Destigmatizing Depression

Let's talk about depression! My goal is to de-stigmatize mental health. Making the topics within mental health readily available, talking about them, and normalizing them. So that is the goal for this blog post.

The majority of Americans have experienced depressive symptoms or depression at some point in their lives, and with us, in me being in mental health, that's what I do. I see it day in and day out, but within this the whole world as a whole, it's so stigmatized that if you're having or experiencing depression, something's wrong, or you're lazy or snap out of it or get over it or things like that, which is just simply not the case most of the time. So basically, I want to spread awareness about depression, symptoms of depression, what to look for in loved ones that you might be suspecting that are depressed, how we treat depression. So as you guys know how Covid pandemic and isolation, the suicide rates have increased, and drug addiction has increased with the relapse rates. It's just unfortunate. It is the isolation, the lack of being able to see family, and the lack of being able to see friends.

The isolation and fear have caused people, who typically have some preexisting condition, to worsen their symptoms. So one thing I want to start with is the symptoms. Depression can be something as simple as weight loss or weight gain. It can also be that lack of sleep, increased sleep, or something as small as spiraling in your mood. So everybody can have depressive symptoms like sadness, anxiety, lack of ability to focus, memory loss, and lack of interest in doing things they used to do. Also, low energy, suicidal thoughts - and what kind of thoughts you have doesn't have to be an active plan. It can be like, "I don't care if my car drives off a cliff," or if I have a wreck or somebody hits me, and I die. That is what we would consider a passive suicidal thought.

Those are some generalized symptoms of depression. Typically, we need to see at least five of these experiences every day before diagnosing a major depressive episode. We need to look into this because everybody can experience some of these symptoms. The marker or point of difference would be when it affects daily life. That's when we say, okay, something is going on, and from there, we will start the appropriate treatment. I have often seen within my practice that patients suffer, and they get stuck in that grieving process and are not able to progress through the grieving process, which turns into depression.

Typically these symptoms are just discussed if you have been experiencing these for two weeks every day. From here, what are we going to do? The modes of treatment are what we usually look into first, and I am less restrictive as possible. No patient has ever been on medication unless we need to. Let's try therapy first. Let's see if we can talk this through, and part of this is discussing the onset if it is relevantly new to the patient. Then it's typically stress related to a situation that has caused this. That's typically what we see. But there are times when the patient has depression that it could be a genetic predisposition where it could be something as simple as, I've always felt depressed as a kid.

When we're looking at depression, we're looking at the neurotransmitters in your brain. Precisely the serotonin and dopamine levels, and when the serotonin and dopamine levels aren't correct that's when you start having symptoms. We can see some of these depressive symptoms when looking at the milder side of depression. Therapy typically works—exercise -when you go out and exercise. I know you've heard of the runners high because your body releases endorphins and chemicals and lifts your mood. We also have Seasonal Affective Disorder, which is when you experience depression in the winter months when there's not much light. Bright light therapy is excellent.

We try different things before providers say, "let me put you on some medicine." It's like your pancreas is not producing insulin and you have to get on insulin because you have diabetes. Your brain is not regulating the serotonin levels in your brain. If the therapy and exercise are not helping. Depending on the level of depression, patients do not have the desire or want to exercise. So we evaluate and decide that medicine is probably going to be our next choice because many times, if the depression is not treated, it just worsens, and it goes from, "I don't have any energy" to "Now I've gained 20lbs so now I have suicidal thoughts.

A good indicator is to look at your house and your car. How messy is it? Getting an overwhelming feeling is very common with depression. Often, patients say, I feel like I have £10,000 on my shoulders, and I can't get through this. That is a common side effect with depression. So it's hard to keep up with the daily tasks of life. All that to say, these are some symptoms, and these are things a loved one to whom you see these things happening, you see they're gaining weight. You know, they're isolating themselves. Isolation is immense with depression.

