Transcription:

Caitlin Whyte (Host): Dealing with depression is difficult. And with the added stress of the pandemic and the general winter blues, it's harder than ever right now. Dr. Kathleen Young will join us today to talk about some of the symptoms and treatment options available for those with depression. Dr. Young is a Clinical Health Psychologist and Director of Behavioral Medicine at the New Hanover Family Medicine Residency Program.

This is Healthy Conversations, the podcast from New Hanover Regional Medical Center. I'm Caitlin Whyte. So, Dr. Young, the term depression gets thrown around a lot, but what does depression really mean?

Kathleen Young, PhD, MPH, ABPP, Guest): Oh, well, thanks for asking that. So, depression is different than what a normal sadness would be that everybody experiences from time to time. Depression is a clinical condition that can make it difficult to get through your day to day responsibilities and can interfere with your relationships with others. And it's important to know that depression is a fairly common mental health condition. Actually, almost one in five people will experience a bout of depression in their lifetime. There are a lot of factors that can contribute to someone developing depression. And these can include genetics, changes in brain function, life stresses, and other circumstances.

Depression can also take many forms and has varying levels of severity. It can also occur alongside other mental health conditions, things like anxiety or substance use disorders.

Host: So, what are some symptoms of depression? What does depression look like?

Dr. Young: Okay. Well, when thinking about clinical depression, healthcare providers are usually referring to a diagnosis that's called unipolar major depression. And there are a number of symptoms that can make up an episode of major depression. The first is depressed mood. And so, that is usually having a down or depressed mood most of the time during the day for an extended period of time. And so, we'll talk about depressed mood. They can say that they're feeling sad, blue, also feelings of discouragement, just kind of feeling blah or empty or even irritable.

Another symptom is a loss of interest or pleasure in doing activities that are typically enjoyed. A lot of times, people who are experiencing depression will kind of feel apathetic about completing activities. Other things include having either increased or decreased appetite or weight, disrupted sleep that could look like insomnia, not being able to sleep very much, or it could be what we call hypersomnia, which is sleeping more than what you usually would.

You can also have either restless behavior or maybe sluggish behavior moving slower than normal. Another component of depression can be fatigue or having low energy. People who are depressed also often have feelings of worthlessness and can have difficulty concentrating. And then often people will even have thoughts of death or suicide.

To be diagnosed with a major depressive episode, you need to have at least five of those symptoms. And one of them needs to be either the depressed mood or diminished interest in activities. And that would be for at least a period of two weeks.

Host: So, if we're starting to feel this way, what are some professional help options that are available to treat this?

Dr. Young: Yes. I think the important thing to remember about depression is that you don't have to suffer alone. And so, there are a number of professional treatments for depression, different medications, and then counseling or psychotherapy. So, I'll start with medications. And a lot of times people think whenever they are experiencing depression, that they need to see a psychiatrist, right? But common medications for depression can actually be prescribed by a primary care doctor as well. There are a number of different medications that can be used for depression, but the ones that are typically used first are called either selective serotonin re-uptake inhibitors or SSRIs, or serotonin norepinephrine re-uptake inhibitors or SNRIs.

And I know that's a mouthful, but they are medications that make changes in your brain chemistry that will help with these symptoms of depression. I know that sometimes people worry about taking these medications because they think it might change their personality or that they might become addicted to those. But those are not the case. You will not have a change in who you are as a person by taking these medications. And they are not addictive either. Another important thing to think about when taking medications like this, is that they can take some time to start working. It can even take up to six to 12 weeks before you start noticing improvements in your symptoms.

Finally, I think it's important to keep in mind that you may have to try more than one medication to find out which one works for you the best, or has the least side effects because everybody's brain's a little different. And so, sometimes you have to work with your doctor a little bit to find out what works best for you. The other key treatment that can work for depression is counseling or psychotherapy. And so there are a number of different types of counselors that are available. The names for them include psychologists like myself or social workers, mental health counselors, marriage and family therapist, or psychotherapists.

So, a lot of these people, if you're looking for somebody, you can check online to see if these professionals are licensed, but sometimes whenever you meet a therapist for the first time or a counselor for the first time, you're just looking for somebody who's a good fit. And then honestly, someone who takes your insurance as well. There are many types of counseling and therapy that's available. The one that has been shown in research to be the most effective is what we call cognitive behavioral therapy or CBT, but there are other therapies that can also be effective in treating depression. And those can include things like interpersonal therapy, family and couples counseling, problem solving therapy, or psychodynamic therapy.

