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I'd like to welcome everybody today's
presentation on Social Work and case
management issues in the management of
depression I am your host Dr. Dawn-Elise
Snipes
we are going to define depression
symptoms and learn how to ask strengths
based assessment questions and then
we'll identify a range of potential
causes for depression and explore
activities and interventions that can
help people address some of the
underlying causes of depression so
depression represents a cluster of
symptoms as we well know and diagnosis
with depression only requires people to
have a few of those symptoms so you may
have three different clients who have
three different relatively different
depressant depression presentations some
may have difficulty with sleep while
others don't
some may have difficulty with appetite
while others don't some may have more
irritability some may have more lethargy
so we really want to be individualized
when we are presenting solutions for
clients and we need to remember and
remind clients that depression often
indicates the loss of something
important now this is more situational
depression people who are dealing with
chronic major depressive disorder there
may not be a particularly a
neurochemical imbalance depression
itself just like any other emotion is
not necessarily bad it can cue us that
we've lost something important that we
may need to grieve it also can cue us
that there may be something wonky for
lack of a clinical term going on well
that may be contributing to our body's
inability to stabilize the
neurotransmitters as well as it normally
does a variety of different things can
cause depression you know emotions can
cause depression we talked last time
about how the fact that most emotions
are not singular
we don't just feel depressed we don't
just feel angry we generally have
multiple emotions in there and the
emotion that we are displaying is sort
of like the tip of the iceberg anger
when we are angry for too long we tend
to get in this negative mindset and it
can when we keep our HPA axis activated
because of anger or anxiety we can start
to feel worn down and exhausted and we
can start to suffer from the side
effects of elevated HPA axis including
sleep deprivation so anger and anxiety
are two things
that can contribute to depression and we
don't want to forget those we don't want
to just help people try to feel happier
you know that's great but it is pretty
invalidating in a lot of ways we want to
look at what is contributing to the
neurochemical imbalance that is causing
these symptoms grief guilt and shame are
three other feelings that can coincide
with depression that we may need to take
a look at cognitive distortions can
contribute to depression when we see the
world when we think of the world in
terms of things are against us things
are negative we're helpless we're
hopeless then guess what we're probably
going to feel depressed because one of
the key features of depression is
helplessness and hopelessness when we
are seeing things in all-or-nothing
terms we may feel very disempowered so
we're going to talk about how to help
people adjust their cognitive thinking
styles relationships including self
relationships like poor self-esteem can
contribute to depression if people feel
hopeless to that they're loveable they
don't think they're loveable they don't
think they can change they don't think
they'll ever be lovable unhealthy and
unsupportive relationships can trigger
fears of abandonment and a need for
external validation which often goes
back to that low self esteem can also
contribute to depression
if you don't can't look in the mirror
and say I'm good enough and you're
relying on other people to do that then
when that doesn't happen cuz that's not
gonna happen all the time
you may start feeling that fear of
abandonment fear of rejection and
helplessness and hopelessness to be
loved
physically neurochemical imbalances
caused by a variety of things including
poor nutrition exhaustion insufficient
sleep medication side effects traumatic
brain injury there are a lot of things
that can throw our neurotransmitters for
a loop and contribute to depressive
symptoms and environmentally high stress
environments that
prevent relaxation and rest and increase
hopelessness and helplessness also
contribute to depression one of the
things we want to do when clients come
into our office and this is one of those
culturally sensitive responses as well
as strengths-based
ask them what depression means to them
what caused it where did it come from
what do you think is making it worse
when you say you're depressed you know
some people come in and they say I'm
depressed and okay you know you're
depressed I'm glad you're here tell me
you know how you know you're depressed
what symptoms do you have that tell you
that you're depressed which symptoms are
most bothersome for you and why because
sleep disturbances they may not see that
as super bothersome but excessive guilt
may be something that is causing them a
lot of problems now obviously the apathy
and lack of pleasure is gonna be a an
issue for a lot of people but a lot of
clients that I've talked to who come in
with self diagnose depression report
that fatigue and the psychomotor
retardation or the slowing and heaviness
they feel and sometimes the pain is more
problematic than just not being able to