If you see a loved one or yourself isolated along with those depressive symptoms, talk to them about it, reach out to them, let them know you're there, and be an advocate for them. Often, patients don't have the desire or the will to get help, or sometimes they don't see it. As far as we talked about the symptoms and some of the triggers and stress, I like to give this analogy, if you have a trash can and keep throwing trash in that trash can, and you don't take the trash can out. It overflows, and it creates a big mess—the same thing with life. The stress happens, and life happens before you know it. Things pile up, and you feel like you’re drowning and completely overwhelmed. That's when I say therapy would be beneficial. There's a vast stigma related to treatment. People think that therapy is just you sitting in this chair and talking about how you feel. Treatment is being challenged and having someone you can trust, speak with, and relate to. Therapy is just like a doctor, sometimes, you have to figure out and find the right fit for you. Every therapist will be the right fit for someone. So therapy is key, most of my patients are strongly encouraged to be in therapy because it is very beneficial.

Even if you find yourself healthy emotionally, I still encourage therapy because it is so beneficial to be challenged emotionally and to be challenged in the core of why you're doing the things that you're doing and how you're feeling the way you're feeling, and how to grow in life. But especially when life is at an overwhelming point, that's when it's key. I've seen patients make full recovery, especially in conjunction with medications. I've also seen patients fully recover from depression especially dealing with a situation. As far as we talked about the treatment, we talked about therapy. We talked about exercise, phototherapy -the bright lights that you can do.

I love bright natural sunlight in my house, opening up the blinds because it makes me feel better. As I said, that's a form of treatment. But fourth is medication. With depression, we use antidepressants. There are different antidepressants, and we use different antidepressants for different things, depending on the patient's symptoms. There are plenty of other aspects. We have a plethora of different medications that we use, like selective serotonin, reuptake inhibitors, and more.

Antidepressants that's how we treat depression. If it's a lack of serotonin in your brain, it can be attributed to other chemical imbalances, and there could be other causes of depression, and we always look at other comorbidities that might be causing this through lab work. For example, I have to test your thyroid to ensure that your thyroid is not active, and I'm making sure that your vitamin D levels are okay. I guarantee that your vitamin B-12 levels are okay—even magnesium levels test. I even test for thyroid antibodies many times to make sure it's not Hashimoto's or that it often goes undiagnosed, which causes depressive symptoms. Another key is informing a correct diagnosis when dealing with depression and making sure it's not being caused by something else, even something as simple as botulism that changes the genetic makeup in your brain that can cause depression. Many different things can contribute to that, and it's our job as providers that we do the appropriate diagnostic exam to determine. I do genetic testing to test for the gene mutation to make sure that that's not going on. That is also another thing that can cause depression.

All these different causes and stresses in life can trigger depression, and so forms of treatment, like therapy, exercise, bright light therapy, and medications. It is okay to feel not okay sometimes, too, because it's life.

How does depression look in children?

Often, children can present with irritability, and it's finicky. And you have to get a good history, and it has to be a solid basis. I don't diagnose kids or adolescents with depression after only two weeks; I don't do that because children are going through hormonal changes. They're going through all the different changes, figuring out themselves in and of themselves. So with children's irritability and isolation, there are the two biggest things: 1) staying to themselves in their rooms, not wanting to socialize with their friends., not wanting to do the things they used to do like sports, "I don't want to play sports anymore" and 2) grades are starting to decline where they once worked.

Also, we have to know what's going on at school? I can't even begin to tell you how wrong bullying is—horrible, and people dismissed it growing up. Nowadays, kids take it to a different level. They have social media. Cyberbullying is bad. To answer the question: isolation, irritability, that irritability wants us to be consistently mountainous, discord with siblings, parents. Not all the time does major depression present with extreme sadness in adolescents, but that is a symptom of sadness, tearfulness, and an overall low mood.

What is PTSD?

