Latest / The Dr. Psych Mom Show with clinical psychologist Dr. Samantha Rodman Whiten / When Your Depression Won't Go Away

Transcript

When Your Depression Won't Go Away · The Dr. Psych Mom Show with clinical psychologist Dr. Samantha Rodman Whiten

• 0:05
  Hi guys, welcome to the Doctor Psych Mom show.
• 0:09
  Today I'm going to talk about treatment resistant depression,
• 0:13
  which many of my clients have experienced.
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  I experienced that myself. Um, so treatment resistant
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  depression is like a fancy way of saying you're one of the many
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  people that don't respond to medication easily, which is like
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  so many people because side effects have, you know, make
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  things hard for you. You're sensitive.
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  You end up with sexual side effects or weight gain or
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  fatigue, or you end up feeling even worse.
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  You go into a manic phase or whatever the hell, or your
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  stomach hurts. You can't sleep.
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  A million different side effects.
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  If you've been here, you know what I'm talking about.
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  And therapy only works so much. There's a lot of biological
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  genetic component. So while I'm a huge proponent of
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  therapy like, the best case scenario is a.
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  Holistic approach where, yeah, you're working on making your
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  life better and identifying and getting out of stuck places in
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  your thinking due to the depression and other issues such
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  as your family of origin issues, your marriage, whatever.
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  But there are also other ways to deal with depression, because
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  depression can feel extremely hopeless.
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  It can. Feel like everything that you
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  try doesn't work. And you know, many of us have
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  tried many medications that didn't work.
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  Sometimes they do, sometimes they stop, sometimes they do and
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  then they stop. Sometimes you go off it for
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  another reason, like you get pregnant or something.
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  Or you're having side effects and then you go back on the same
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  thing that worked or mostly worked, and then it doesn't work
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  anymore. So there's like a lot of
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  different reasons. That people get really fed up
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  with medications. Now of course medications work
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  for many and try it. Like try a medication, Go speak
• 2:01
  with a psychiatrist and try medications.
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  You know, if they work. For you, then you're in the
• 2:07
  lucky lucky percent, you know. But then this is for other
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  people where that doesn't work. So what are some other things
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  that you can do when you're? Depressed besides therapy and
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  medication. Well, the first one.
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  Applies to a lot of women. In particular, if you have
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  seasonal affective depression, many.
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  People swear by a light box and this is just like a big light
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  and you. And and there's also lights that
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  can turn on to simulate Dawn Dawn simulators.
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  And it basically tricks your body into thinking that it's
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  warm weather and it's longer days when it's not.
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  So you could find a lot of interesting information about
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  light boxes on the Internet and. Don't.
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  You know, don't spend like $1,000,000 without looking at
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  like, reviews of something because some of these are a
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  couple 100 bucks. But a lot of people swear by
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  these because they help with seasonal affective depression,
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  which particularly is relevant for many women.
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  The next one is exercise. So this sucks because the last
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  thing you feel like doing when you're depressed is exercising.
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  But a lot of research shows that exercise can help depression and
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  particularly strenuous exercise can.
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  Really help which you know, kind of.
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  Sucks for those of us who feel too tired to do that when we're
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  depressed, but even moderate. Exercise can help.
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  It also makes you feel better about yourself for just fucking
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  going, you know and like. Pushing through, so even if your
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  actual exercise routine is nothing to write.
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  Home about the fact that you got to the gym when you feel like
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  garbage is something to be proud of.
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  Hormones. The next one is something that I
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  talk about a lot. Are massively implicated in
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  depression low. T can make a man feel depressed,
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  tired, and just not like himself.
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  No libido, No ability to exercise.
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  No positivity, No even no. Like competitive drive, nothing.
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  And testosterone can be big for women too.
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  I've talked about this. Testosterone can is implicated
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  in both male and female libido and mood.
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  So a functional medicine or integrative Dr. can really help
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  you figure this stuff out, whether it's testosterone or for
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  women, Estrogen and progesterone both have large impact on mood.
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  Sometimes going off birth control can help mood.
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  That's happened for a lot of my clients.
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  They have like no sex drive and they're kind of depressed all
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  the time. Then they go off birth control.