feel a sense of happiness or joy because
that fatigue and that heaviness and
lethargy negatively impacts so many
areas of their life it's important to
understand what's prominent for the
client how is life more pleasurable
pleasurable Wow prior to you getting
depressed if people have had multiple
major depressive episodes then we want
to know when you're not depressed what's
different what's more pleasurable if
they are experiencing situational
depression as a result of a loss or a
divorce or something we want to look at
that we also want to look at things like
maybe they say both
for I started getting really depressed I
was going out hiking you know five times
a week or something that's a lot of
hiking but you get my points they were
outside and then they got caught up with
a lot of stuff at work and it's been
raining outside so they couldn't go
hiking oh well let's how long has that
been going on because we know that lack
of sunshine and lack of vitamin D messes
up circadian rhythms and is associated
with seasonal affective disorder which
has symptoms of depression so this gives
us some ideas where we can start looking
at what is it that you do when you're
not depressed how is it different now
that you are depressed and how do you
expect life to be different when your
depression is gone what things do you
want to start doing again what things do
you have hope will bring you joy and
that really gets people looking forward
to the end goal what is life going to be
like why is it worth the effort to make
these changes that I need to make or do
this hard work that I need to do because
therapy's hard work and we come back a
lot of times again to neurotransmitters
when the neurotransmitters are out of
balance for whatever reason people are
going to have a variety of different
symptoms your neurotransmitters dopamine
serotonin norepinephrine acetylcholine
gaba serotonin are all important to have
in order to help people feel happy to
help them feel relaxed to help them get
good sleep to help them concentrate and
learn things to help them have
motivation to give them energy Oh
glutamate is the other neurotransmitter
I knew I was forgetting one to help
modulate their pain to help prevent
irritability and agitation and you know
neurotransmitters are also really active
during when that HPA axis is activated
cortisol is released which triggers the
release of glutamate norepinephrine to
prepare the person to fight or flee when
those neurotransmitters are out of
balance for whatever reason
then people are going to have difficulty
with some of these very basic life
issues or life tasks if you will
HPA axis hyperactivity
now remember HPA axis is just the short
term for our body's stress response
system when it is hyperactive it causes
the release of inflammatory cytokines
we've talked about this before which are
really meant to help you you know you
think why is inflammation ever helpful
well generally the HPA axis is activated
when there's a threat and in the
immediate the acute phase of this HPA
axis activation the cortisol actually
acts as an anti-inflammatory which is
awesome and then when the threat is
passed the HPA axis causes the body to
secrete inflammatory cytokines that are
supposed to circulate throughout the
body find anything that might have been
damaged increase inflammation and help
it you know get better bring blood to
that area to nourish it and help it heal
well when the HPA axis is activated for
too long eventually the body says well
we got a repair you know the cortisol
still saying hi but I've got to start
repairing and keeping the body you know
going even if the stress is going to
stay and think about again a soldier in
a war zone at a certain point it's not
like you know they go out they fight a
skirmish they come back and they just
start you know popping back cokes or
beers or whatever they're drinking and
everything's relaxed they are on the go
but their body still has to repair
despite the fact that they can't relax
during that time because it's not safe
to completely relax
when those inflammatory cytokines are
secreted throughout the body one of the
other interesting things that happens is
that it causes symptoms of depression
and we know that there is a strong
correlation between depression and
inflammation and one of the reasons is
inflammation is the body's way of
breaking down tissues and whatever else
needs to happen and creating energy to
repair whatever has been injured so the
body is diverting an energy from other
things like mood in order to help the
person repair their body so they may
feel lethargic they may have reduced
locomotor activity or psychomotor
retardation as the DSM calls it they may
have altered food intake and an
increased need for sleep now they may
not be getting good sleep but they may
have an increased need for sleep and all
of this is because the body is trying to
conserve energy they're saying you know
we got to find energy somewhere even if
you can't relax we got to pull from the
energy reserves in in order to repair
the things that have been broken down
what can we help people do now we're
going to talk about some cognitive
interventions in a few minutes but let's
start by just doing some basic lifestyle
medicine is what it's now being called
in PubMed lifestyle medicine
interventions to help reduce that HPA
axis activation to help the body relax
