Transcription:
There is Help for Depression

Melanie Cole (Host):  Do you know what really causes depression? It may not be as simple as you think. Most people associate the words “clinical depression” with what’s popularly called chemical imbalance as though we have too much or too little of a single brain chemical, when in fact, depression in an individual is often caused by a perfect storm of several issues coming together to create this mood disorder. My guest today is Dr. Amanda Starling. She specializes in mood and anxiety disorders, body image, women’s issues, and mindful meditation at Summit Medical Group. Welcome to the show, Dr. Starling. Tell us a little bit about depression. What might be a red flag? What might signal that somebody is suffering from not just occasional sadness but real, true depression? 

Dr. Amanda Starling (Guest):  Well, I think that you described it accurately. When a normal person experiences a low mood or sadness, it might be something where they feel that sadness and it passes relatively shortly or they can identify why they’re feeling sad and take appropriate steps to manage the situation to deal with whatever the structure of the trigger for their sadness is. Somebody with clinical depression experiences classic symptoms of low concentration, low motivation, something called anhedonia, where things that you once enjoyed you no longer enjoy as much or at all, and some of the biological symptoms of sleeplessness or too much sleep or under or over eating. And it really lasts for longer than what we’d say, a day or two. It’s usually at least about two weeks, and it interferes with your functioning. When we say interfere with your functioning, it means that it’s getting in the way of work. It’s getting in the way of personal relationships. It’s getting in the way with your ability to function as you normally would in your life. That would be the difference between somebody who’s just experiencing some lowness, some low mood or sadness, and somebody who might be experiencing depression. I guess I should also note that a really big, red flag would be if you are having negative thoughts of self-harm, either to yourself or to somebody else. If you are experiencing suicidal ideation, which is talk about wanting to die, which doesn’t necessarily mean you intend to do it but you’re thinking about wanting to escape your situation or no longer feel the way that you do. You have thoughts about wanting to be dead. And if it exacerbates into some sort of plan or intent to do that, then it’s really serious and you should seek treatment or help, immediately go to the hospital. For most of us, it doesn’t escalate to that point. It’s just sort of a chronic state of feeling really down and feeling not yourself and as if you really can’t function in your life the way that you want to. 

Melanie:  If someone recognizes these things in themselves or in a loved one and they do go for help, what do you do for them? What’s the first line of defense? Because we hear so much today, Dr. Starling, about antidepressant medications, and some people are very resistant to start on them. Tell us a little bit about the treatment for depression. 

Dr. Starling:  Sure. Well, at our center, we do cognitive behavioral therapy, and research has shown that that’s extremely effective. And it’s usually the first line of defense for a mild to moderate depression. If you’re feeling mildly depressed or moderately depressed, when going to a cognitive behavioral therapist and working on the negative thoughts that you’re feeling, changing some of the behaviors that you’re engaging in that might be maintaining your depression or exacerbating it would be your first line of defense. If it’s a loved one, you want to encourage them to go see someone who can do probably this form of therapy first because it’s really proactive, tends to be short-term, and you get a lot of bang for your buck with CBT if you’re going to have an active goal-directed therapist who is really going to work on things with you. I would encourage that. If it was a high-moderate to severe kind of depression, that’s when you want to think about medication. Because sometimes people are having so much trouble functioning at all that they really can’t engage in the therapy the way we would like them to. Still, they might want to go see a therapist who can recommend that they have a psychiatric consult or they might want to make an appointment with a psychiatrist right away and get started on some medications so that they can get some symptom relief, but then they would still definitely want to engage in therapy because that’s where the long-term changes are really going to happen. Their medication might take care of some of the biological components of the depression, and that can be extremely therapeutic or helpful, but then you also want to work on making some changes to your thinking and to your behavior and where you kind of tolerate certain feelings, and that’s where you’re going to get the most therapeutic change long-term. 

Melanie:  What is the therapy like? Do you think if people are going through this therapy, is this is something they keep to themselves? Do you feel that there is a stigma out there still about people who suffer from depression but they don’t want to tell anybody about it? What goes on in therapy? 