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  And then there's other clients who have PMDD, premenstrual
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  dysphoric disorder, where you feel terribly depressed right
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  before your period or for a week or even 2 weeks before your
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  period, and they feel a lot better on birth control.
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  So I'm not a medical doctor. You got to go talk to one,
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  though, You know, hopefully a psychiatrist who specializes in
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  these matters and a functional medicine Doctor Who thinks
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  outside the box, right? Google functional Medicine
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  doctor. It just means somebody more
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  holistic and that that uses different approaches.
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  You know that that looks at the whole person versus just
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  prescribing you a medication. The next one is TMS Transcranial
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  Magnetic. So you sit in the I've done
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  this. You sit in a chair and this big
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  thing with a magnet, a helmet type of thing, circles around
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  your head and. A lot of people say makes them
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  feel better. I think it made me feel better
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  too, but as is the case with many people at the same time, I
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  was pursuing all the. You know, at that point it was
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  hormonal stuff, I think. So I'm not exactly sure what
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  made me feel better. Then it hits spring, so I felt
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  better anyway. So you know, you never know.
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  Again. All of these things are things
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  that have had empirical support in the literature that make
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  people feel better. Meditation.
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  Meditation. You can read the book wherever
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  you go. There you are.
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  I'll link to that. There are many, many studies.
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  Showing that meditation helps with depression.
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  So mindfulness meditation, yoga, any form of meditation can slow
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  down your brain and really promote a sense of well-being,
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  calmness, acceptance, and so forth.
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  Now dietary changes are also big.
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  You know if some people are very responsive to what they eat, if
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  you're a highly sensitive person, you probably are also.
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  So if you're drinking too much caffeine, if you have too much
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  sugar and processed foods in your in your diet, and those
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  don't make you feel good. You know, I mean you, you know,
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  if this is you or not by by this point in your life probably, you
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  know, I mean, there's a lot of people who get headaches from
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  eating like shit and who feel depressed down and just blah
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  when they do not have enough healthy foods in their diet or
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  when they're not making time to eat regularly.
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  So diet is a big one and you can work with a nutritionist if you
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  really think that this is kind of an out of control area for
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  you, you know? The next one, changing your
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  schedule. So I mean, why make things worse
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  when you're depressed? I mean, why?
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  If you are somebody who's tired in the evening but somehow like
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  you've decided to, you know, have your clients in the
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  evening, for example. If you're like in my profession,
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  stop. Try to work with your natural
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  rhythms, your natural circadian rhythm.
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  If you if you, for example, can only exercise in the morning
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  because that's when you have your energy, but then somehow
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  you never prioritize you getting out and doing that, and instead
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  you do everything for everybody else all morning, then why
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  you're in the long run, you're not helping yourself or your
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  family. You need to prioritize a type of
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  schedule that works for you. Another one is massage.
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  Massage has been shown to have real positive effects on mood.
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  Some people do not like professional massage.
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  I don't like professional massage.
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  Maybe your partner can do it. I'm lucky my partner does it.
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  Your partner will do it if it puts you in a good mood usually.
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  If they don't, you can refer back to like all of my one
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  zillion articles on like why they shouldn't be selfish.
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  But anyhow, massage and touch in general can be very helpful for
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  people with depression if that is their love language.
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  This has been shown, I mean this soothes all mammals positive
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  touch. That's why they you know, even
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  in the in the NICU you know they want babies to to have touch
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  that helps them grow. Next, scheduling positive things
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  in your life. So particularly for women who
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  suffer from atypical depression more commonly, which isn't
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  atypical at all but is it means a type of depression more common
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  in women and more common with bipolar depression, where you
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  feel very fatigued, you overeat, you oversleep your rejection
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  sensitive. And you respond to positive
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  events in your life with an uptick in your mood.
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  So you have a temporary uptick in response to positive events.
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  It goes back down. But unlike melancholic
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  depression, where you're just kind of sitting there staring at
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  the wall, in a typical depression, again more common in
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  women, your mood does rise temporarily in response to
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  positive events. So guess what?
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  You can use this knowledge and schedule yourself some positive
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  events. So, like seeing friends, even if
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  you think that you won't want to.