so it's not using energy staying hyper
vigilant and it can use that energy for
repairing so it's not having to borrow
from a bank account that's already you
know empty get quality sleep and you see
all these hyperlinks in the PowerPoint
these are all the studies that you know
highlight these different points and you
see there's a lot of blue on this slide
because there is a really strong
correlation between crappy school
and crappy mood people need quality
sleep sleep deprivation increases the
risk for major depression and major
depression increases the risk for bad
sleep is this downward spiral we need to
help people figure out how to break that
sleep disturbances contribute to
inflammation and major depression
additionally increased HPA axis
activation alters or creates sleep
deprivation and we we see that after
somebody is sleep deprived they have an
elevated HPA axis let's think about why
this is somebody sleep-deprived they
didn't get enough sleep last night they
wake up their body says it's daytime
it's time to be alert and there their
cortisol levels are kind of out of whack
the HPA axis says oh you need energy I
guess I need to ramp up a little bit to
help you have energy so that HPA axis
goes into overdrive help people create a
sleep routine remind them or educate
them about the problems with blue light
especially within two hours of bedtime
and that includes not only their digital
devices but their overhead lights if
they've got a lot of the cool or
daylight bulbs in their area that they
spent that they spend their evening
hours in encourage them to think about
switching those out to at least softer
white bulbs if not some bulbs that have
a slightly yellow tint to them reduce
stimulants including caffeine and
nicotine before bed include encourage
people to address pain we don't sleep
well when we're in pain whether it is
you know a kink in your neck or your
bed's not comfortable my puppy was up on
the bed the other night and somehow she
managed in king-size bed little puppy
well she's like 30 pounds now but she's
still a puppy managed to scoot me over
to the very very edge of the bed and I
am sleeping in this contorted position
and I am very uncomfortable
I don't want to go through all the
trouble of moving at 2:00 in the morning
or whatever it was so was I getting good
quality sleep at that point no because I
was uncomfortable and that was just mild
discomfort if you're talking about
somebody who has chronic pain
fibromyalgia is something like that then
it may be worse when you have an upset
stomach and I think a lot of us have
experienced that you know you eat
something that's a little different at
night and your tummy gets all rumbly
tumbly before you go to bed and you have
a little bit of a stomach ache that
actually can keep you awake or impair
your sleep throughout the night if you
have a fitness tracker you can look at
your heart rate throughout the night and
you can get an idea about whether you
might have been experiencing pain I know
when I'm over trained or if I'm
experiencing pain for some reason my
heart rate tends to be a fair bit higher
it tends to be about 10 to 15 beats
higher per minute throughout the night
and that tells me that I probably wasn't
getting good restful sleep sleep apnea
is repeatedly associated with not only
increased activation of the HPA axis and
increased cortisol levels but also
increases in depression continuous
positive airway pressure or CPAP
machines have been found to be very
helpful with reducing apnea problems
encourage people to improve their sleep
environment a lot of people don't think
about the fact that they're snoring
spouse may be impairing their sleep and
am i advocating for everybody to sleep
in separate bedrooms no not necessarily
but I am advocating for considering
earplugs if your if your spouse snores
or significant other snores or your dog
snores it is helpful to encourage deep
sleep if you can have a quiet
environment if you live in an area like
New York City or somewhere where there's
a lot of street noise that your windows
can't quite
walk out using a white noise machine can
be extremely helpful because at least
that's that constant noise whether it's
the my daughter has chirping crickets
that she has going on constantly and
that's her white noise and that works
for her she habituates to it and goes to
sleep we want to make sure that they get
rid of allergens HEPA filters really
helpful hypoallergenic pillows anything
to help them not wake up in the middle
of night coughing but they've also found
an association between
alergic rhinosinusitis you know stuffy
noses and poor sleep and depression it's
important that you can breathe when
you're sleeping even if it's not because
of apnea the light in your sleep
environment your sleep environment
should be as dark as possible and if
there has to be light for some reason a
red light something that doesn't have
the blue colors and a yellow light even
better in order to preserve your night
vision and not make your brain think
that it's time to get up if people have
night terrors or for children who are
afraid of the dark having a tap light by
their bed something that they can easily
just reach over and smack you know when
you have a lamp by your bed and you have
to try to reach up and find a little
knobby thing if you're stressed out if
you're freaked out because you had a
