Latest / Millennial Mental Health Channel / Depression Part II

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Depression Part II · Millennial Mental Health Channel

0:00
A lot of times when I talked to our listeners or people who are just
0:02
getting into the show, they always tell me I started at episode one and
0:07
I'm walking my way up. I know it makes me cringe too, and
0:10
I'm like, don't do that, Like go at the most recent episodes and
0:15
move backwards, because it's kind of like a TV show. Like we feel
0:19
like we are really hitting our stride now. This is Millennial Mental Health Channel.
0:25
I'm doctor Justin Romano, a Child and Adolescent psychiatry fellow, and I'm
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Eddie Creo, a licensed clinical therapist. Our podcast is here because we wanted
0:32
to start a much need a conversation about mental health. Our goal is to
0:36
teach you as much as we can by sharing our own experiences and interviewing experts
0:40
in the mental health field. We will discuss topics like mood disorders, psychotic
0:44
disorders, substance use, personality disorders, and many more. Millennial Mental Health
0:48
Channel buy Millennials for everyone. We hope you enjoyed today's episode. M MHC
0:55
is a production of Spreaker from iHeartMedia. Yeah, welcome back to MMHC.
1:03
Eddie. How are you doing? My friend? You know I was I
1:06
was already good before we started recording, and the further people listening that don't
1:10
watch the YouTube video. Just and I basically have like matching shirts, so
1:15
like that makes me feel pretty good. I'd like to call this the tourist
1:19
Hawaiian shirt. So yeah, we're rocking the tourist Hawaiian shirts. Yeah.
1:25
When we saw each other, we're like, no way, did we really
1:29
unintentionally match? Are we really that good of friends? The best part is
1:33
we both said we changed into it, like I had a different shirt on,
1:38
so we're just on the same level. We finished each other's sentences when
1:44
Justin farts, I know it, so we're just we're just on the same
1:47
level. That's true, especially because he can usually hear it from my microphone.
1:52
One quick thing I want to say about this shirt, and this is
1:55
absolutely an incentive to get you guys to go and watch our YouTube videos because
1:59
we're trying to get that off the ground. This is actually a Jurassic Park
2:04
Hawaiian shirt. There's a picture. There's little dinosaurs in here too, so
2:13
it's pretty cool. That's the guy that gets eaten, yes by the diapasaurus.
2:17
Yeah, was he in another movie like wasn't he in Uh honey,
2:23
we shrunk ourselves. Oh no, different actor, but looks very similar space
2:31
Jab. Nope, he it is Eddie Gotlin. That's a big thing for
2:39
you. Yeah, if you've been listening to the show. I don't know
2:43
shit about movies, so this is like, this is big. Yeah,
2:47
that's actually pretty obscure a reference. There A good job on Space Jam.
2:52
I wouldn't have been able to remember that off the bad I'm very impressed.
2:54
Thank you. Well, let's kick it off with our mindfulness question, and
3:00
so along the lines of the physical manifestations of mental health, like you know
3:07
the book out there, The body keeps the score. A lot of times
3:12
when young people feel anxiety, they feel in their stomach. That's why they
3:15
say their stomach hurts, they're feeling nauseous. How does your body feel sadness?
3:21
And what do you do about it when you feel sadness? Eddie?
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Immediately the question takes me to like just feeling like almost like heavy, like
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my shoulders are heavy, Like my body feels like it's like that lethargic feeling
3:32
of like not wanting to move around, maybe not being able to move around,
3:37
Just feeling like like almost man, do I want to say like feeling
3:42
like a like a weakness, Like yeah, Like I just feel like almost
3:46
like weak enough that like it's hard to move my arms and my body and
3:50
the rest of my body. So in my rambling way like that, that's
3:53
how I would describe it. That makes sense. And I feel the same
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way. It's like a low energy just it's it's almost ineffable. It's really
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hard to describe. You just feel down. I noticed that maybe this is
4:10
not necessarily how my body feels, but I noticed when I start to feel
4:13
sad, I have a natural draw towards my guitar because that's how I kind
4:17
of get out a lot of my sadness and emotions. I pretty much exclusively
4:21
only play sad songs, so that helps me get it out in a healthy
4:25
and positive way. So that's that's how my body and brain feel my sadness.
4:30
Yeah, thanks for sharing. If you can't get the gist of today's
4:33
episode, we're gonna be talking about depression, and we wanted to talk about
4:38
depression. I think we almost wanted to redo because this is our very first
4:42
episode. Our very first episode was about depression. I had like my twenty
4:46
dollars microphone. My setup was like I had this table, like this table
4:54
that I could use in my bed and I'll just put my microphone next to
4:57
my laptop, and it just it was not Jesse. Every since the beginning,
5:01
Justice All Justice has been great, but just like we were just in
5:04
a different heads it. We're just in a different space like three and a
5:08
half years ago. So really we wanted to do a redo because we think
5:11
we can do much better, agreed. And I just happen to have all
5:15
this stuff already because with all the music stuff I used to do, I
5:18
had a lot of recording things laying around. But I would like to also
5:23
say that I'm very proud of you for how much you've learned and researched about
5:26
recording and now you have like a complete professional, real podcaster setup, and
5:31
that's pretty cool. It only took a while. Shout out to KB from
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buying me my microphone a couple of years ago for my birthday. That really
5:39
helped a lot. Yeah, helped speak time. Oh yeah, a lot
5:43
of times when I talked to our listeners or people who are just getting into
5:46
the show, they always tell me I started at episode one and I'm walking
5:50
my way up. I know it makes me cringe too, and I'm like,
5:54
don't do that, Like, go at the most recent episodes and move
5:58
backwards, because it's kind of like a TV show, Like we feel like
6:01
we are really hitting our stride now and we're getting used to it. We've
6:06
got the programs we like, we've got the nerd alerts, the stats and
6:10
facts, all this stuff that we've discovered over the past couple of years.