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  Or getting yourself a manicure, pedicure.
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  Or going out to eat, if that's what you like to do.
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  Or buying yourself a book on Kindle instead of waiting for
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  five years to get it on hold from the library.
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  You know, whatever a positive thing is that could increase
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  your mood temporarily. Now, on a deeper level, figuring
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  out a new purpose in life. Viktor Frankel, Man's Search for
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  Meaning The father of existential psychotherapy talks
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  about the importance of finding meaning in your life.
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  You cannot always make yourself happy, you know.
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  He wrote that book in notes when he was in Auschwitz, so you know
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  he wasn't super happy. But he found meaning in his life
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  and if you honestly are just wired to be depressed.
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  This does not have to be the death sentence that you think it
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  is. You can still lead a meaningful
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  life alongside your depression if you are somebody who
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  struggles with depression. But you still get up and make a
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  difference, whether that's in your family's life or in other
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  people's lives. Helping, volunteering.
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  Anything you can feel proud of that you can feel prouder than
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  you would be able to if you just felt awesome all day And we're
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  bounding around with limitless energy and.
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  Everything was easy. When everything is not easy,
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  then you really, really can be proud of yourself for doing it
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  anyway. So if you feel like shit but you
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  still play a board game with your kid, well, that's really,
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  really good. You know what?
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  And even if you're so depressed that you're barely present when
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  you're doing it. You know you did it.
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  Take a picture of it. It'll come up in your Facebook
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  memories from last year, when it's next year.
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  And you could say, you know what?
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  Even though I felt like such trash, I still tried to be a
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  good parent. Same with finding meaning in
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  your work, or in your marriage. Or as a friend, sibling, adult,
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  child, whatever it is. So listen.
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  Every day, new things come out on the market, new types of
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  medication. I mean, I just read this book.
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  I could link you to it. So interesting by Deuce.
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  You remember Deuce? She's a mommy Blogger, one of
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  the major mommy bloggers. Heather something.
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  I'll link to it. And she just, like, wrote this
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  memoir about she had. Terrible, debilitating, suicidal
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  depression. And now there she was in a
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  research study where they took her down into basically a coma
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  for 15 minutes, 10 times over the course of many months, and
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  it resolved her intractable depression.
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  It's similar to ECT, which is, you know, the electroshock
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  therapy, but it didn't lead to memory loss.
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  So like, they haven't come out with this for mainstream people
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  yet, but they will. It's only a matter of time.
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  Look what they're using now, ketamine.
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  They're using all sorts of different things to, you know,
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  make people feel better that we didn't even know about it.
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  Science marches inexorably forward, and that is something
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  to to really count on. It's hard to think I will never
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  feel better, but if you can get outside yourself for a second,
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  there's two ways to reframe that.
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  That can be comforting. A You don't have to feel better
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  to be meaningful member of society and to be somebody that
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  does good things that you are proud of.
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  That doesn't have to happen with you having a good mood.
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  It doesn't have to be nice, but it doesn't have to, right?
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  You could still lead a very meaningful life.
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  And secondly, practically speaking, every day scientists
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  are working on other ways to cure depression.
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  This is, I mean even just for the money alone.
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  I mean shit, this is the cash cow to find an antidepressant or
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  some something that actually works.
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  Money is a tremendous motivator. So the tides of change will
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  press on and on and within a year, two years, there may be
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  the thing come that that that helps you.
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  You know, you never know. So don't let yourself get
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  hopeless. That's very dangerous.
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  Do not let yourself get hopeless.
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  Now in if you do find yourself feeling hopeless about your
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  depression, you can also work on it in therapy.
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  That very hopeless feeling. Because, as I said, there are.
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  Practical reasons that you don't have to be hopeless.
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  There could be something that comes out tomorrow that helps
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  you and cures your depression, right?
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  I mean this is like like diabetics all used to die before
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  there was insulin, then they came up with insulin, but the
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  day before they came up with insulin, nobody knew it was
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  going to happen. That could be what's happening
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  today and tomorrow, could be when the medication or the the,
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  the whatever protocol is that that's going to work for you.