nightmare that ain't gonna work but if
you have something that people can just
reach over and smack generally that is a
reasonable compromise to the presenting
issues and temperature there are beds
now that you can get they're expensive
that can help regulate temperature I
don't know how well they work there are
some that have a tube that goes up under
your sheets and blows air you know
basically circulating air underneath
your sheets all night long to keep you
from getting hot and sweaty whatever you
can do to regulate your temperature is
also helpful and what temperature is
comfortable for you to sleep is it's
variable between people I tend to like
to sleep on the much cooler side whereas
some people like 68 to 72 is I think
what the Sleep Foundation recommends
other factors that can impact sleep
shift work it takes people at least 30
days to adjust to a switch and shifts
and this can only be a switch in shifts
of about three hours is not you know
going from morning shift a midnight
shift it's important that when people
are on a shift
that they maintain that shift even on
their days off in order to help
stabilize their circadian rhythms and
that is sometimes not realistic for life
outside of people's work and they're not
willing to do that and it is important
to encourage them to consider what
alterations that they can make or are
willing to make while they are in the
recovery process in order to help them
alleviate their depression can they go
today shift would be you know the first
thing that we might ask if people travel
between time zones pilots are a perfect
example of this they are at much higher
risk for depression because their
circadian rhythms if they start over on
the East Coast and the end their day
over in California their circadian
rhythms are going to be completely out
of whack and then they fly the next day
and they land in Nashville which is
splitting the difference
helping them understand the importance
or the impact of regularly switching
times time zones on their circadian
rhythms and advocating and encouraging
them to figure out how they want to
handle it not ever like I said not
everybody is going to be able to change
something a pilot's not going to be able
to say well I can only fly on the East
Coast but what can they do and empower
them to be creative safety and PTSD I
kind of put those together when people
go to sleep they want to be able to
relax in order to relax they need to
feel safe people who have a history of
PTSD often have difficulty feeling safe
difficulty not being hyper-vigilant
which negatively impacts their sleep
quality and can contribute to concurrent
depression helping people figure out
what they need now emotional support
animals are super helpful with this
there are a variety of other
interventions that can be helpful but it
comes down to asking the person what
would help you feel safe when you close
your eyes interestingly enough
antidepressants can also cause
depression really yes we know that
antidepressants are not the panacea that
you know some of the pharmaceutical
companies might want us to think they
are they work for twenty to thirty
percent of the population but for the
other sixty to eighty percent seventy to
eighty percent the antidepressants may
not be super effective additionally many
antidepressants with activating effects
like Prozac is one that is known for its
activating effects it's supposed to help
people who have depression and fatigue
have some more energy that can disrupt
sleep they found that people who take
those may have less deep sleep because
they are hyper activated the
antidepressants that have sedative
properties some of those antidepressants
like paxil that tend to make people
sleep
may cause may improve sleep initially
which is really awesome but it may cause
problems in the long term due to over
sedation talking with clients
encouraging them to advocate for
themselves with their doctor about
what's working what's not if they're
taking this drug and it helps them sleep
but they just can't wake up throughout
the rest of the next day and they're
pounding back coffee
that's defeating the purpose they're
actually probably causing more problems
encouraging them to advocate for
themselves sometimes doctors will start
with changing the dosing time
my stepfather used to take paxil in the
evening before he would go to bed
because it would help him get sleepy and
then but he would take it early in the
evening so when he woke up 12 hours
later it wasn't still as prominent in
his system and didn't have overly
sedating effects so sometimes that can
work other times people may have to
consider trying a different
antidepressant there are dozens of them
out there and encouraging patients not
to give up if the first antidepressant
doesn't work for them but they really
feel like they need one relaxation is
another non pharmacological way to
reduce HPA axis activation biofeedback
has been shown repeatedly to be really
helpful and it can be as simple as
getting a fitness tracker or a chest
strap that monitors your heart rate and
encouraging people to spend a little bit
of time each day focusing on trying to
reduce their heart rate you know deep
breathing and seeing how when they
breathe deeply and slowly it actually
slows their heart rate they start
feeling a sense of empowerment because
they realize that they can control some