6:13
So if you're new to the show, start with the more recent episodes,
6:16
or maybe pick out a couple of the topics that you really like and enjoy
6:20
that just jump out at you. On the list of episodes. This is
6:24
episode eighty nine for us, which is just, yeah, how are we
6:28
doing this? It's crazy to me. Essentially our first like two years or
6:32
like the pilot episodes and just now, just now, it feels like we're
6:39
really hitting a sweet spot. Just kidding. We had some good stuff in
6:43
those first two years, but yeah, once we once we signed on with
6:46
Spreaker, it's really starting to hit another level. MMH is a production of
6:49
Speaker from iHeartMedia. That's an extra ten dollars right there. Hell yeah,
6:57
boo, yeah doing it for the cash. Here we go. Well,
7:00
story time for today. I will start first story about depression. So we
7:04
have lots of treatment for depression, but I want to emphasize that treatment is
7:10
only the back half of the equation. You have to start looking at reasons
7:15
why you became depressed in the first place. Sometimes depression truly comes out of
7:20
nowhere, especially if there's like a family history of severe depression, and episodes
7:27
just can come out of the blue. That does happen to people. But
7:30
mostly for most cases and most of the people that I've worked with, I
7:33
have found that people are depressed from a combination of factors in their lives.
7:40
For example, I had an adult patient who had tried nearly every antidepressant in
7:45
the book and none of them had helped significantly. And they came in wanting
7:48
to find that magic pill that would fix them. And the more I dug
7:51
into it, the more I unearthed some childhood trauma that had never been fully
7:57
addressed or processed in therapy. Patient was getting the vast majority of their calories
8:03
from highly processed sugary foods, mostly soda. Actually, they were getting zero
8:07
exercise, their sleep was terrible, They had some medical issues, that were
8:13
not being addressed, like thyroid issues and sleep apnea, and plus they were
8:18
in a really unhappy relationship which was adding to their stress. So you can
8:22
see why that person became depressed. There were so many things going on that
8:28
are risk factors for depression, but they still came in looking for that pill,
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that answer, because that is what our society has told you you should
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look for. But that magic pill doesn't exist. That's just going to fix
8:41
everything overnight. And a large part of my job was just educating that person
8:46
on how this stuff works, how to start fixing things slowly and getting their
8:52
life back on track so that if they do start a new medicine it'll be
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effective at all. But you have to start really digging in trying to understand
9:01
why you became depressed in the first place. I think I've noticed a lot
9:03
with my teens of like when I asked them they come in and tell me
9:07
like they're feeling. A lot of them will just say flat out like they
9:09
feel depressed. And I think it's either one or the other, one of
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the one of the why when they say they feel depressed. One reason could
9:16
be like maybe they really are, like they meet the clinical criteria of depression.
9:20
The other reason, which I think is maybe more often than not,
9:24
is that they feel sad or they feel down, and like maybe they don't
9:26
meet the criteria, but that's the words that they know how to use to
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describe what they're feeling, So they use that, which is all completely fair,
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like that's what you know, that's that's totally fine. A lot of
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times when I when I meet with teens and they tell me this, I
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start to try to like move backwards, like, well, has anything happened
9:41
recently? Has anything I've been over the last like year, a couple of
9:46
years, Like what has changed for you? Like when did you start to
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feel this way? How long has this been going on? And a lot
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of the time when we start going through that, in the beginning, they're
9:54
like, well, know, nothing's happened, like I just feel this way.
9:58
But the more you kind of like pick at it and you prod at
10:00
it and you ask different questions, ask different questions, but ask the same
10:03
thing of like, Okay, well if nothing has changed recently, like have
10:07
you experienced anything new? Have you have your friendships changed at all? Has
10:13
anything happened at home? I'm asking essentially the same thing, but I'm just
10:16
being a little more specific, and a lot of the time we can get
10:20
oh, yeah, like I recently broke up with this person, or my
10:22
mom and I and my dad and I are my foster parent and I we
10:26
had a huge fight two weeks ago and since then we really haven't been talking
10:30
and it's been really hard. So trying to like like justice and trying to
10:33
get to like what the maybe root causes or like what has contributed to that.
10:37
We'll talk about it. There are genetic factors to it. There are
10:39
other things that maybe you don't you aren't aware of that contribute to it.
10:43
But a lot of the times it can kind of go back to something that
10:46
has happened specifically. I've mentioned it before. I live in Oregon. It's
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cloudy and rainy, like feels like every day. Thankfully we're getting some sun,
10:56
but it happens a lot. Seasonal effective disorders a real thing. We've
10:58
talked about it. So sometimes I'll get kids and they don't even realize that
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we'll be talking about it. I'll be asking them questions and then it'll click.
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They're like, oh, you know, I do notice that every time
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we hit like wintertime, like I get really sad and then it goes away
11:11
in the spring. It's like, wow, cool, I'm glad we can
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get to that that reasoning together. So I guess my storytime is basically to
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echo with justin sane. Is that trying to when whether adults were with teens,
11:22
trying to help our clients and patients see like, what has happened or
11:26
what is happening to you that has maybe contributed to these other symptoms that you're
11:31
experiencing and that you're feeling. I love that, and that's one of the
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reasons why you go to a professional because we've learned in our big fancy books
11:39
about what specific things increase your likelihood, So we know the right questions to
11:46
ask. Hopefully, I mean we're not perfect, but we know some of
11:48
the right questions to ask to try and understand what may have happened to you
11:52
in your life, how we can start to overcome those things and move forward
11:58
and not have your mental health you back anymore. Yeah, well, let's
12:01
jump right into stats and facts for today. According to the World Health Organization
12:07
who I very much trust, five percent of adults in the world suffer from
12:11
depression. Five percent. That's a ton. That's a ton of people.
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The WHO also categorizes major depression as the single biggest cause of disability worldwide.
12:26
Yeah, you know, you say trust the World Health Organization, but I
12:28
think there'd be some people out there who don't. That's true. You always
12:35
have your detractors, you hate us. Moving forward, According to report from
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Columbia University in twenty twenty two, the rate of depression in Americans is at
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about ten percent, So we're double the rest of the world, which the
12:50
whole world. That five percent was huge. Ten percent is really big.
12:52
How many people were in the United States doing off the top your high?
12:56
Justine, three thirty million? That's what I thought. That's what I was
12:58
gonna say, I promise. So, like, what is that ten percent?
13:01
That's thirty three million people in the United States. Good math. And
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that's only the people that like meet with a clinician or like a professional and
13:11
are like diagnosed, right or are they trying to say like in general that's
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probably where the number is at. Good question. I'm guessing it's in general
13:20
because the vast majority of people with depression never seek help. True, Oh
13:26
man, we might go down a rabbit hole. Then we'll keep going forward,
13:30
we're fine. So the same report also indicated that the rate of depression
13:35
in adolescence in young people is nearly twenty percent. It's also important to note
13:39
that this is pre pandemic data from twenty fifteen to twenty twenty. I'm gonna
13:41
go out on a limb. I would be willing to bet one month's paycheck.
