Speaker: 00:03
YNA is a podcast that focuses on mental health and other aspects relating to what goes on inside a person's head. We are by no means professionals in this field and only aim to make these conversations about mental health easier for the listeners. Nothing we say or talk about is professional advice unless explicitly mentioned. If you seek professional advice or experience symptoms of an actual mental health disorder, please contact a professional or visit your closest center for behavioral health. You are not alone.
Speaker 2: 00:30
Welcome back to You Are Not Alone. We are here with Dr. Nelson. We this episode is on depression. So before we get started, Dr. Nelson, if you'd give us your credentials, just tell us a little bit about how long you've been in the industry and your experience.
Speaker 1: 00:48
Sure. I am a counselor educator and supervisor. So I have a doctorate in counselor education and supervision. I train mental health professionals academically, and then I also coach and mentor them. And I have a private practice with two office locations in Rockford and also in Lake in the Hills, Illinois. I've been a people helper for about 20 years, but in private practice since about 2011.
Speaker 2: 01:12
So this one kind of hits home for me. This episode is extremely important. I really wanted to not just be able to speak about it, but be able to have all of the information to make sure that the people who are feeling depressed are able to get that the help that they need. So we can just start it off with what is depression?
Speaker 1: 01:33
Depression is not how a lot of times people talk about it, like, hey, I'm depressed because the weather's rainy today, that kind of a thing. Depression is a mood, but it's unusually, it's remarkably low. And so it's not just what pop culture kind of calls depression. Um, it's characterized one of the big things that we look for is a sense of hopelessness. And so it feels kind of like a rut that somebody gets into, and then we feel trapped and like there's no way out. So it's a it's a deep, dark, depressed mood.
Speaker 2: 02:05
And it seems like what I've heard and how to understand this is like one of the disorders that many people struggle with. And it's something that a lot of people don't seem to be able to get a grasp onto, or they can't find the difference between what is being sad and what is being depressed like. And especially for people who do go with it and have friends who don't have depression. And if a friend does reach out and say that they're depressed, that they don't know understand how to talk to somebody who maybe they're just not feeling the way that they should be.
Speaker 1: 02:45
And that's characterized by an unusually low mood. But how we define it in mental health circles is failure to fulfill major role obligations. So that means like I'm I'm not doing schoolwork, so I'm in danger of getting kicked out of school, or I'm I'm too depressed to get up and get out of bed, so I might lose my job, or it affects my family relationships. So it affects my ability to function on a day-to-day basis. It's not just a normal I feel kind of down because of circumstances or something. This is deeper than that. And the symptoms are pretty much most of the day, nearly every day.
Speaker 2: 03:24
Okay. And so if someone is feeling depressed, what are some things that they do go through in their everyday lives?
Speaker 1: 03:32
They can feel sad, tearful, empty, and primarily hopeless. That's one of the things that we really look for as a diagnostic symptom. They can also, which is kind of interesting, be irritable, angry, frustrated. They tend to have a loss of interest in pleasurable activities. So that could include uh things they do for fun, hobbies, sports, uh, including sex. It can affect their ability to sleep. So either they sleep too much or not enough. Typically they're going to be tired and have a lack of energy so that even small things seem overwhelming. And the way that I describe that to clients sometimes is it's it's like you're trying to get through life and you're waiting through like molasses, this thick, syrupy stuff, and trying to move forward. So even small things become overwhelming, can have a reduced appetite and weight loss, or the opposite, increased cravings and food and uh corresponding weight gain. So, in essence, I binge kind of or I uh restrict my eating. I can also, which is another interesting symptom, experience anxiety, agitation, or restlessness. So depression can have anxiety kind of symptoms that go along with it. I might be uh find it difficult to think. I might slow down in terms of my speech, my body moments, my uh thinking. And a bigger one is feelings of worthlessness or guilt. Now, typically, too, what clients will do is they'll fixate on past failures and start to blame themselves. So there's actually a corresponding characteristic of people that are depressed tend to be very self-critical and self-blaming. They can have trouble thinking, concentrating, making decisions, and or remembering things. And they might have recurring thoughts about death, suicidal thoughts, suicidal attempts, or suicide itself. And lastly, they can have unexplained physical symptoms that like uh somatic symptoms like back pain, headaches, those kinds of things. But these symptoms are not just the dips that everybody experiences, these are where the mood goes way too low and it kind of stays there and it makes it hard for people to function in life.