of these symptoms then when they start
feeling anxious they have this sense of
personal efficacy that okay I'm
hyperventilating here I need to belly
breathe and I need to focus on
slowing my breathing down because that
will make my heart rate go down that
sense of personal control over your body
goes a long way towards reducing
feelings of helplessness and
hopelessness
it also helps reduce any HPA axis
activation sooner you know if somebody
gets anxious we don't want them to stay
anxious for four hours because that's
gonna contribute to depression we want
to help them you know recognize that
okay I feel angry I feel anxious
feelings are normal that HPA axis kicked
off just like the fire alarm goes off
and says check to see if there's a
threat but with biofeedback that allows
them to check and then relax
afterwards progressive muscular
relaxation meditation and yoga have all
been shown to help with reducing HPA
axis activation and reducing symptoms of
depression recreation therapy and that
is brought everything from art therapy
to you know playing ball to checkers
anything that's recreation oriented that
can be kind of fun that helps people
divert their attention from a stressor
to something that might be at least
mildly enjoyable has been shown to
reduce HPA axis activation and reduce
symptoms of depression forest and eco
therapy have also both been shown to be
very helpful at reducing depressive
symptoms in adults I didn't see any
Studies on children but basically this
is encouraging people to be exposed to
nature to get away from the you know
digital things to get away from the TV
to get out in nature because nature
tends to go more slowly and people tend
to be more relaxed when they are out in
out in nature out in the forest hiking
you know or even just going through a
park where there's a lot of greenery
they found that there's a pretty
positive correlation between the amount
of greenery and nature
and people's moods so it's kind of an
interesting little side effect with that
people can arrange their home
environments to be a little bit more eco
friendly if you will have a place in
your house most people have a place
where they can have a couple of plants
or a window that looks out onto a
landscape little area it doesn't have to
be this huge landscape but looks out
onto this little garden area that they
can appreciate we also want to look at
other medications side effects and we
often forget to consider these things
when we are doing our assessments with
people we already talked about
psychotropics and there's a lot of other
psychotropics out there the atypical
anti-depression
atypical antipsychotics tend to be
extremely sedating to people some people
will experience rebound anxiety when
they take benzodiazepines which can
contribute to their depression people
are the best judge of what medications
are working best for them and which ones
make them feel worse and we need to
listen however other things that are not
even you know identified as mood
altering drugs have been associated with
increasing people's risk of depression
beta blockers which are used for high
blood pressure statins which are used
for high cholesterol anticholinergic
drugs well you are like we should what
are those those are the ones they're
used pretty ubiquitous Lee actually for
bladder problems Parkinson's disease
COPD asthma and motion sickness to name
a few
they can also be used some for allergies
but it's important to recognize that
some of these physical conditions people
may be getting medicated for we need to
understand the impact that those
medications are having on their mood
they may not be able to stop taking that
medication but we need to help them
identify if okay when I started taking
this statin my mood went into the into
the toilet I know with motion sickness
medication oh that's a doozy on my mood
I can tell you what I can't take it
because it's just I would rather be
motion sick than feel the way I feel
after I take the whatever it is
Dramamine not everybody may be as
sensitive but it's important for people
to understand what causes it and talk
with their doctor about how to address
it opioids depress the system they tend
to slow respiration they make pain go
away but they have a lot of other side
effects when we are not breathing enough
when we have shallow breathing we tend
to feel more lethargic and tired which
you know is one of those symptoms of
depression corticosteroids like
prednisone are increased people's risk
for depression as well as certain
antibiotics who new levofloxacin and
ciprofloxacin ciprofloxacin is also
known as cipro most of us have taken it
or are familiar with it both of those
are uniquely associated with potentially
triggering or exacerbating depression
most of the time there are other
antibiotic alternatives if your clients
are sensitive to that and then birth
control or hormone replacement therapy
and this is specifically for women they
haven't found depressive side effects of
testosterone therapy they do have seen
people with low testosterone
experiencing symptoms of depression but
people who take birth control including
the implanted progesterone birth control
do have higher rates of depression some
people are more sensitive than others
increased encourage people to improve
their nutrition remember the
neurotransmitters that help us feel
happy and focused and energetic are made