13:46
And I work in public education, so if I lose one month of
13:50
paycheck, that's kind of a big chunk one month's paycheck that we're definitely past
13:56
twenty percent. I was actually just giving a presentation in the health classes about
14:01
social media use and internet use, and I use a lot of Justin's topics
14:05
from and his stats from his ted X talk. So if you haven't heard
14:09
it yet, look down our catalog of episodes. It's in there. There's
14:11
a link, go listen to it. It's great. But in there I
14:16
talk about how between like twenty eleven to about twenty seventeen, twenty and eighteen,
14:20
people noticed an increase in depression and anxiety and teens around the same exact
14:26
time is an increase in use of the Internet and social media and all of
14:30
these things that we now see as like normal. So again, I would
14:33
be willing to bet I'll go on out on a limb two months paycheck that
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it's probably a lot higher than twenty now with teens and young people agreed.
14:45
It seems like the pandemic has catalyzed a lot more mental health issues for a
14:50
lot of different reasons. And speaking of the Ted Talk, it just it
14:54
clips six thousands on YouTube and it's actually still growing, like there's still people
15:01
more and more people watching it. So I'm pretty pretty excited about that.
15:03
So if you haven't seen it, go check out. It's time to confront
15:09
our global addiction. Justin Romano, Ted x Omaha. Have you watched Parks
15:15
and rec Yes, sporadically, just for those who who've watched it, there's
15:20
like a port like I forgot what season it is, but um, it's
15:24
when Ben Wi's character is running for like some type of or maybe it's Leslie
15:30
Nope, one of them is running for office and they're going up against Paul
15:33
Rudd. Paul Rudd has a character in there, and they're talking about like
15:35
how they want to do like a smear campaign, so they start going Bobby
15:39
Newport quells babies. I don't think they say the last part, but they
15:45
make their voice like that, so it's basically the voice I did from my
15:48
ted ex So justin Romano ted X killing babies one oh one, how to
15:54
get away with it? So that that same Columbia paper that Edny referenced argues
16:02
that depression is the most common mental health disorder in the United States, although
16:07
I've always learned that it was anxiety, so there might be a little bit
16:10
of give and take there. Well, here's the best part. A lot
16:12
of people probably have both. So really that's the thing. Well, they're
16:15
very concurrent though usually it's about a fifty percent. If you have depression,
16:19
you also have concurrent anxiety fifty percent of the time. Yeah. One of
16:23
the specifiers of depression in our DSM our Diagnostic and Stittical Manual Mental Health Disorders
16:30
has there's a specifier for like you meet the criteria for a major depressive disorder,
16:33
and then there's with anxious distress. So they're like very related to each
16:37
other. A lot of people have both. Unfortunately a lot of people will
16:40
experience both at some point in their life. We've alluded to it, we've
16:45
talked about it, and I think we've talked about it like almost every episode.
16:47
But depression rates are definitely getting worse, like it is, there's no
16:51
doubt about it. They are getting worse. It's on the rights and unforced
16:53
is particularly getting worse in young people and especially in young women. Depression is
16:59
a strong risk factor for suicide, so that's why we bring it up because
17:03
we don't want people to die by suicide. Depression is most prevalent in the
17:08
households with the lowest income, which I also find interesting too because oftentimes you
17:14
hear that suicide and depression is a disease of affluence, like rich people have
17:18
it. But the stress of constantly trying to figure out where your next paycheck's
17:22
going to come from, how to just pay for this expensive life really gets
17:26
to people and it translates into worst mental health. You know why we might
17:30
hear of it as like an affluent disorder or like impacts those kind of people
17:34
more is because they have the resources to go out and get help. So
17:37
because they want to get help, that's being like monitored and like now countered
17:42
as a statistic. Unfortunately, people who like you mentioned, if you're struggling
17:45
with income, with poverty, with home security, all of that kind of
17:48
stuff. It can impact your ability to get help. So if you're not
17:52
gonna help like no one, no one, no, you know, anyway
17:55
we can there's a lot of rabbit holes we can go down today. Despite
18:00
all the ground that we've gained in understanding depression and like better being able to
18:03
help treat it, when how much people are able to talk about it,
18:07
unfortunately, rates of actually seeking help for depression are still low and they really
18:11
haven't changed much over the last ten years. Again, it could be because
18:15
of your financial status, it could become it could be because of just like
18:18
ability to get services, like being in the Portland metro area. Yeah,
18:22
there is a lot of providers, but unfortunately a lot of them are booked
18:26
out all the way and like there's no there's there's a finite number of resources.
18:30
So imagine going to somewhere where there's less people. Not to throw you
18:34
under the bus, it's not really throwing you under the bus, but Wyoming
18:37
not a whole lot of people, right, it's hard to get services.
18:40
And if you're in one of the more rural places Montana, North Dakota,
18:44
South Dakota, like there's my guesses, I've never been to any of those
18:48
places. But my guesses there's just not a lot of providers the services out
18:51
there, so it's hard to get the services. If the issue is increasing
18:56
and getting worse, the number of providers is not growing at the same rate,
19:00
it's going to be really hard for people to get help totally. And
19:03
COVID has showed us that we need more mental health providers, that we have
19:08
a huge lack of mental health providers, and the ones that we do have
19:11
right now are so overworked by trying to compensate for this current mental health crisis
19:15
that they're expecting a lot of burnout in the next couple of years and a
19:18
lot of people to start quitting and leaving the profession, so it might even
19:22
get worse. Yeah, and here, okay, some people are not gonna
19:26
like to hear this, but here's the other piece to it too, is
19:29
I think a lot of people, let me preface this, you have the
19:33
right as a person to make as much money as you want to take care
19:36
of you and your family, to do all that. But what I'm really
19:37
having a hard time with, especially as someone who's like trying to get kids
19:41
and families connected to services, is the amount of providers that don't take insurance
19:47
and whose rates are just like through the roof, and then they have things
19:51
like, oh, we offer sliding scale, but I've heard from a number
19:52
of providers who will not be named, that like sliding scale and their agency
19:56
is like their bosses are really not trying to use it. So unfortunately,
20:02
I have seen a trend which is, again, fine, you can make
20:04
whatever money you want. But I've definitely seen a trend of providers unconsciously,
20:10
subconsciously not deliberately choosing what kind of people they want to work with based off
20:15
of the rates that they set and based off of how much they charge.