Speaker 2: 05:49
So, would you say that's the difference between the biggest question of I'm feeling sad one day and I'm feeling depressed?
Speaker 1: 05:56
Yes. It's it's a degree of severity and longevity. So the when someone is depressed, they typically don't get better without counseling andor medication. And it's when they are not functioning in life, like at home, at work, at school, they're just not able to keep up. They they have difficulty getting out of bed or doing things that used to be easy. And so that's when we really want people to seek help from a qualified mental health professional andor their medical professionals.
Speaker 2: 06:27
I believe the hardest thing with depression really is um having other people understand what depression is like or understanding if someone is depressed. How do I, as somebody that if I didn't have depression and I was speaking to a friend who did have depression, how do I tell whether they are feeling depressed or not? Or how do I even speak to them without making them maybe even feel more depressed?
Speaker 1: 06:55
Well, that's a good question. Because even when someone might have suicidal ideation, let me just address that for a second. Ideation is psychobabble for I have thoughts about self-harm, like suicide. Um, that as a mental health professional isn't alarming in and of itself because most people at one point or another in life, if life just hits them again one too many times, they can feel down or like it's it's painful. I don't want to do this anymore. That doesn't mean that I'm actually a risk to myself. It just means that life kind of sucks right now and I don't want to deal with it. Intent is a whole nother issue. So when we screen someone for suicide risk, we look at ideation, that's the thoughts. In and of itself, that's not that big of a deal. And most people experience that at one point or another. Intent is I intend to not be here, I intend to kill myself. That's a whole nother level. And that's kind of a red alert kind of a thing. When someone has intent, we need to make sure that they're safe. But then we also look for things like do they have a plan? Do they have means? So there's a whole process that we use to screen for that. But um, suicidal ideation by itself isn't that big of a deal. It's when the mood gets way too down, people have a sense of helplessness and hopelessness, like I can't get out of this. There's nothing I can do to make things better. And that really, I'm gonna kind of classify that as a delusion, but it feels real to the person at that time. And typically, from what I've seen in the research, it has to do with uh low serotonin levels. And so one of the medications that uh a physician can prescribe is called a selective serotonin reuptake inhibitor. It has minimal side effects, it's not habit forming, it's not dangerous, but basically it functions like a cork or a plug in the bathtub. When you when you put the stopper in, the bathtub level, the water raises up. And that's what the serotonin reuptake inhibitor does, is it plugs that part so that the serotonin stays in the brain longer, and that can really help people to get, I call it get their oomph back. And combined with counseling, that's a very effective method of treating depression. But depression is the mood is too low and it's affecting someone's ability to function in life.
Speaker 2: 09:05
With the ideation of if someone did explain to you that they did want to kill themselves, and there it because there is a separation between the ideation of someone actually plan on doing it and having the forces to do it, then someone who just keeps saying that they're gonna do it and it's not doesn't, they just keep reiterating things that don't really are are not really a plan. How do I, as a friend, if my friend does say he wants to kill himself, how do I speak to him or how do I tell that, hey, this is a plan of action, this is gonna happen, this is gonna happen if I don't stop him, or this is just him just going through a bad day and just got punched too many times?