from the foods that we eat if you're not
eating your brains
not getting or your body's not getting
what it needs to make those
neurotransmitters well what might be
preventing clients except for just
apathy they may not have good access to
nutrition if they can't drive because
they've lost their license because the
nearest store is 15 miles away because
they are elderly and are afraid to drive
for whatever reason if they can't get to
it
they can't ingest it there are a lot of
places that will deliver fresh groceries
as well as places like Meals on Wheels
that can deliver to homebound people
affordability is another thing that
prevents access to good nutrition your
healthiest foods tend to be the most
expensive unfortunately we need to help
people figure out you know where am I
going to spend my my nutrition dollars
where I'm going to I can spend my
grocery budget and encourage them to
learn about growing their own vegetables
we can grow a lot of things
hydroponically now using the crack key
method is KR 81452
sprout then that is something else they
can consider I don't really like the
taste of sprouts myself they tend to
Tate to taste too rata she to me but
some people love them and if they're
willing
to sprout and eat them anybody can do
that it takes one ball jar and a little
bit of time every day some people don't
have access to good nutrition because
they don't know how to cook and yes you
can buy some frozen frozen dinners and
things like that that are somewhat you
know they have they're colorful but
people may get bored with that and
frozen dinners tend to be more expensive
we can help them learn how to cook rice
and beans we can help them learn how to
cook affordable healthy meals there
they're not that hard to do encourage
people to be and yes planning ahead also
helps with eating more economically and
healthier great point Barrett when we're
hungry
we tend to want something that is really
we can do fast and rice and beans is not
something you can cook quickly unless
you already precooked the rice and
precooked the beans which is what I do
on Sunday on Sundays i precooked pasta
rice beans and lentils I'm vegetarian so
I don't have any meats in there and then
throughout the rest of the week I can
put things together in to make different
types of dishes and casseroles and and
things like that so pre-planning
definitely helps getting people excited
about cooking is is also helpful and
group activities this is a great
activity for recreation therapists to
help people learn different dishes that
they can make different casseroles you
know focus on one dish meals if you want
to so there's less to clean up encourage
people to be aware of nutritional
principles their macros your your
proteins carbohydrates fats you know
those are the big things that you're
considered considering most of our
neurotransmitters are made from proteins
they break down different proteins but
in order to break those proteins down
they need vitamins and minerals like
calcium and iron and zinc and selenium
from the other foods you can't just eat
protein alone people need to eat
colorfully
I have three colors on their plate at
every meal hydration with as little as
2% dehydration and you're not even
really feeling super thirsty when you're
2 percent dehydrated 2% dehydration has
negative effects on your feelings of
vigor your mood your short-term memory
and your attention span drink water
preferably clear water with a little bit
of lemon if you want to encourage people
to brainstorm ways they can start
ingesting more fluid especially non non
sugared non-caffeinated and ideally
non-carbonated fluids aspartame has been
associated and we know that as
NutraSweet has been associated with
increases in headaches and irritability
in certain aspects of the pot certain
segments of the population not everybody
is going to experience it but some may
so if people are have been eating
drinking a lot of aspartame it's
important for them to be aware and if
you look on the side of the drinks like
Crystal Light and things like that a lot
of them unfortunately still do have
nutrasweet in it and it's going to be
important for clients to recognize how
that NutraSweet impacts them their mood
their energy and whether it gives them
headaches people who quit drinking it
they were drinking it you know they had
a weekend that they were out at their
in-laws or whatever they drank a bunch
of it and then they came home and
switched back over to a different no
calorie sweetener
they also may start having headaches and
feeling lethargic wow their body detox
is that aspartame out of their system
again not everybody's gonna experience
this but it is one of those triggers
that is worth noting because it does
affect enough of the population
addictive behaviors alter dopamine
serotonin and norepinephrine levels and
different addictions alter different
neuro
transmitters stimulants are going to
ramp up that dopamine and your
norepinephrine and your glutamate it's
going to get you excited and then you're
gonna crash depressants tend to increase
levels of gaba and dopamine in in our
systems alcohol is kind of interesting
because initially it serves as a
depressant and a relaxant but then as it
exits the body it actually causes
anxiety the body can't keep up it leaves
the body faster then the body can
secrete gaba
to balance it out so we do see people