20:18
And I think that part sucks for a lot too. And I think us
20:21
as therapist, we really need to take a look, take a look in
20:23
the mirror, really think about like what's important to us. Again, yes,
20:26
make whatever money you want, but like there's a part in the ethics
20:30
goes at least for the American Counseling Association that does talk about social justice and
20:34
equality and helping serve those less fortunate. I don't know. I think it's
20:37
just important that people think about that. I agree, and I wish we
20:41
had a system that incentivized people to take or incentivized to mental health professionals to
20:48
take patience of all insurances. But unfortunately that's not the way it's set up.
20:52
So if you have a great insurance, you're more likely to find more
20:56
therapists in the area that will take your insurance. But if you don't,
21:00
if you're on Medicaid Medicare, who offers pretty garbage reimbursement rates, a lot
21:04
of people don't accept those insurances. So it's systematic issues and the system incentivizes
21:11
people away from doing the right thing from and you know a lot I know
21:15
a lot of therapists and psychologists who they want to see more low income families,
21:19
but they literally can't keep their own doors open because they don't make nearly
21:23
enough money if that's all they saw. So it's it's a whole system problem.
21:32
Thanks for being the voice of reason. Oh, it's That's what I'm
21:34
here for. And you know, trying to be a little bit, a
21:37
little understanding that just the whole system is broken. We need to figure something
21:41
else out that's fair. So let's follow the money a little bit. One
21:48
of the major drivers of Americans being so depressed is industry prioritizing profits over the
21:55
well being of their employees. It seems like corporate America pushes people so hard
22:00
to sacrifice their lives their well being for their jobs. And this is ironic
22:06
because the economy often takes big losses because of disability and the inability to work
22:11
due to mental health. According to Workplace Dash Mental dashealth dot org, the
22:17
total economic burden of major depression on the US economy is two hundred and ten
22:22
point five billion dollars per year and this is up to This is up by
22:26
twenty one point five percent since two thousand and five, indicating that we are
22:30
losing money because of depression. And we want to make this point because employers
22:34
in society need to start valuing the mental health of their employees, as workers
22:41
have been pushed for too hard for too long. And the only way things
22:45
are going to change is if employers realize that this will cost them money if
22:51
they run their employees into the ground and it's not good for their business.
22:56
Like for example, say you own a trucking company. You push your truck
23:00
is too hard, They're not getting any sleep, they have a major depression
23:03
episode to have to miss a couple of months, and then you lose all
23:06
those months worth of money worth of income, so you have to value your
23:11
employees well being. I think the other part of it too is I feel
23:15
like I heard somewhere that like it's cheaper. I don't want to say cheaper
23:21
to like diminish anything, but like it's it's more cost effective to keep employees
23:26
than it is to continue to hire employees. But I don't think a lot
23:30
of people, like agencies and places are like really understanding that, Like that's
23:33
why it's so messed up of like like places will you'll get like here's your
23:37
like two percent race every year, and people are like, damn, I
23:41
need to be making more money. So then how do you get a bigger
23:42
race as you jump to like different companies. And it really sucks because in
23:45
a place like for example, community mental health, like you end up losing
23:49
like really good clinicians and people who really care deeply for the community that they
23:53
potentially live and work in that want to be there, but they're not getting
23:56
paid enough, and they're not getting paid what would be a sustainable wage.
24:02
So then you got to spend money to rehire people. You got you gotta
24:04
spend money to what is it like a headhunter to find talent. You gotta
24:08
spend money to run your ads like all that stuff. It would just be
24:12
more cost effective to pay people what they deserve and to keep employees. But
24:18
I don't know, I don't know. Yeah, in America, we used
24:22
to give people good benefits, We used to give people pensions, but we're
24:26
moving towards this gig economy where you get zero benefits, you get zero health
24:33
insurance, you get zero benefit like any long term pension, that sort of
24:37
thing. So it really takes a lot of the risk away from the major
24:40
corporations who are already making billions of dollars and putting all of the risk on
24:42
the employees. And medical debt is one of the main reasons why people go
24:48
into debt in this country. So it's and a lot of people I know
24:52
have a ton of medical debt are super stressed and depressed about it because they
24:56
don't know if they're ever going to be able to pay off these astronomy Michael
25:00
bills that they rack up. You see sometimes on Reddit, like people posting
25:03
like this is how much it cost to get treated after a scorpion bite.
25:07
Thank god I had insurance and it was like two hundred and fifteen thousand dollars
25:12
and then covered by insurance was like two hundred and fourteen thousand, nine hundred
25:18
ninety dollars. It's like, holy, like, what would any of us
25:22
do if that happened? Like, yeah, it's probably wildly inappropriate to talk
25:29
at about in a public forum such as this, but oh hell yeah,
25:33
So we got my son circumcised. Yeah, sorry boy, I'm spilling your
25:41
beans to the world. But we got the hospital billback one thousand dollars for
25:48
a circumcision. And I don't know if like I actually got to participate in
25:52
some circumcisions while I was in medical school. It is the simplest procedure.
25:57
It takes all of about five minutes, and just like the medical waste,
26:03
it's just like, how could that possibly cost a thousand dollars? That's just
26:07
blew my mind. So if it's a thousand dollars for five minutes, essentially
26:14
the doctor that did that should be getting paid twelve thousand dollars an hour?
26:19
Am I doing that? No? I'm not doing Yeah, if I'm at
26:22
five, there's twelve Yeah, twelve thousand dollars an hour. What the sounds
26:26
about? Right to me's a scam. It's all big scam and I'm a
26:30
doctor and jeez yeah yeah. In conclusion, when it comes to money and
26:37
the well being of other people, if if we want to make any type
26:41
of change, if we want things to get better, if we pay workers
26:44
what they're worth, give them time off to be with their families and have
26:48
lives outside of work, and support them, then they'll be more productive and
26:51
save the company money. People will be happier. I will, I know
26:55
for me, I will put this out there. I don't know if I
26:57
can have another job out side of working out of school because having summer off.
27:02
Last summer was hella cool. I used to go on walks and shit
27:07
and just be outside. I got like I was so happy because like I
27:11
got like my tan back. I was like never outside before because a little
27:17
was working Like it was great. And I'm about to have summer breaking like
27:19
six weeks like man if we and I think it's all because like really like
27:25
my work life balance is like so much better than like any other job I've
27:29
ever had. I get to work by seven forty five. I leave every
27:32
single day unless we're doing an event or something happens at three forty five.
