Transcription:
Is it 'The Blues' or Depression?

Caitlin Whyte (Host): Depression as a term is used so much in our culture. But how can we tell the difference between a simple case of the blues and a true diagnosis of depression? Dr. Joseph Berg joins us again to tell us more. He is a Family Medicine Physician at Upland Hills Health Mount Horeb Clinic.

This is the Inspire Health podcast from Upland Hills Health. I'm Caitlin Whyte. So Doctor, depression, tell us just what it is and how do we know if it's more than just a case of the everyday blues?

Joseph Berg, DO (Guest): Yeah. So depression by definition is a persistent down mood, you know, feeling sad or having little interest or pleasure in doing things you used to like to do. That often comes with other symptoms. So you may be just maybe think that you aren't sleeping enough or other things are going on, but oftentimes some of those symptoms are depression. So like eating too much or too little, you know, not having an appetite, sleeping all the time or not being able to sleep, just having little energy or feeling fatigued. Feeling like you're worthless, you're helpless. You can't do anything about what's going on in your life or just feeling like there's no hope in your life. Having trouble concentrating, getting things done. You can even have some psychomotor changes where you just, all of a sudden talk really fast or twitch, or you just are feel like you're in molasses and you can't get anything out.

And you're moving slowly and kind of that last big symptom that we all worry about as doctors is thoughts of self harm, you know, thoughts of hurting yourself. And to know if, you know, we all feel sad at times, we all have those days where we're like, I just want to sleep all day. We all have those days where we just can't concentrate at work, but it's when it's a disease or a disorder when your symptoms are all the time or more often than not. And they last a decent amount of time. So like three months or longer. And most importantly, these symptoms, aren't just a nuisance that come and go. These symptoms are significantly impacting your daily life. So, maybe you have trouble at work. You are, you know, you're missing deadlines.

You're not getting your job done. Your manager is talking to you about your work performance. Maybe you having difficulty interacting with your friends and family. You're screaming at your kids all the time. You're not calling your friends, you're ignoring your family. You're really struggling. Or maybe you're a college student and you just can't get your schoolwork done. And you're starting to fail your classes. That's when you know, hey, this is not just like I'm down and I'm sad because things aren't great where you may have a depression.

Host: Now tell us more about when you should talk to your doctor about these feelings. When might intervention be needed?

Dr. Berg: Like I said, the best time to do that is when you know what you're feeling down, you're feeling sad and now like, oh, things are starting to not do well day to day, right? Again, you're screaming at your, your wife, you know, you're maybe lost your job, you know, and you starting to, to fail in school. That's when you're like, well, I think I gotta go see the doctor.

Host: Is there anything we can do at home to ease the symptoms of depression?

Dr. Berg: Yeah, there's lots that you can do at home. And these are things that I generally recommend to everybody who has just isn't feeling great or has depression. These all have evidence, right? So someone did a study where they had one group that did one thing, and then another group that didn't and they see who was more depressed and the people that did them were less depressed.

So specifically those are, get outside. The sun makes a big difference. We may all feel sadder during the wintertime and that's for a good reason. It's because we don't see the sun as often. Exercise is very important. Exercise increases the happy chemicals in our brain, but it doesn't have to be a ton of exercise. You don't have to become an Ironman. You can just go for a walk. Next is thinking positively, writing in a gratitude journal, but just thinking about the things that are good in your life will help make you feel less sad. Right? Which makes sense. But people don't do that. Taking time for yourself, doing things that you enjoy and kind of forcing yourself to do those things you enjoy, like read your favorite book, play that video game you always wanted to play. Watch that show that you've been missing. You know, take a walk with your family, go see a friend. Those are very important. Therapy can help. Socializing, that's maybe one of the most important things is when we're, when we're sad and we're depressed, a lot of us or a lot of patients. I see, just want to sit in a room all day, you know, but it's, it's having meaningful interactions with people which are really going to help increase those, those good chemicals in their brain.

And then lastly is maximize your spiritual life. If you believe in God, go to church, pray. If you don't, think about something greater than yourself, you know, read a book about meditation or mindfulness. When we think about things above ourselves that are greater than us, it often makes our problems seem smaller. So we feel better about that stuff.

Host: Let's talk about medications, what kinds help and how do they work?