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  Is made available to the public. Now, if you ever do have the
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  opportunity to be in any sort of drug study, you know, like this
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  woman was with this study of these things, that's also
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  something that many people try that gives them some kind of
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  hope and also makes them feel good about, you know, being part
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  of science. I've never had the opportunity
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  to do that. But I mean it is something that
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  some of my clients have sometimes done.
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  You know, so that is also an option.
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  You could see what sorts of treatment studies are going on
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  near you and clinical trials. There are always new things
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  coming out. There's also, you know, your
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  life changes something that is a stage that's really, really
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  hard. Like, for example, postpartum
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  depression. There are some people, many
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  people whose postpartum depression just passes.
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  It just goes away. One day they look up and they
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  feel better, and then they look back and they realize it was
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  postpartum depression. And it's the same thing when
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  you're dealing with another difficult situation, like
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  raising teenagers, or the death of a parent, or a spouse being
• 15:46
  ill or divorce. These situations can plunge you
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  into what feels like a depression that will never go
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  away. But it does.
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  It can go away because the situation changes.
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  So that would be more situational depression, which is
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  of course going to feel worse when it's against a backdrop of
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  genetic depression. You know, if your parents tended
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  toward depression, if they're just real miserable, have, you
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  know, frowns on all the time, then they weren't diagnosed.
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  But, you know, it's likely. And so then you're fighting
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  against and then you're parented by them too, right?
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  I mean, most of us are not adopted.
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  And if you're adopted, you got other problems, right?
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  That could lead to depression too.
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  So nobody's immune, but in the people who are raised by parents
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  who are genetically depressed. Who?
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  Who? Parents who are depressed.
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  Not only you have the genetic part, but then you're raised by
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  the same people. So on the nature end and the
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  nurture end, you were raised to be depressed.
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  So you deserve to try. This isn't your fault.
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  How could it be otherwise than to be depressed when you have
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  depressed parents who raised you right.
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  So you deserve to give yourself all the options that you would
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  give your kid if your kid was depressed.
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  You should be seeing a psychiatrist.
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  You should be seeing a functional medicine doctor.
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  You should be seeing a therapist.
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  You should be reading new things.
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  You should be Googling every so often about medications or
• 17:07
  treatments for depression. Never give up hope and you can
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  live a very meaningful life. Even if you feel like shit, you
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  will not always feel like shit. Very few people never go into
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  remission. Depression is very cyclical.
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  It doesn't feel like it when you're in it.
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  It feels like you'll never get out of it.
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  I know that. But it isn't.
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  It is not the case. It's really not the case.
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  And if you can live a life that you're proud of despite being
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  depressed, then you are really, really doing something
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  meaningful, something you could be proud of.
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  And when your children are old enough and you say I was so
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  depressed that whole time, but I tried very, very hard then.
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  They're going to, they're going to be proud of you too.
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  And they're going to be appreciative that you did not
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  just give up right and just lay in bed.
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  So if you are currently, by the way, just laying in bed, then
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  this is no referendum on you. Things have gotten bad for you.
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  So this is the point at which you would call a psychiatrist, a
• 18:14
  therapist, and all of the things that I say, right?
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  There there are like emergency ways out of this to some people
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  go inpatient, right? So they have they they get into
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  a hospital or almost a rehab setting where where they kind of
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  can go in for like a week or a month and deal with things.
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  But usually most of the people I deal with them in private
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  practice, people don't get to that point.
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  There's nothing wrong with getting to that point.
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  If this is you, then you would talk to your psychiatrist or
• 18:43
  your therapist about what's an inpatient option near you,
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  right? So this this podcast was meant
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  to be kind of a practical look at what it is like to have
• 18:55
  treatment resistant depression and all of the options that are
• 18:58
  open to even though it. Doesn't feel like it at the
• 19:01
  time. I know that, but don't get mired
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  in hopelessness. That that's the worst you can
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  lead a meaningful life where you are still always trying to work
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  on your depression okay. So that's my public service
• 19:17
  announcement for today and please subscribe and write in
• 19:22
  with topic ideas and I hope everybody has a great day.
• 19:27
  Bye, bye.