27:37
It's great. I wish everybody had like felt the same way about their job
27:41
and their scheduling everything. I know, it almost seems like somewhat of a
27:45
rant or in a side that we talked about that, but we wanted to
27:49
really emphasize the fact that if we want change in this country, if we
27:53
want things to get better, we have to understand that work and our work
27:57
environment is a maze your stress. And we have to let employers know that
28:03
if they value the mental health of their of their employees, that it is
28:07
an investment and it'll pay off long term, and that letting your employees suffer
28:12
will cost them billions of dollars potentially down the line. So that's why we
28:17
wanted to bring up that point specifically. Next up, we're going to talk
28:30
about symptoms of depression. I didn't tell justin this, but I was looking
28:33
forward to this because I think we're gonna do so much better than three and
28:37
a half years ago talking about symptoms. So let's just jump into it depression.
28:42
So for this episode, you know, it's depression. There's a lot
28:45
of different disorders that are in like the depression section of the DSM. We're
28:51
just gonna be talking about major depressive disorder. So we like to talk about
28:53
symptoms on the show so that anyone listening can hear and be like, oh,
28:56
that sounds like something I'm experiencing with the of like Okay, maybe now
29:00
I can go out and get help, or I can help a friend who's
29:03
having these symptoms. I can help them get help. We want people to
29:06
know, like, these are things that you can look out for. It
29:08
really helps to take the guesswork out of it. We hear a lot of
29:11
the time, like my friend was depressed and couldn't get out of bed.
29:14
I can get out of bed. So am I depressed? Now you'll know.
29:17
Now we'll give you kind of like a little bit of a toolkit so
29:19
you can see and understand like what goes into anyone that's diagnosing these types of
29:25
disorders. Yeah, so if you go in to get help, these are
29:29
the symptoms that they should be asking about, they should be looking for.
29:33
So in terms of these symptoms, you have to have at least five of
29:37
the ones we are about to list off five out of nine for a period
29:41
of two weeks. So people will say like, oh, yeah, I
29:44
get sad from time to time, but I'm fine in a couple of days.
29:48
In order to meet full criteria from major depressive disorder, you gotta be
29:51
depressed for two straight weeks. And yes, two weeks is the cutoff.
29:56
I don't know who decided that that was going to be the cutoff, but
29:59
that's the so let's do it. Symptom number one depressed mood most of the
30:07
day, nearly every day, as indicated by either subjectively on how you say
30:11
you feel, or if others around you notice you are markedly more sad,
30:15
irritable, or down. Also important to note, and something that I think
30:19
is in every single diagnosis, is that these symptoms lead to a change in
30:22
functioning when I would do in things I would say like daily functioning, daily
30:26
daily life basically, So just remember that as we read through them. The
30:30
second symptom that's on the list of symptoms the criterion is a markedly diminished interest
30:37
or pleasure in all or almost all activities, most of the day, nearly
30:41
most of the day, nearly every day. So this is called anhedonia.
30:45
You just do not enjoy the things you used to anymore. Oh, I
30:49
like it, but I believe it is criteria because it's plural and criterion.
30:55
Nope, nope, we're looking this up. Nope, nope, you're probably
30:59
right, but we're looking this up. Hold on, nope, this is
31:03
live. I'm doing this live. Okay, okay, hold on, okay,
31:10
what is fuck? It's typically damn it. I thought I learned something.
31:19
All right, keep going, you got We fact check ourselves on the
31:22
fly on this show. Symptom number three decrease an appetite, typically leading to
31:29
weight loss. Number four is significant changes in your sleep, So insomnia or
31:33
hypersomnia nearly every day. Yeah, so if you're just sleeps off, like
31:37
if you're not getting as much sleep, we're getting too much sleep, that
31:40
could be a sign that you're depressed. Symptom number five psychomotor agitation or retardation.
31:47
And boy, I hate saying that word. Nearly every day observable by
31:51
others, not merely subjective feelings of restlessness or being slowed down. So what
31:56
we mean by psychomotor agitation or retardation is just if you like your body is
32:00
moving is trudging through the mud, you can't get up to full speed,
32:05
you're just moving slow, or you're just so on edge that you're moving a
32:08
lot faster than than normal for yourself. I think it's important too that you
32:13
mentioned that, because I think a lot of the times people only think of
32:15
like the slow version, like the slow part of depression, and not like
32:21
the hyper sensitive, agitated on edge part of depression. Like that's also completely
32:29
part of it. Yeah, next up, we have fatigue or loss of
32:32
energy nearly every day. I hear this a lot with teams who are like,
32:37
if you're from Oregon or if you're anywhere that has like a Dutch bros,
32:39
Like, you know, Dutch isn't helping anymore, Like Starbucks isn't helping
32:44
anymore. I just I can't like that's that's a pretty significant thing. I
32:49
just love thinking about the like super sweet, like coffee is like this prappuccino
32:53
is just not doing what it used to anymore already is not hitting the same
33:00
it at all. Man, that's the best part about teenagers. They just
33:02
be saying shit. The other day in one of our club medians, I
33:06
asked a kid how they were doing is Monday morning. I was like,
33:07
oh, how was your weekend? They're like, oh, my weekend was
33:10
pretty sligh. I was like, all right, cool, all right,
33:15
cool. Symptom number seven feelings of worthlessness or excessive or inappropriate guilt. And
33:23
that's one that a lot of times when patients don't quite get it when I
33:28
ask them. But a lot of times, if you feel depressed, you
33:31
have this overwhelming sense of guilt, like you've done something wrong. But when
33:36
you ask them, like, well, I guess I didn't really do anything
33:37
wrong. I just feel like I'm letting everyone down. I feel like I'm
33:42
letting myself down. So that's that feeling of guilt that sometimes a company's depression,
33:46
feeling like you're a burden on anothers. That's another one that ye.
33:51
Next up is diminished ability to think or concentrate or indecisiveness nearly every day.
33:57
This is another one that kids do not often enough. No, it could
34:01
potentially be a part of the depression. Like they will ask the other questions,
34:06
and then I'll ask them about like how's how's schoolwork? How's school?
34:09
Like do you feel like you're able to concentrate pay attention to class? And
34:13
they're like at first, or like why are you even asking that? And
34:15
then they're like, oh, yeah, I guess I guess it is hard
34:17
to pay attention. It has been tough, like I have like a brain
34:21
fog going on, Like it's all part, it's all a piece of the
34:23
puzzle. And I oftentimes get ADHD evaluations from kids that are just severely depressed,
34:30
and they're like, oh, they were totally fine, but then six
34:32
months ago Grandma passed away who they were really close with, and all of
34:36
a sudden, they can't pay attention in school. They must have ADHD.
