welcome viewers i am your host dr heidi weinhold and you are watching ask the nature of past today's topic is depression and i am so pleased to introduce my guest dr heidi noble a clinical psychologist with a thriving difference between psychiatry and psychology so it's good to start out with that psychiatry are trained by going to medical school and they do prescribe medication the answer to this for psychologists is there are people that we  meet one on one with individuals and our focus is to change behavior and change thoughts rather than prescribe new medications but we were quite often in conjunction with psychiatry to get the best possible outcome mood condition that is diagnosed by a long term incidence of bad feelings so it has to be occurring over a two week period it's not that i feel sad one day and i'm fine the next  new may have temporarily caused a change in our mood so when you diagnose depression it really is that so many experiences sadness loss of interest and a lack of initiative in behavior and possibly suicidal thoughts over a long term period so and there are different types of depression to sleep please explain this later the difference between major depression and somebody w suffering from some minor sure ashen as i said a major depressive disorder is a long standing period that so many may feel the see these feelings of sadness and they can affect different aspects of people's behaviors and their fops it affects cognitive functioning it affects their memory functioning their ability to pay attention and concentrate people describe feelings of hopelessness and worthlessness and feelings of guilt so those are some of the more emotional symptoms that people experience with major depressive disorder now there are other types of conditions with depression that include define make disorder which is more of a mild depression that may be more temporary and generally people don't experience these overwhelming feelings of sadness that just maybe someone of a low grade sadness where they're not suicidal and you also have probably heard about seasonal affective disorder where  yes experience sadness when there is a lack of sunshine so in the winter months tend to elicit more of those feelings of sadness and depression does late he does is that effective yes yes they've looked peon often with folks who come into my office and and we talk about some of the seasonal effects of depression absolutely recommend that they sit around and so with more light that when the sun which really does come out in pittsburgh is around that they get outside and soak up some of those raids so yeah the sun and the sunlight and sunshine and light the fact us other types of depression too you may have heard of is postpartum depression that is definitely a hormonal condition following the birth of a child where the estrogen levels are in flux and there's a period of time that that women experience depression following the birth of a child are you seeing an increase in postpartum depression  somewhere that had postpartum depression increases with fertility treatments or when when women have more than one baby it at a time like with twins or multiple cars i'm not sure i haven't i haven't seen that research  that's a possibility or that we're becoming more aware of identifying and looking for those conditions sometimes it gets a little confusing as to whether there's an actual increase in the incidence or we're just more aware of looking for it so that may be the case that there's an increase in post partum but that's also an area of depression that we want to we want to pay attention to after the birth of a child legal over a little bit to about how recognizing the symptoms of depression  teenagers because you know there's a lot of information out about well prozac for example being being used for depression but it's actually an increased risk of suicide among teenagers people under the age of twenty four and within the first couple of weeks of starting can you can you address that sure well there are several components to the question that you're asking one when talk about depression we look at different symptoms and i talked briefly in the beginning about what to look for in some of the emotional and cognitive symptoms of depression and depression comes out in various ways with different age groups so that when you're looking at children i see some kids in my office i also treat some older folks in my office as well is that the dip of the depression really emerges in various ways with children oftentimes you see a social withdrawal sometimes there's an irritability sometimes there's acting out behaviors so what you look for with children really varies somewhat you may see in older folks so that's one population that we definitely want to pay attention to which children and particularly in the news lately with the most recent incident in ohio where a child obviously had some significant emotional disorder that was not identified and ultimate acting out behavior with hurting other children  so you definitely want to identify kids at risk for depression because the consequences for it for not treating depression in children can be quite grave including some suicidal and homicidal behaviors with the older folks what you may see is more of the social withdrawal is that older folks because of feelings of sadness that may be related to medical conditions  loved one because of the passing of a spouse for example is that you may see again more social isolation lack of initiative to participate in at activities outside of the home not taking care of themselves they may stop eating their sleeping becomes disrupted and then they want to be