Speaker 1: 09:46
One of the things that sometimes loved ones' family members, friends are reluctant to talk about it with the person for fear of maybe putting them over the edge or making it worse. But what we find is that it's okay to address it. In fact, some mental health professionals, when it comes to suicide risk assessment, they're a little shy to do that because it's it can be scary for novice counselors, for new counselors, family members too, it can be scary for them to address or loved ones. So one of the big things is to talk to that person, express your concerns, listen to what they have to say, and um hopefully read between the lines a little bit and tease out where they're really at. Because if they are higher risk, that's a big deal. And we need to assure that they're gonna be safe. So then that would usually involve like uh talking to family members, um, maybe even taking them to the hospital if it seems like uh they're higher risk. One of the things maybe the family or friends or loved ones could do is kind of trust your gut. If something creeps you out deep down, you're like, ah, something's just not right. I'm worried. That probably is a good indicator that you need to take some action to help your friend or family member get some help.
Speaker 2: 10:58
I've I've been into the position where I have been telling myself in a situation where I've had a depressive episode. It's I feel as if it's very difficult to sometimes talk about the things just because they're so heavy on me and the ideas and the feelings also, I feel like if I do explain them to somebody else that maybe I am hurting them in the process, how would you respond to somebody who is feeling something like that and is having a hard time opening up and talking about what they want to talk about?
Speaker 1: 11:31
That's actually a great question. There's a uh I'm gonna answer it with a proverb that used to uh be in my mom's bathroom of all places. Um, but it says, uh, a shared burden is half a burden and a shared joy is double joy. So sometimes what happens is when we get into uh a depressed state is we don't want to be a burden, and that can actually increase my risk. But uh the thing is, uh a shared burden is half a burden. And one of the things that I do is a tool that I like is called the flip reality test. And so what I do is I imagine a friend or loved one in the exact same circumstance, and I ask myself, what would I think or tell my friend? So if I'm depressed and I don't want to be a burden to anybody, so I'm keeping it in, I'm actually making the symptoms worse, not better. But if it was my friend that was depressed, I'd probably say, Hey, you know, help me understand, tell me about it. I want to be there for you. Well, I need to turn that around on myself and take my own advice. And there's a there's that's the delusional component to depression where um I feel like nobody can handle it. I don't want to be a burden to my friends or family. But if I care about them, I would want them to tell me. So they would probably want me to tell them. In essence, it's kind of a balancing thing too. Most of us are more self-critical of ourselves than we would be a friend. And we need to treat ourselves with the same care and love and concern that we would a friend.
Speaker 2: 12:57
That's the hardest is treating yourself with the love and care that you do with your friends because speaking those kind of words and giving yourself positive recommendations, I believe, is what I found to be really helpful in the um episodes that I've ever had. It's it's just it feels sometimes like I've been punched way too hard and I'm on the ground, and I just feel like I'm keep getting punched. How do I punch back?
Speaker 1: 13:23
Social support, probably number one. So uh they did a study years and years ago, and I never forgot once I read that one, where they had people stand in buckets of ice water, and I don't remember the exact numbers, but I think the average person could last about three minutes and they jump out. When they did it in pairs, they went six minutes. So, what's significant about that is uh social support is vital for us to do better in life. And so I need to have friends and family, and that's actually a protective factor for depression and anxiety is connection with other people, which goes back to a shared burden is half a burden. So most people feel better when they talk through something, even if they don't get great advice or something like that. It's just more like getting it out there talking through it can help. But when someone's deeply depressed, we probably need to get a medication on board to get the serotonin levels back up, and then they can snap out of it and get the help they need. So for severe depression, usually medication is going to be best practice combined with counseling. But for many people, for depression and anxiety, counseling by itself is quite effective without medication. But when someone can't function, they're having difficulty just doing the daily things that they need to do and that they used to be able to do, that's usually when we recommend a medication assessment.
Speaker 2: 14:42
Do depression and anxiety play hand in hand with how people react and emotionally in situations? I feel as if sometimes the depression can come in, but then the anxiety comes right behind it and smacks even harder. Um, so does it actually play hand in hand with other disorders as well? Or does it just try to play by itself?