34:39
But no, it is the depression that is causing that number nine recurrent thoughts
34:45
of death, not just fear of dying, recurrent suicidal ideation without a specific
34:51
plan or a specific suicide plan, or having a suicide attempt. I know
34:55
that a lot of social media won't allow you to say that word of suicide,
35:00
but it's a big part of our job and a lot of people who
35:02
are severely depressed to have those thoughts, and so that's our job to ask
35:06
about it and yeah, educated you guys about it. It's just important to
35:09
know, Like it's important to know the language and to talk about it openly
35:14
to a point where like someone can feel comfortable of like I am having these
35:17
thoughts, like I am really struggling, Like it's important for them to know,
35:21
like you can talk about this openly. If you want an objective way
35:24
to measure or score depression, you can always check out the PHQ nine.
35:29
I believe that stands for what is it? Patient hell questionnaire being dam If
35:37
you're not, if you're listening, I'm flexing right now in front of the
35:40
camera, because that's right, that's how we do it here. So this
35:45
is a depression screening to a lot of doctor's offices. US if you go
35:50
see your primary care physician and you do if if it's like a yearly checkup
35:54
or it's like a new doctor like you, actually a lot of them will
35:57
include it in their in their new patient paperwork. You can typically find it
36:00
for free on the internet. It gives a specific score that puts you in
36:04
either a none, mild, moderate, or severe range, And it really
36:07
is just a good way to validate if what you're feeling actually matches up with
36:10
what the medicine says. Also just important to note it's good to have like
36:15
a tool, but also just if you're going to use it, maybe have
36:20
a plan for afterwards, like have a plan to like, okay, like
36:22
this says maybe I'm moderate, I should talk to somebody don't just keep that
36:25
to yourself. And if you do have depression or we score high on the
36:30
PHQ nine, here's how to get help. A great first place to start
36:35
is to reach out to your primary care doctor. They tend to be the
36:37
first line and a lot of this stuff, or you can start to go
36:40
directly to a therapist. Therapy is amazing. I don't need to tell Eddie
36:45
this, and because it does help you identify the reasons why you became depressed
36:51
in the first place and gives you the tools for the future to prevent it
36:54
from happening again, hopefully. So many people think that therapy is just event
37:00
have done correctly, it's a lot more than that. A great therapy that's
37:02
been validated to be effective is called CBT or cognitive behavioral therapy. So if
37:07
you want an evidence based therapy, that's something to try. I'm gonna go
37:09
on my soapbox just for a little bit for evidence based treatment. Just always
37:14
important to remember, like evidence base does not always mean that it's going to
37:16
work for everybody. There's a lot of people who should on CBT. Just
37:20
to be completely honest, a lot of people should on CBT. A lot
37:22
of people love CBT. A lot of people get so much benefit from CBT,
37:27
A lot of people don't get anything from CBT. So it's just important
37:30
to know, like there's different things out there that can be helpful. There's
37:32
DBT, there's ACT, there's person centered, there's psychodynamic, there's all these
37:37
things, but CBT really is for I feel like sometimes our field will go
37:43
out of the way to like disprove CBT or say that CBT is CBT is
37:46
not helpful, But I think it's tried and true. It can be helpful,
37:52
and I think it's important to know that. So I say all that
37:54
to say, be open to other treatments, but also like CBT can't be
37:59
really helpful if you want an evidence based form of therapy, because sometimes you
38:04
do go to a therapist and they really do just let you vent. They
38:07
really just talk about, oh, how was your day? Would you have
38:09
to and they don't follow any sort of model, they don't follow any sort
38:13
of guide. So it's okay to try and keep your therapists honest and say,
38:16
like what are we doing, Like what specific type of therapy are we
38:21
doing? Are we following a model? Are we following CBT? Because I
38:24
want to get better, and I want to make sure that I'm doing something
38:28
that is evidence based, and sometimes you have to keep people honest in their
38:31
professions. We always recommend too, if you're looking for someone who's going to
38:36
do therapy, is contacting your insurance company to see or try and get a
38:40
list of different therapists in the area that are covered under your plan, because
38:45
the best therapy is the one that doesn't bankrupt you. Absolutely. Psychology Today
38:52
is very popular in trying to find therapists. It's a very convenient tool.
38:57
You put in your insurance, your zip code, any other preferences, and
39:00
you can get a list of therapists. I'll give you all a little secret
39:02
insider info because of a big part of my job is trying to help students
39:07
find service as students and families. What I'll do is, I'll go on
39:10
Psychology Today. I'll also go on a specific one for the Portland area.
39:15
It's called Portland Therapy Center. I'll go on there and I'll look up a
39:17
bunch of I'll get the list of providers and open a new put them in
39:22
a new tab like right click new tab, new tab. All the ones
39:25
that are potential that might have openings, I'll go on. I have a
39:29
script ready on a Google doc that I use for every student. I make
39:31
a copy of it, and it's my care coordination forum, and I have
39:36
on the form. I have a script because every single one basically asked the
39:39
same thing, what's your name, what's your email address, what's your phone
39:42
number? Has like a drop down many for insurance you use, and then
39:45
it says like, what's your message? So I have that already out,
39:49
I copy and paste and I just paste it into each single one, and
39:52
then it helps them be able to send out like ten or fifteen inquiries in
39:55
like twenty minutes thirty minutes, so that I can get a bunch out there
40:00
and I can see how many I can get back, because honestly, it
40:01
can be tough, Like you can be really discouraging if you send a lot
40:05
out and you don't hear anything back. So that's why I just say,
40:07
like, cast the widest net possible for people that fit your criteria, and
40:12
see what you get back in return, and don't be discouraged to because it
40:15
could be you could try one day and hear nothing, or you can try
40:17
tomorrow and like every single one messages you back on the same day, like
40:21
it's it's not a perfect science, but it can be helpful to do it
40:24
that way. Yeah, and you're right, Eddie, it can be really
40:27
discouraging. You're looking for help, you're trying to get therapy, and no
40:31
therapists are taking patience, no one's taking your insurance. You hit a lot
40:35
of roadblocks out there, and that can be really discouraging. Absolutely. I
40:38
wanted to talk briefly just about the medication side of things. I figured I
40:43
should because you know, I prescribe them. But medications can help. They
40:49
are relatively safe. And some people believe that antidepressants will increase your risk for
40:53
suicide, because there was a black box warning that came out in two thousand
40:58
and four saying that it could increase your risk for suicide. But overall not
41:02
that we have more data. We found that the antidepressants that will lower the
41:07
risk for suicide in the long term, and although there were slightly more suicide
41:12
attempts after starting these medications, suicide completions did not rise. So that's one
41:16
of the things I hear the most is like, oh, wait, can't
41:20
antidepressants increase your risk for suicide? But we've also found that if you don't
41:25
treat the depression, then that's a higher risk for suicide too, that there
41:30
might be a slightly higher risk for attempts once you start an antidepressant, but
41:34
overall, the benefit outweighs the risk, and so that's why we as doctors
41:39
tend to recommend medicines if people are really struggling with depression and the depressions getting
41:44
in the way of their lives. But like Eddie said, if it's not
41:46
getting in the way of their lives, we tend to take these pretty seriously.