So, I think it's important to know a little bit about what you might expect the first time that you go to see a counselor. When you have your first appointment, usually the therapist is going to gather information about you, find out what is troubling you and begin to work on developing a plan for how you can work together to improve your depression. You may end up seeing your counselor weekly or every other week, or sometimes even monthly, depending on what you decide together. And usually you can expect that a counseling session would last no more than an hour, even though the timing can vary on that.

Host: So, hearing all of these symptoms, what if I'm starting to get a little worried about myself? Where do I start the process of getting this help?

Dr. Young: So, that's a great question. Sometimes depression can actually sneak up on you without even realizing it, but there are a number of things that you can do yourself if you are feeling down and that might be able to help you along with seeing a counselor or taking medication. So, I think the important thing to keep in mind is you want to take care of yourself. And this can look like a number of things that we think of, just with regular self care, that have been shown to be effective in treating depression. And so first and foremost, it's important to work on being active. And so, this could include completing activities that you would usually find are enjoyable, even if you're not finding them to be enjoyable at the moment, but then also more specifically, exercise and that can look like exercise that's aerobic, as in get your heart rate up, or it can be strength training. If you try to do that 15 to 30 minutes, a few days a week, that can be as effective as taking medication or seeking counseling for depression.

It's also important to focus on R and R. So, rest and relaxation. Resting and focusing on sleep can be really important. And then also finding ways to be able to alleviate stress. And so that can include breathing exercises. Doing some relaxation activities or meditation, those can be helpful as well. It's also very useful to reach out for your social support because when you're depressed, you can start feeling more isolated. And I know that's more difficult these days when with COVID. But if you can find ways to be able to reach out to people and talk, that can be really helpful. And that can include if you are a religious or spiritual person reaching out to those resources as well. There are also a number of self-help books.

And so sometimes you may feel like it's better to read a book and kind of go through a process yourself rather than working with a counselor. And then another thing that has been shown to be a real focus on feeling better is to focus on gratitude. And so looking for the things in your life that you can feel grateful for and reminding yourself of this as well. And along with all of those things you can do for yourself, I think it's important to mention something that's best to not do. So, that means you should really avoid alcohol. Sometimes we think that alcohol will help us to feel better. Ultimately though, alcohol is what we call a depressant. And so, it actually can make your symptoms of depression worse and make your sleep patterns worse and just make it more difficult for you to get over depression.

Host: Now, what about if I'm starting to notice these symptoms in a friend of mine or a family member? How can I navigate that conversation when I think someone around me is suffering from depression?

Dr. Young: Yeah, that can be really difficult, but it's important to think about the things like that we would think about for yourself, with other people. If you notice someone that is not really quite acting like themselves, I would encourage you to reach out to them and try to engage them in doing some things. You know, help them to be active, invite them to do activities. Also, just even listening can be helpful. I think it can be useful at times to express concern and just even say, you know, it just doesn't quite seem like yourself right now.

So, they may not have seen that in themselves. And so hearing it from someone else might be beneficial. Finally, I think it's really important not to give up, because sometimes when someone's depressed, they might say no to doing things. They may say they don't want to talk, but if they become more and more isolated, it's going to be harder to get out of that slump. So, continuing to reach out to somebody that you care about, who could be potentially experiencing depression is really important.

Host: Great. Well, Dr. Young, anything we didn't touch on? Any last minute tips you have for people who might be suffering from depression right now?

Dr. Young: Yes. There is something that I think is incredibly important because like I said earlier, one of the symptoms of depression can be having recurrent thoughts of death or even suicide. I want to say that if you are having thoughts of suicide or wanting to harm yourself, please reach out to someone, to a professional, your physician or a counselor, definitely find some help, but there's also, if you really need help more immediately, there is what we call the National Suicide Prevention Lifeline. And that is a phone number that is available 24 hours a day, seven days a week, and is a resource for you if you're having thoughts of suicide.

And I want to give you that number so that that's available for you. The number is1-800-273-8255. And so it's 1-800-273-T-A-L-K. So talk. And so please, please, please reach out if you are having those thoughts and get the help that you need.

Host: Well, Dr. Young, I really appreciate you joining me for this important discussion and helping us get people the help they need. That was Dr. Kathleen Young, a Clinical Health Psychologist and Director of Behavioral Medicine at the New Hanover Family Medicine Residency Program. Dr. Young is welcoming patients at NHRMCs Coastal Family Medicine. To schedule an appointment at the practice call (910) 763-5522. This is Healthy Conversations, the podcast from New Hanover Regional Medical Center. I'm Caitlin Whyte. Stay well.