Dr. Berg: Most commonly, what we use are medicines called SSRIs or selective serotonin re-uptake inhibitors. So very, very generally they increase the happy chemicals in our brain or our serotonin. And how I like to explain it to patients is, well, just take a little step back. Every disease process is a combination of our genetics, what we were born with and our environment, right? And in depression, this is especially important. So think of your brain as like a castle wall, right. And stress or problems in our life as an attacking army. Some people have very, very high walls and archers on the wall and a mote and guard towers. And so they got, they were born with lots of defenses, right? So they can handle a lot of stress and a lot of problems in our life and still feel happy and still get by on their day to day life. But some people, you know, have, have like a rickety fence or a very low wall. Right. They don't have as many of those protections, they didn't have that, they didn't win that genetic lottery to be, to be happier when problems arise.

So again, so depression happens when all that bad stuff overcomes our defenses and we, and we have all those symptoms and we can't kind of get out of it and it affects our daily life. What the medicine does is it kind of improves your defenses. Right. So if that, that army is overcoming and breaking down that wall, you know, taking the medicine, maybe builds it back up or adds an extra line of defense to help you kind of stave off that, that problem.

Host: Medications are of course a great step, but what do you do if they aren't helping?

Dr. Berg: Think of like the, the wall, right? You're not going to build a new wall in a day. You're not going to add, add a new defense in a day. You get it need, you need time. The medicines take time to work. So if you're, if you're not thinking the medicine's helping often, it's the first couple of weeks you got to stick with it. It's going to take almost a month or longer for them to help.

And at the same time, make sure you're doing all those non medicine things we talked about, you know, make sure you're exercising and getting outside and seeing friends and stuff like that. So if the medicines aren't helping right away, stick with it and try to do those non medicine things. If after four weeks, you know, they're not working and we've tried maybe a dose change, there are other medicines of different classes that we can try that can help. And each person is different. Like, remember we talked about genetics, everybody gets a different lottery, so there's some medicines work better for other people. And they're actually some genetic tests that we're starting to use more to tailor medicine to each patient. So that is an option. If you're, if you're struggling with something and not getting better, maybe we need to look at your genetics and see if there's one that would work best for you.

Host: Now, where does talk therapy fall into this treatment? And what do you recommend?

Dr. Berg: Talk therapy is important. It can help. What usually they do in talk therapy is something called cognitive behavioral therapy. Where they talk you through a way to take the feelings you're having or the thoughts you're having in your brain and kind of reframe them. So you don't feel the same way or react the same way to adverse events or stress.

So it does, it does help, but it works best in like a plan of care, like doing, not doing just that may help some, but I think adding all of those other non medicine treatments that we talked about, plus medication is probably the best plan, but some people get by with just talk therapy, but usually I recommend it if it's severe enough to do both medication and talk therapy.

Host: Doctor, there are many new treatments being talked about in the media and published in the American Journal of Psychiatry. I've seen shock therapy, brain stimulation, even talk of hallucinogens. What are your thoughts and advice to people regarding this information as we wrap up today?

Dr. Berg: Yeah. Most of those treatments are, are not as frequently used as the ones we more commonly use. And only for those people with very severe symptoms that are, are not getting better with the more standard type treatments. So it's not something that I'm ever going to use. I'm never going to probably prescribe mushrooms to one of my patients, at least not now.

Maybe in 10 years, we all, we're all using mushrooms every day, but yet, you never know. But the the strategies that we've talked about already work for the majority of people. And if they don't, there are psychiatrists or experts that will maybe suggest maybe one of these other treatments, but most of the time it would be fine tuning a different medication or talking about a little bit better way to do something outside of medication to improve your symptoms.

And, and these aren't, these aren't things that you have to use your whole life, right? If we, if we improve your defenses for a short time, when you're going through an extra hard time and things are better, oftentimes you don't need the medication forever.

Host: Well, Doctor, it's always important to lift up mental health awareness and things we can do to help ourselves and those around us who may be suffering. Thank you so much. You can find more about Dr. Joseph Berg, how to make an appointment with him and all Upland Hills Health Family Medicine Physicians at UplandHillshealth.Org. This has been the Inspire Health podcast from Upland Hills Health. I'm Caitlin Whyte. Be well.