identified as a good potential risk for it for depression and possibly suicide and there is a difference between actually males and females and the potential for suicide particularly with older folks that men are actually more at risk of suicide as they get older than women which is kind of an interesting is interesting i thought i thought what why do you think that is my personal thoughts may be that they are more comfortable with more aggressive acting out behaviors and so the potential of hurting themselves may be more likely in men than women particularly their guns available so they may be more at risk in that regard they do use a good support group and went throw out and maybe can in share some others with with the audience but i nearly didn't know how has it as a good grief support group program there's also a grief program through ken it's both hospital i'm aware there's a group and in the name of the group escapes me right now they meet in green tree for parents that have lost children but those tend to be more grief groups and there's also some mental how all support groups around the allegheny and washing county areas that are support groups for folks with mental illness so yes they are definitely out there and available  you seeing it a decrease in the number of services available do you did like that cutbacks with the legislature does that is that affecting i haven't seen that and i haven't seen that it's significantly but there i want to i guess we'll come back to also what do you do when you do see depression because you're asking about how do you treat it what exactly rips it and what becomes important and i guess that was a good place that we started with the identification of the symptoms because if someone is experiencing these symptoms they shouldn't just disregard them and say oh i'll get over it or you know it's just passing or everybody goes through it that really minimizes depression and that shouldn't happen so if folks are seeing that in in themselves or their friends identified or family members or identifying depression in somebody else they absolutely should recommend one they see their primary care doctor first and foremost they get treated by some mental health practitioner whether it's a psychiatrist or psychologist whoever is true is trained in treating depression and they should look for treatments that are appropriate so we're going to talk about what alternatives  as well as medications and therapy we enter report groups but that's somewhat of the sequence of events that should occur when somebody is diagnosed with depression ok and then throw a couple questions because i want to discuss united both aware that anti depressant pharmaceuticals are a multibillion dollar industry and there was recently a psychiatrist from harvard who was on a very popular t v show and he just expressed the statement that anti depressant medications are no better than a placebo intreating mild to moderate depression what would you think about that that's actually other folks have looked at this as well that's not a new study  i think in our society we're very quick to look for a pill to fix things anyway i do too so i think we have to do one a thorough diagnosis to make sure that the type of treatment and the type of depression we're seeing is not severe and i want to separate out that if folks are seriously severely depressed and thinking of hurting themselves they have to get treatment right away and they argue this not well should i look at some alternative it's absolutely first and foremost if you're suicidal you need to be hospitalized and the infallible facilities for folks here in peter's township are through st clair hospital washington hospital western society children also can be seen at southwood and also down in west virginia so it's important to folks know if they are truly depressed suicidal immediate treatment is necessary after that when you look at diagnosis you do one identify whether we're looking at some level mild moderate severe depression and oftentimes i use a scale that folks will fill out when they come into my office  to look at certain symptoms when we identify the level of depression then we look at what's the appropriate treatment now the treatments that are available if it's somebody severely depressed medication is a really good option because you need immediate response and i believe that i do believe that for severe depression absolutely that it's an it's a must be you know i actually went through this with with even a friend and we went to the emergency room and without insurance and they didn't get the medication now it's really a would do people do because there are a high incidence of uninsured out there and when there is severe depression where can they go and then emergency room and play the first appointment for site tied tresses like six week yeah yeah if you watch and the person walked in the door with severe depression heidi what do these people do well your question earlier and whether i've seen cuts no i haven't seen cuts but the care that we often provide is not the best level so yeah for folks that don't have insurance a difficult situation watching communities mental health is available for folks that don't have insurance also ok so that's an option but again there's no guarantees that you're going to be seeing right away and it could be several weeks before treatment and that's again you're coming asking about people with severe depression right because they will provide care for folks that don't i have insurance ok and they may receive some medication they may be treated right away and yeah they'll probably be a referral to a community mental health service for