41:51
Like if I don't think a kid did necessarily needs medication, I will
41:54
not give it to them if I think they can do it with therapy alone.
41:59
I really try and not push medicines as much as I possibly can.
42:02
And we don't want to talk too much about medicines because as the doctor,
42:09
we recommend all sorts of medicines. But if if you needed a place to
42:14
start and you just feel like there's lots of different medicines out there and you're
42:17
not really quite sure which one to choose for young people going down to age
42:22
twelve, I really like lexepro or s S. Telepram is the other one
42:27
is the other name for it. So if you feel like you need somewhere
42:30
to start a medicine, that's going to be good. And you know,
42:32
in no way are we paid by these run drug companies. But a lot
42:36
of the research has showed that lexepro or s telepram is one of the more
42:39
effective ssrise. It tends to have the less amount of side effects, it's
42:44
the best tolerated and that's why I typically reach for that first when treating young
42:47
people with depression and anxiety. We're not paid by drug companies yet or ever
42:55
we're willing to Oh yeah, we're not willing to listen. Just kidding.
43:05
Besides medication, besides therapy, besides listening to our silky smooth voices, what
43:10
are some other things that you can do that can be helpful, either proactively
43:15
reactively. Just it's important to know like what is available for you. But
43:20
it's also important to know that there are a lot of things out there that
43:22
say that they can help with your depression. They claim they can fix it,
43:24
but again, you have to be really careful with those things and what
43:29
you end up choosing. So, in terms of evidence based lifestyle changes that
43:31
you can make that have been proven for your mental health, that can be
43:35
that could be proven to help your mental health. There are four that we
43:38
focus on. Justin calls them the four pillars. I will say what they
43:42
all are, and then we'll go through each of them individually their diet,
43:45
exercise, sleep, and stress management. With diet, there's a lot to
43:50
unpack, just because diet in America is a mess and everything we eat is
43:55
pretty much garbage. But typically we recommend increasing the amount of plant based,
44:00
whole and natural foods, reducing highly processed sugary foods as they are bad for
44:06
mental health, but trying to increase the whole It's like fruits, vegetables,
44:09
nuts, whole grains, seeds, legumes, and beans tend to be the
44:14
most beneficial for your physical and mental health. In terms of exercise, we
44:17
like to say that the best form of exercise is the one you like the
44:21
most and see yourself doing for the rest of your life. I definitely know
44:24
when I was times when I was playing football in college and I would work
44:28
out and we do the workout for the day, and we were doing like
44:30
extremely heavy squats or extremely heavy bench sets and all these compound lifts. I
44:37
could not see myself forever. So it is really important if pick and choose.
44:40
Walking is like number one, Like can be so helpful for you and
44:45
so easy to get into. And if there's one thing that I will endorse
44:49
and say that I think is really helpful, it's definitely walking. Like walking
44:52
doing that, it's like one of the easiest things you can do. You
44:54
don't have to go to the gym. You can do it outside as long
44:58
as you don't live in organ for like nine months a year, but you
45:00
can walk almost anywhere. But yeah, it doesn't have to be the StairMaster
45:05
that shit sucks. It doesn't have to be walking on the treadmill for two
45:07
hours. You could be walking outside, walking around your neighborhood, and then
45:10
you get double the effect. You get some sunlight, you get some nature,
45:14
you get some fresh air, you get to hear those birds that chirp
45:16
all the time, and you get some exercise by walking around. There's there's
45:20
a lot of things you can do. Yeah, do something you find fun.
45:22
So many people think exercise is something that you have to just slog through
45:27
and something you don't enjoy. But yeah, like you said, walking is
45:30
a great one. I'd love going for walks, especially with my dog.
45:32
But if you enjoy weightlifting, go for it. Biking yoga. Who should
45:37
check out our yoga therapy episode with Amy Huffman. If you like jogging,
45:43
be my guest a high intensity interval training, boxing, disc golf, hiking,
45:47
basketball, YouTube exercise videos, video game exercise. Just find something you
45:52
enjoy and do it. Hit up the Just Dance. A lot of good
45:57
songs. They got the newest one out. I think Reese Only Just Answer
46:00
is a fun one. A lot of good options. Sleep a lot of
46:04
people, a lot of experts will say like about eight hours asleep per night
46:07
is important and helpful. About nine hours if you're younger than the age of
46:12
twenty. Some basis of sleep hygiene tips from the CDC so they include setting
46:15
a regular bedtime and sticking to it, trying to wake up around the same
46:20
time, not having too big of a difference in your sleep schedule. I
46:22
know it's easy on the weekend to want to like sleep in a lot,
46:25
it's important to trying to keep your sleep schedule pretty on track even on the
46:30
weekends. Trying to make your sleep environment cold, dark and quiet. Using
46:34
an eyemask has been something that's been really helpful for me of helping me fall
46:37
asleep right away, trying to limit screens before bed, not being someone that
46:42
falls asleep with their phone in their hand. I used to definitely be someone
46:45
that have my phone in my hand. I'd fall asleep and then I'd wake
46:47
up because my phone fell out of my hand. Avoiding large meals and alcohol
46:52
before bed. I will also say when talking to doctor Kristen Casey, our
46:55
friend, friend of the show and with you, the idea of like alcohol
47:00
and how much it messes with your sleep has completely changed it for me,
47:05
like in a very positive way. Like I basically since like December, between
47:09
now and December, I've I've hardly drank it all. I really only drank
47:13
when we went on a trip to Japan, and other than that, I
47:15
haven't drank at all other than that week a little bit during the week,
47:19
and definitely like I haven't had to do with any of that like shitty sleep
47:22
that alcohol like gives you, like it really fucks with your sleep. So
47:25
it's some point you know that, also trying to limit your caffeine consumption.
