathizing and feeling their pain and sharing in that space with them for a little while. Let them know that the weight that they're carrying is real and validating them. That's what a real psychiatric nurse, that's the real role.

Host: With your long experience and perspective, from your experience, are there any common misconceptions about depression you would like to address?

Desserie Morgan, MSN, RN, PMHN, NE-BC: I'll just say that you can't just get over it. A lot of people think, just get over it, be happy, cheer up. This is a phase. Sometimes you just, people put on a happy face and they're really just so hurting inside.

So no, there's so many misconceptions about depression. We would need a whole podcast just on that.

Host: Fake it till you make it doesn't seem to apply here.

Desserie Morgan, MSN, RN, PMHN, NE-BC: Absolutely not. You need help. When you have depression, you need help. You need, whether it's going to be somebody to talk to, maybe some medication to get you through. You just need someone. You need professional help to make sure that you're okay.

Host: Can you tell us more about the resources Maimonides offers for mental health?

Desserie Morgan, MSN, RN, PMHN, NE-BC: Sure. We have so many. Maimonides does an incredible job. I mean, we have from intake, we have adult, child, the wellness program, perinatal. We have the college track, which is an amazing, amazing resource. We have the Addiction Health Center, LGBTQ+. We have Psycho Pharm, we have all different therapies.

We have the licensed creative arts therapy where we have dance therapy, drama. We have tons of groups, so that's not even naming all of them. That's off the top of my head right now.

Host: But that gets us an idea of the scope of resources that you offer. You also do initiatives, and I know you've been involved in the Stigma-Free initiative for a while. What is that and how does the Stigma-Free Initiative aid in mental health awareness?

Desserie Morgan, MSN, RN, PMHN, NE-BC: So that's my baby. Stigma-Free it was a grassroots movement it started in New Jersey, which is where I am originally from. And I was a Stigma-Free ambassador in New Jersey. Every county had a Stigma-Free ambassador. It was a small idea that took off. It exploded in New Jersey and 72 towns within one county took off within like three years. And I was amazed with it. All it is, is you just proclaim yourself a Stigma-Free environment, but then something amazing happens.

All of these resources come out of the woods. You weren't even expecting them. They just came out of the woods like, oh, I want to be part of this. I want to be part of this. And so I started to see the interest here in New Jersey of all of these organizations from, we call it Division in Child Protection.

So, used to be called DIFUS in New Jersey. I guess it's called Child Protective Services in New York. To give you just an idea, something terrifying to parents. No one would ever go to Child Protective Services for something good, right? Those are baby snatchers. They steal babies. But when we did a Stigma-Free, they set up a table at an event I had and showed the resources that they have, and they have so many amazing resources for parents who are struggling that they've become a place people seek out now instead of something to be afraid of.

That's one area. Other things where there's cultural barriers to getting mental health, resources to understanding mental health so that maybe your family members don't get mental health care because you don't understand it just by nature of your culture. There are organizations that we aren't even aware of that heard of the Stigma-Free that wanted to become part of this and have a table and get their resources out there.

So when I came over to Maimonides, I asked them, you know, who's your Stigma-Free ambassador? And I realized that I didn't see Stigma-Free signs in New York as I drove over the bridge and I wasn't seeing Stigma-Free anything. And then when I got there and I started having the conversation several years ago, they were so excited about it.

They just embraced it and made it this enormous thing. And we found out that we were the first area. We were the first in New York to become a Stigma-Free hospital and opened our doors to our community. And said, this is who we are. Our arms are wide open. This is a place where you will find hope and you will find judgment free zones where you will get the help you need.

And we had so many resources. We had our first ever Stigma-Free designation on October 22nd, which we will be doing yearly. And we had resources from upstate downstate all over, just eager to help and to show our community that we are one, and that our doors are always open and we want to be like the beacon of hope for anybody struggling living with, mental health challenges.

Host: Well, I was going to ask how can communities work together to create a supportive environment for mental health awareness? And it sounds like the Stigma-Free initiative is part of that.

Desserie Morgan, MSN, RN, PMHN, NE-BC: Absolutely. It's education. We do trauma-informed teaching to everybody in our organization. We lead with empathy. And that basically means having conversations around mental health, not whispering them anymore.

We talk about it, we normalize conversations so that it's something that we speak about freely, which makes people feel included and not something shameful when they do have to talk about it or their family members are living with it.

Yeah. So that's breaking the stigma is what Stigma-Free obviously means.

Host: Mm-hmm. Mm-hmm. And the enthusiastic response indicates a positive shift in how we think about mental health. Talk about 9 8 8, how it serves individuals experiencing suicidal thoughts.

Desserie Morgan, MSN, RN, PMHN, NE-BC: Yeah. So it's a 24/7, crisis lifeline, which I love that. It used to be called a hotline. I love that they call it a lifeline now. And it can, it's a resource. It can be called from anywhere in the US actually. And there's someone there, there's a counselor on the phone, you call in an emergency, there's someone there to talk to.

Host: Well, Dessiree, thank you so much for your time today, your insights, making this information accessible and leading the way in providing meaningful resources for depression.

Desserie Morgan, MSN, RN, PMHN, NE-BC: It has been my pleasure.

Host: Dessiree Morgan is Vice President of Nursing for the Department of Psychiatry at Maimonides Medical Center. If you are having suicidal thoughts, call 988. For more information about Maimonides, visit MAIMO.org or follow us on social@maimo.org. If you found this MAIMO Med Talk podcast helpful, please share it on your social channels.

To listen to additional episodes of MAIMO MED Talk, please visit MAIMO.org.