Speaker 1: 15:05
Another good question. Uh, anxiety and depression can actually be like uh hand in glove or your fingers crossed, kind of like uh like twins almost. And so, for example, I could be depressed and then I'm not doing the things that I need to do. I might be not going to work, I might not be paying my bills, then I could get into financial trouble. Now I'm getting anxious. So, in that scenario, the depression leads to like not taking action on doing the things that I need to do, and then bad things happen. So suddenly I become anxious. Similarly, if I'm anxious, then um I can avoid things that need to be done, and high levels of anxiety are not sustainable. And so what can happen is I can just kind of crash into a depression. So they can ping pong back and forth, and that's another reason why I'm a fan of the selective serotonin reuptake inhibitors. Again, non-habit forming, uh, they have fairly minimal side effects for most people, and they treat both anxiety and depression. So it kind of knocks both out. Not everybody needs medication. Uh, again, it's going to go back to are they able to function and how severe the uh the lack of function is. But uh selective serotonin or reuptake inhibitors combined with counseling are very effective for both anxiety and depression.
Speaker 2: 16:28
If I'm I think what people are trying to get a hold of is that crawl, that boundary or that line that we have set. It's where you you pass it and you're like, I'm deeply depressed compared to just being depressed. What is that boundary? Is it many days of me not wanting to wake up, or is it many feelings of different symptoms? Or how do I know that I'm actually deeply depressed and just actually just depressed?
Speaker 1: 16:56
It's going to be when life is getting becoming unmanageable. So failure tick to technically in the psychobabel language, it's failure to fulfill major role obligations. So I'm I'm not working like I used to, I'm not going to school like I used to. My family relationships are falling apart. Life is just not working. And it's just because I'm too down, everything is a chore, and everything that used to be pretty normal and fairly easy to do is now a burden. So it's really where life becomes unmanageable. That's going to be the symptom that you're going to look for for major depressive disorder. Now, again, normal ups and downs are a whole different thing. Sometimes there's uh seasonal changes or the economy or whatever else can get to me and I can feel kind of down, but I'm functioning, I'm getting through life, I'm doing what I need to do. The difference from a mental health perspective for depression is I'm not. I'm not getting through life, I'm not doing what I need to do. And that's when we need to someone to seek help from a qualified mental health professional and/or medical professional.
Speaker 2: 18:05
Holland does, I mean, depression, I feel as if never goes away and it doesn't ever just completely disappear one day, and you're just like, I'm now cured from depression. But I think that with depression, you do it comes in waves, and and you can not control the amount of like how hard the punch is, but how how you can it control your emotions? And so, do you believe that depression can just simply go away, or does it or can I subside it and could continue my life and it can just come back in episodes?
Speaker 1: 18:45
That's that's kind of an intriguing question. I I would have to say it kind of depends. So, on the one hand, sometimes people actually just get better with time, but it's if life is challenging, not so much. It makes it harder. So some of it is uh nature and some of it's nurture. So there's can be a biological predisposition to anxiety andor depression, but then there's life, there's circumstances, there's uh economies, there's breakups, there's all kinds of different things that can kind of kick someone in the solar plexus and have them go down on the mat. But one of the intriguing things about depression that I've found over the years is that more often than not, it's actually repressed emotion. So I have a saying that if we self-deny, repress, or ignore our feelings, it comes out in anxiety, depression, and or compulsion. So when I help somebody to be able to identify their feelings, their emotions, and talk about them and work through them, lo and behold, anxiety and depression get better. In extreme cases, though, then we need a medication on board just because it's uh it's been going on too long to where the serotonin is depleted in the brain. But uh depression is very manageable. It does tend to come in waves and different levels of severity based on circumstances and how I'm dealing with it. There was a guy that was an ancient Greek guy called Epictetus, and he said something very profound back in ancient Greece. He said, people are not upset by things, but the view they take of them. So one of my sayings is sometimes life is just hard, but I can make it a lot harder, almost infinitely harder, by what I tell myself about it and how I view it. So it's important that I kind of have my head screwed on straight. And that's where I go back to the flip reality test. So I need to be talking sense to myself like I would a friend. So I always use that day in, day out. What would I think or tell a friend in the same circumstance? Then I swing it around on myself and I tell myself that. That helps me make sure that I'm seeing things accurately and my perspective is in the ballpark of, you know, where it is, where it needs to be. And that helps me to navigate things without falling into a deep depression. But if I am super self-critical and I keep telling myself I'm doomed, I'm hopeless, that kind of a stuff, then that's going to make it infinitely worse. And then that can help to precipitate a major depressive episode.