Dr. Starling:  Well, unfortunately, there is still a mild stigma, but that has changed so dramatically. And I don’t believe there should be any stigma and I think more and more and more if you were to survey the majority of people that are sort of knowledgeable about mental health, they would agree that depression is a very normal thing to go through at some point in your life. In therapy, there is nothing to be afraid of or be intimidated by. You’re going to be working with somebody who is going to be really trying to assess what it is that is bothering you, what you’re struggling with, and to get in there with you and try to help you make some changes. One of the big components of depression is having negative thoughts about yourself, having negative thoughts about the world and other people, and having negative thoughts about the future. That’s really sort of the staple of the negative thoughts that we work with. Soyou’d want to work with a therapist who could help you identify what those negative thoughts were and then begin to either evaluate them, restructure them, change them, test them out, sort of work on the thoughts because not all thoughts are necessarily truths. Because we have a negative thought doesn’t mean it’s true. Then we’d also be working on behaviors, which is what are some of the things that would improve your quality of life. With depression, we know that people tend to start doing less things that bring them pleasure or that bring them a sense of accomplishment. We call that mastery and pleasure. A big part of the therapy is working on trying to increase activities that bring you either mastery or pleasure. You’re working on the thoughts and you’re also working on those behaviors. You might do some activity scheduling. You might work on trying to increase social relationships. You might work on trying to get out of a negative situation, not just brings you down and it’s really hard for you to feel better in. So it’s proactive and it’s effective, and there really should not be any stigmas associated with getting help when you’re depressed. Everybody goes through low moods and situations in their life, and some of us are more prone to depression. But it’s just all the more reason to address it and work with somebody who can help you. 

Melanie:  Give us some tips on things people can do at home, some lifestyle things that they can do, and also cover a little bit of some alternative because there are a lot of things out there—fish oil—that have been said to help mood disorders and help elevate mood. Do you agree with any of those, and what can we else do at home and throughout the life to help with those feelings? 

Dr. Starling:  Well, one of the huge aspects of feeling better is to have a good social support system. We know that there are certain types of therapy actually that just work on increasing your interpersonal relationships. But if you have people in your life who are supports, one thing that you can do is you can reach out to your support. You can either talk about what’s going on, how you’re feeling, or you can even just call somebody up to distract yourself to hear about what they’re doing. You want to make sure you’re in touch and doing activities or talking with people that you feel comfortable and close with. Joining activities, being part of groups, spending time with family, spending time with friends, I would say that’s something that definitely is a protective factor for depression. Another thing you can do is we know that physical activity really helps with depression. When people are moving and they get some sort of movement—and that’s what I like to call it. It doesn’t have to be extreme, hardcore exercise, but some sort of movement, whether it’s a class, it’s going for a walk, it’s taking your dog for a walk, it is more formal like going to the gym, that’s something that can really help. Alternatives in terms of fish oil, my attitude towards that is that is as long as it’s not harmful. I don’t know all the research on different alternative medicines, but if something’s not harmful, why not try it? You can always check in with your doctor. They should be abreast of whether it’s a psychiatrist or a primary care doctor. They should sort of have some knowledge of whether something would be neutral to helpful. Again, as long as it’s not harmful, might as well try it. And I think just a general sort of active, meaningful life, having things that you feel are important to you and that you’re doing, things that could help. 

Melanie:  In just the last minute, if you would, Dr. Starling, give listeners your best advice for those suffering with depression or loved ones that have depression and why they should come to Summit Medical Group for help. 

Dr. Starling:  I think the best thing you can do for depression is to be brave enough to realize that you might be dealing with it and to ask for help and to come see somebody. The worst thing that could happen will be that you come in for an assessment and you and your therapist decide it’s really not something to be concerned about and there really doesn’t need to be anything proactively that you do. It’s never going to hurt to come in and to talk about what you’re experiencing. And the best-case scenario is that you are able to identify something and you’re able to work on it proactively with a person who is experienced, who has treated it before, who has an effective research-based way of helping people through depression, which again, has been extremely effective, and you start to feel better and to start to learn some things that you can apply to your life to help you cope and manage with depression. 

Melanie:  Thank you so much. You’re listening to SMG Radio. For more information, you can go to summitmedicalgroup.com. That’s summitmedicalgroup.com. This is Melanie Cole. Thanks so much for listening.