PTSD is Post Traumatic Stress Disorder. Post-traumatic stress disorder is typically in response to a traumatic event happening in your life. We diagnose it as a stress disorder immediately following the event. If depression, anxiety, and all symptoms that begin after the traumatic event continue past a certain period, that's when PTSD is diagnosed. Things like abuse, physical, sexual, emotional, car accidents, just anything that's traumatic. (IMPORTANT NOTE: what's traumatic for me might not be traumatic for the next person, and something that I would say it's not traumatic might be very traumatic for someone else.)

If it's causing nightmares, flashbacks, and all these things, and we're looking at this as problematic, we need to look further.

Can depression be cured, or is it something you have to be treated for throughout your lifetime?

There's situational depression, and there's genetic predisposition. Genetic predisposition is why I've always felt depressed and anxious as a kid. I never really was happy, or there's a family history of depression and anxiety. Those are all precursors, and we're looking at a chemical predisposition—a genetic predisposition in the brain.

We're looking at medication for a lifetime. Situational depression most definitely can be cured once the stress resolves through therapy. You challenge yourself to get through whatever pressure it is, combined with medication to help you get through that time. Most patients can come off their medications.

Have you seen a depression increase in adolescents due to social media usage and screen time?

Absolutely, yes! The number one cause of death in Teens was suicide. According to research, it was very apparent that it was due to cyberbullying and just the overall bullying and access to social media that these kids are taking the extremes that they're getting bullied at school. However, they're being forced at home too because they're going home, and they're looking at kids teasing them over the phone or on social media like Instagram or Facebook and inappropriate pictures.

I've seen kids even go to the extreme of cropping their heads on nude pictures and sending them around. There has definitely been an increase, and I don't quote me on the suicide, but it was back in 2018 that it was the number one cause of death in teens. So very alarming.

What is the treatment for kids with depression?

Number one, most children are medication naïve, and obviously, somebody has not been on medication before, and this is their first time coming to me unless this is something severe. I don't want to start them with medicine.

With Children, the number one thing is going to be therapy. If their behavior during the treatment within the first month does not improve, we're looking at starting with medicines. Again, it depends on the severity. Suppose you have a child who's cutting themselves if they're having suicidal thoughts if they were starting medication that day, and we're going to start pretty quick. Cutting is their negative way of coping, and kids are doing it, and even adults do it, but it's simply a negative form of coping.

Again, as in psychiatry, suicide or anything like that ever happens. I do a suicide risk assessment.

Does this child need to be hospitalized to keep them safe?

Typically, if they don't have a plan and they don't have other risk factors in place, then you know, we'll try to manage outpatient as much as possible. So starting therapy, they're not progressing because sometimes, with the mood being so low in therapy, they can't progress as they should. So therapy first, medication second, and there are also all kinds of alternative medications that aren't just antidepressants that I use, something as simple as melatonin for sleep, even magnesium for sleep, sit assisting for anxiety with hair pulling or picking their skin. It can be supplements and stuff as well.

Do you have to change medication after?

You have been taking it a while. That is what we call drug intolerance. So drug tolerance can happen with medication. I have patients who have done great on medication. I haven't had to change. Drug tolerance is entirely dependent upon the individual. Whether they become tolerant to it or not, how they metabolize medication is very common.

Once the medication reaches the therapeutic threshold and there's no more increasing and a safe dose, I'll add on medication we call treatment-resistant depression. So we'll add on to it to help patients. So yes, sometimes we do have to change.

How do you convince someone that it's depression?

The report that you have with the patient is the key. If you have a good connection with the individual and then explain the symptoms of depression, you can even show them this blog. That's something that you can do.

But the majority of patients have to want to go to the doctor. You can't make them unless they're suicidal or they're homicidal. They can be admitted because they cannot keep themselves safe or can keep other people safe.

If you're on medication for many years, can your body get used to it, and your dosage has to be increased?

Yes, it's called drug tolerance. There can be times when you have to switch medications or add on another medication in conjunction with other medicines.