Speaker 2: 21:08
So affirmations are extremely important, clearly, especially on how you speak to yourself, because how you speak to yourself uh plays right back to how you're gonna feel. Are there any other types of things I could do when if if I'm wake up and I just feel at my worst and the positive affirmations are not helping? Because I know people get help from different ways and they get better in different ways. Do you have any other recommendations that maybe not medication, not counseling, and not the affirmations, but anything else that could help people that uh have depression and are getting their butt kicked?
Speaker 1: 21:46
Sure. It's best practices is increase the frequency of pleasurable activities. The problem is when I'm depressed, I don't want to do anything. Uh, even if it was something that was fun, like a hobby, a sport, uh playing video games, whatever it is. I don't want to do it. But if I can get moving, if I can get going, uh, and one of the easier ways to do that is leverage leverage social support. So like call somebody, tell them I'm having a hard time, help them to help me to get out and get moving, and or take care of stuff. Like sometimes I just need to chip away at things like pay my bills, or you know, if I got behind on my bills, go ahead and write those checks, pay them, uh, or whatever else I need to do to make life better. The flip helps me to determine that as well. Because I would tell my friend, you need to do this, you need to not do that. If I take my own advice, lo and behold, life tends to get better. Social support, increasing the frequency of pleasurable activities. Um, interestingly enough, too, one of uh the things that we do in our practices called EMDR, eye movement desensitization, reprocessing. There are EMDR-based techniques that can actually change the way neurons fire in the brain and can help take an affirmation or more accurate statement of truth and really make neurons fire around it to help me to kind of experience it rather than just tell myself something. So it's kind of like cognitive behavioral therapy and on steroids, in a sense, it helps my neurons to fire around those more accurate, adaptive ways of thinking and viewing things. So uh EMDR can also be helpful.
Speaker 2: 23:19
And so the last question to wrap it up. Again, mental health is a stigma. We don't really like to talk about things, we don't really like to explain how we feel. And a lot of the times um there's been people in your life that you've explained something to and they just looked at you and didn't really understand or didn't really try to help either. But could you explain to somebody who has depression that this is normal, that people do go through this, that it's okay to be feeling the way you're feeling, that things do get better.
Speaker 1: 23:50
Absolutely. I I can't tell you how many clients that I've had were actively suicidal. I don't mean they just they had ideation. I mean that they had attempted or they were high risk. And with counseling andor medication or the combination thereof, uh, they get their lives back. And I can't tell you how many people have come back and said I was hopeless. I didn't believe that it would work, the counseling that is. I didn't think anything would work. And um you you helped me to keep going. And by normalizing things and dealing with the things that I needed to, I got my life back. And now they're very happy that they didn't do anything unwise or foolish, like hurt themselves. Now, from a counseling perspective, that's stressful for us as mental health professionals because we care about our clients and and we have to walk uh a fine line there to assure for safety and then also to help people to learn and to grow. So, yes, depression, major depressive disorder is very treatable with counseling andor medication or both. And I cannot tell you how many people have gotten their lives back. And that's one of the reasons why I really love doing what I'm doing.
Speaker 2: 25:05
That's a great way to end this, is just to tell anybody who's ever felt the weight that you're feeling and you're depressed, sad, not just not you, that it's okay. There's people out there who have come back, who have clearly shown that they can fight this. And there's people that will fight this, and you are one of the people that can fight this. If you're listening to this and you're dealing with these kind of emotions, you can fight this, you can get through this. Please, please, please, please always remember you are not alone in this fight. I'm gonna help you get through it, figure it out. I hope you have a great rest of your day, and thank you for listening.