follow up ok unfortunately that's a level of care that often folks without insurance will receive let's step away from this we're depressed i would love that and i actually because really the truth about like overprescribing and i depressant is it's really being more prescribed in people with mild to moderate depression in my question to you is because you mention the first step is to go to your general practitioner but do you feel there's a problem with overprescribing an depressed medications is that general practitioners are too quick to prescribe was just a ten minute evaluation i think that's true i think that is true and i think that's part of their training is that they're trained to diagnose and immediately provide a cure or what they perceive as a cure and that's within the medical community what's accepted so yeah it's ok to provide a prescription if you walk out the door the quick fix that often people are looking for in people want to and they feel better and that's what that psychiatrist was really was addressing is that he's he's finding this is harvard speak they are finding that people are getting more of a benefit from the placebo effect of their doctor handing him that pill than actually the chemical in greedy and soon the pill and then here's the thing so people start these in a depressive medications of mild depression maybe they're just going through you know pills and then the side effects of them are you know waking you know different already thinking and you know no decrease in the beetle in official sexual dysfunction and if you're not really depressed boy you are after you've been on  one of the popular antidepressants and she called me afterwards and said you know i'm depressed because i gave this so often times that is true but that's where if the diagnosis is mild moderate depression we need to look at alternative care i think that's where you come in and i really believe that more people can benefit from just from changing their behavior and be willing to start looking at their thinking there's a really depression in mild to moderate depression being more a big chill thinking that's correct and people just get in these these fog patterns and you know how do you change people's perception if you can turn their thoughts or the way that they think about things you know the things in their life start start to change and in i really see it like people with mild depression boy they need to they obsess about what they don't have and in the lack in their lives and their lives and it's and especially at night people i think rehash every saying that you know that didn't go right during the day can you can you talk a little bit about that sure and this gets into how do you treat depression the psychology when we find folks that have depression it's that there is a negative thinking that's occurring is that self esteem is quite or the thoughts the behaviors that  goal long with the negative thinking tend to end up with negative results as well so people think badly of themselves they lack energy they lack initiative they beat themselves up because of what they're not doing  and they show the spiraling downward so as a psychologist when folks come into my office it's a matter of identifying what those negative thoughts are and looking to change them and using positive thinking and then identifying the behaviors that i are attached to those negative thoughts so if i feel badly about myself i'm really tired this morning you know i'm going to stay in bed because i don't want to get up and then i feel terrible because i can't even get up and i can't even get in the shower and you know i have to go to work and as a result i don't really do a very good job anyway that's an example of some of those negative thoughts that occur when folks experience depression so you have to identify what those thoughts are you look at changing those cognitions or thought and looking at creating more positive thinking and then looking at the behaviors are people establishing realistic when do we say hey i should be president of this corporation or do we say hey you know what i have a specific job and i'm successful in that job so you develop realistic expectations so you don't beat yourself up with unrealistic expectations for yourself can i i wanted to ask you this too do you see an increase in depression with the changes in the economy like i heard here once is to stick that thirty eight thousand people whose unemployment run out a leak and i think that unemployment it just it erodes people self confidence a little i absolutely know that's a very good point is that i have seen that in terms of folks that are unemployed for an extended period of time that it does significantly if out affect self esteem because people think they're worthless they think they're not contributing to the family household and you know depression it does not only affect the individual it affects the family because it affects relationships in how you interact with somebody else how would you interact with your children if you were irritable the likelihood of increase abuse occurs because people are angry or they are more irritable they act out that behavior so yeah the consequence of the economy coming down in you know showing changes in a negative way truly effect people's emotional wellbeing so yeah there's definitely a correlation with economic factors and i believe that lou yes we do you feel that sometimes people use alcohol and to self medicate their symptoms of depression ye yes folks will turn toward alcohol or other substances to treat psychiatric or psychological symptoms so they'll use these men these are available substances to treat their feelings