47:30
I'm not the best at that out Definitely, like I love a good a
47:34
good three PM coffee. But I'm able to sleep later, so like,
47:37
that's fine. Some people are not able to so it's important to remember that.
47:39
And then finally the last two points, exercise is really important. It
47:43
can help with your sleep. And there's also an app. It's the cbt
47:46
I Sense for Insomnia Coach app. Again, shout out to our friend doctor
47:51
Kristen Casey on that one. All important helpful tips for your sleep. Yeah.
47:55
And then the last pillar being stress management. This one's a little hard
48:00
to qualify or quantify or whatever, but try to remove some of the stressful
48:06
things in your life. But that's not always possible. So if you can't
48:09
remove some of the stressful things, try to add more time for relaxation,
48:14
time where you can unwind and let your mind and body relax. I think
48:17
meditation is a really good time for this, and I've used it more frequently
48:22
in my residency. If I'm feeling overwhelmed, if I'm feeling stressed, if
48:25
i feel like my mind will not calm down, I'll throw on a Headspace
48:29
meditation app and just let my brain detox for a couple of minutes and just
48:35
calm back down. But our society teaches us that we need to be moving
48:38
and productive all the time. That's not really healthy. Humans haven't really done
48:44
that for the past couple of thousand years. It's only really been for the
48:46
past twenty or so years that we have to be so productive all the time.
48:52
And it's healthy to take a break. It's healthy to unwind and slow
48:54
down. So you're telling me those videos on TikTok where people say that they
49:00
four hours of sleep and then take a cold shower every morning and then don't
49:05
like, don't eat any processed foods and are constantly working and only like only
49:10
work and then sleep for a little bit. Like that's all fake. It
49:15
could be, but yeah, it just it just seems like why are they
49:22
making those videos so like shame people and try and say, oh, you
49:25
should be more like me. I don't sleep and all I do is work
49:28
and I'm all productive and look how great I am. Like, there's lots
49:31
of people who are productive and also very successful who have balance and breaks,
49:37
and I'd say most people need that balance. We are talking about celebrities who
49:43
have dealt with depression. This is primarily from the prestigious web MD, starting
49:52
off with the Man the Rock, Dwayne the Rock, Jones and the Man
49:58
who needs no introduction but I gave him one anyway. So he actually saved
50:02
his own mother from a suicide attempt when he was fifteen years old. So
50:08
wild, poor guy. So we see that he has a genetic predisposition for
50:15
depression. It's in his family with his mother having such bad depression. But
50:19
he has a really good quote that he tweeted and he said, depression never
50:22
discriminates. It took me a long time to realize it, but the key
50:27
is not to be afraid to open up, especially as dudes have a tendency
50:31
to keep it in. But you are not alone. I like that quote
50:35
because he's right. Dudes don't talk about the stuff, and that's one of
50:38
the reasons why men in America are so emotionally closed off. Next up,
50:44
we have Wayne Brady, who is the hilarious improv comedy guru and TV show
50:49
host and he had a recourrean role in How I Met Your Mother. Oh
50:52
yes, yeah, I forgot about that. He was Barney Stinson's brother because
50:59
Barney was so it was like when that episode where in Barney and his brother
51:02
found his brother's dad and his dad was like clearly black and Barney was like,
51:07
oh Dad, and He's like, we're not. But again, Wayne
51:15
Brady, he opened up to ET about his depression in twenty fourteen, saying
51:20
that it seems more acceptable to admit to a drug problem than to clinical depression.
51:24
Well, we've talked a lot about ET on this show in the past,
51:28
especially with Jaz Bono, and the ET has led to some good things
51:32
and giving celebrities somewhat of a voice for telling about how life really is.
51:38
Yeah. Next, we have mister Jim Carrey, one of my all time
51:43
favorites, who's a famous comedian from Canada who has opened up about his mental
51:49
health in the past. He's been a proponent of finding alternative ways of managing
51:52
depression, not necessarily mainstream medicine, his quote being I believe depression is legitimate,
52:00
but I also believe that if you don't exercise, eat nutritious foods,
52:02
get sunlight, get enough sleep, consume positive material, surround yourself with support,
52:08
then you aren't giving yourself a fighting chance. And I felt like this
52:12
really spoke to me. Yeah. And finally on our list, we have
52:16
Miss Alicia Keys, who in two thousand and seven fought a depression episode after
52:22
her grandmother passed away, she was quoted as saying, as I was feeling
52:24
so sad all the time, and I couldn't shake it. I started burying
52:28
my feelings, and I got to the point where I couldn't even tell my
52:30
family or my friends I'm twisted, or I'm exhausted, or I'm so angry.
52:35
I became a master of putting up the wall so that I was unreadable.
52:38
So as we can see plenty of people, plenty of celebrities, twenty
52:43
percent of Americans or sorry ten twenty percent of young people in America. This
52:47
is a big problem. And I'm glad that the conversation is finally starting to
52:52
turn on depression. We're becoming more aware of it, but we still have
52:57
a long way to go. And always is always. This is not medical
53:01
advice. We are not your providers, but if you're struggling, try and
53:06
reach out for help. I take home for a point for today is basically
53:09
echoing with justin Sane is trying to be as open as possible with your trusted
53:14
people, where they're trusted friend, trusted family member, trusted adult. If
53:16
you're a teen, trying to find people that you can confide in so you
53:20
can reach out to for support and hopefully they can help you find the right
53:23
professional support. Afterwards. We've made it to the end of the show.
53:29
Thank you all. This is a little bit of a longer episode, but
53:30
I'm glad we did it. The redo of episode one. We're going to
53:35
delete that from everyone's memory. No, it'll still be up there. Please
53:38
don't go listen to it. You can go listen to it if you want.
53:43
Remember that if you listen on Apple Podcasts, you can leave us a
53:45
review. On Spotify, you can do the same thing, just without the
53:49
review. If you whatever other podcasts app you use, make sure you please
53:52
like, comment, subscribe, retweet, repost, whatever it is you got
53:58
to do. We appreciate your support. On social media, you can find
54:00
us at Millennial MHC and on YouTube. You can also find us at the
54:06
same spot. You can also email us if you really want to, at
54:08
Millennial mh channel at gmail dot com. I think that's everything. I was
54:13
a little scrambled today, but that's okay. Thank you all for listening.
54:15
Thank you all for being here with us, and remember take care of your mentals.