of sadness their lack of self esteem their poor self esteem their difficulties in social situations so they will then drink excessively and as a result they  down some of their guard their defensiveness and they think they are more comfortable in situations however and then what happens is a real know is that alcohol does not have a positive long term effect so it just adds to the problem so they often will develop a cycle with alcohol or other substance to what are some resources for people and they suspected that they have a drinking problem where we're can  well there people are probably really familiar with first and foremost they're an excellent resource alcoholics anonymous has meetings everywhere throughout washington allegheny county very available to for folks anytime there every single day people can attend yeah the substances dual diagnosis with depression yes there's absolutely treatment for substances that's available to folks  hide each you explain a little bit the difference between anxiety depression and often often it's interesting often they do go hand in hand and we do often see anxiety which is restlessness nervousness worry true as occurring with depression part of what some of the reasoning for depression is there may be a turn a predisposition toward depression and that there also may be a genetic predisposition toward anxiety so oftentimes they do go hand in hand and some of the medications that are out there may treat bowl ok so yeah it's often common we see both of them together can you explain the difference between depression and bipolar disorder because i think bipolar disorder is often misdiagnosed used to say that it's be a diagnosis of the month that everybody would get stuck on a certain diagnosis and then everybody would be identified with certain diagnosis of bipolar disorder is often misdiagnosed under diagnosed as a cyclic disorder that people may feel periods of mania or a heightened to the level versus a very low depression so they may tend to go into these cycles of very highs or very low so that's diagnosis of bipolar disorder and there are different diagnosis within that component of that diagnosis and i think it's interesting too it was depression there is like an increase incidence of people if they're not sleeping that they are at higher risk for developing depression i think it's like over's over thirty percent yeah sleep is a very significant factor that does play in with depression in it and i just wanted to mention talked about bipolar but if sleep is an issue there have been some incidents of people taking melatonin with that were diagnosed with bipolar disorder actually can induce a manic episode so i just wanted to throw that out there for the for people that if you do have bipolar the one thing that you should stay away from is is melatonin i mean that in there chances are rare but you want you want to avoid it i'm also come back to your field as well as the with mild depression is that there are some alternative treatments there not just therapy but some of the herbal options that are available to there are in for mild to moderate depression and i do like st john's wort a you have to be careful because st john's wort can interfere with so many other prescription medications and it is good to see nature of the gawker just to go through it and make make sure that that that won't interact but when you look for an eye st john ort you want to look for a standardized extract so in a lot of incidents where it where it hasn't worked is because it wasn't standardized and people need to look for it's point three percent of high paris and and that's the key want to look for st john's wort and that the tentacle name is high parrot but you want to look for it in dosage of three hundred milligram capsules and usually the average joe's is you know two capsules at least twice a day and you need to take it for at least two weeks it for two to be b of a benefit there are there are actually some studies published in homeopathy that with using only opposite the ignatius which is a great remedy for grief so for anybody that has just doesn't interfere with with other other medications but i am such a big believer in boy intervening quickly and seeing somebody like yourself in really in just in talking in use sooner you can flip around that that thinking in those thoughts that the better and it in personally i do tell people to listen to dr dyer the special tonight because i really find that when you're when you're depressed  in the evening before you go to sleep and when the best things to do to turn your thoughts around even to help you sleep is just to listen to a tape and something positive there are other options too that people really need to pay attention to when with exercise there's actually  research to show that exercise on a regular basis really has a positive effect on treating depression and in england and england right now they're spending a half a billion dollars educating people in talk therapy and exercise and i combination and really they can start their day their morning by exercising and you talk about changing their behaviors their habit to set them up for more pot they want to do more positive things for themselves i'm a very strong advocate people just put your shoes on what your shoes i mean it doesn't cost any get out to do a little risk of injury right absolutely and get people to walk it so and so that's one option absolutely getting out socializing with friends so there are ways to treat oneself well to avoid depression and then if people are in treatment for depression i don't stop there's a great point because people tend to prematurely stop tragedy and then