experiencing anxiety on this detox end
on the on the sobering-up end of
drinking alcohol gaming and gambling
produces pleasure it produces excitement
excitement means increased HPA activate
activation increased cortisol levels you
know you're trying to win that game
whatever it is which can also result in
a sort of a dopamine hangover the next
day if you want to think about it that
way same thing with sex and pornography
it in in an addictive fashion when it's
used addictively when it's used too much
it can alter the levels of neuro
chemicals in the brain which can
contribute to mood disorders thyroids
also impact mood libido and energy
levels as well as estrogen and
testosterone it's not hard for people to
go to the doctor and get a test for
their sex hormones and their thyroid
hormones to see if they are in balance
even if they are in balance and quote in
normal range
not everybody feels great when their
hormones whatever hormone it is is in
normal range especially if it's like at
the low end of the normal range well low
end of normal may be fine for some
people but that may be too low for
others having clients learn the numbers
and learn where they feel good and where
they don't feel good can be important
and having them work with an
endocrinology
that understands that you know those
that normal range is just a guideline
and not everybody feels great they're a
lot of your newer physicians are
starting to understand that those ranges
are simply guidelines cortisol is that
hormone that's released by the adrenal
glands and during the fight or flight
situation when the HPA axis is activated
it helps the body adapt to stress by
increasing heart rate respiration and
blood pressure and by impacting
serotonin and norepinephrine levels
cortisol alters the norepinephrine
levels it alters our serotonin levels
norepinephrine and serotonin are two of
the primary neuro chemicals involved in
depression what are our antidepressants
SSRIs selective serotonin reuptake
inhibitors and SNRIs
selective norepinephrine reuptake
inhibitors so for monkey and with either
one of those it's likely that we are
going to affect our mood normally
cortisol levels increase early in the
morning to prepare us to meet the
demands of the day and gradually
decrease throughout the day this is our
circadian rhythm not only does cortisol
do this but our circadian rhythms
influence are feeding hormones are
sleeping hormones are stress hormones
everything we want to make sure that we
pay attention to that DHEA can also
impact our mood DHEA naturally declines
in people as they age it doesn't mean
that everybody needs to take a DHEA
supplement and the supplements that they
sell over-the-counter are like a hundred
to five hundred times stronger than what
your body actually needs in 99.99% of
the cases this is another one I would
not recommend people trying to
self-medicate they really need to see an
endocrinologist but that aside if DHEA
levels are low
then their libido and sexual arousal may
be low they may be low in motivation
they may not have a great sense of
well-being they may experience more pain
not sleep as well and have difficulty
with memory and immune system
functioning so there's a lot of symptoms
of depression that are related to DHEA
levels so we're seeing how depression
itself is not something that is so
simple to treat have people get a
physical to address what may be causing
any imbalances encourage them to talk
with their doctor about eating a low
glycemic diet so their blood sugar is
not going up and down all the time which
can make you feel fatigued and remember
the less sleep you get the higher your
cortisol will be the more sleep you get
within reason the lower your cortisol
will be deep sleep tends to reduce
cortisol levels your rapid eye movement
sleep not so much so we want to make
sure people are getting quality sleep
hormone imbalances affect millions of
people and symptoms of hormone
imbalances are very similar to
depression and include feeling anxious
tired irritable weight changes not
sleeping well changes in sex drive focus
and appetite causes for hormonal
imbalances include poor gut health
inflammation high amounts of stress
genetic susceptibility you know we know
that that exists and toxicity from heavy
metals and other chemicals if people are
trying to eat relatively healthfully and
if they're drinking enough water they
can minimize some of those things
natural treatments include eating an
anti-inflammatory diet consuming enough
omega-3s getting good sleep exercising
and controlling stress so these are some
of our lifestyle factors that may help
people who experience pain need to help
control that and they can do that with
exercise guided imagery progressive
muscular relaxation we already talked
about that one alternate focus when
we're in pain if we focus on what hurts
we're just going to
exacerbate that if we try to focus on
something else then it can help divert
our attention I always grab towards my
ear when I when I do this demonstration
because when I get an earache that is
like one of the worst pains I think that
exists in the world and if I can focus
on something else
it helps me tolerate the pain a little
bit more tense therapy physical therapy
hydrotherapy which is you know water
baths or hot tubs ice or heat and
hypnosis and and EMDR have also been
effectively used with pain we may not be
able to help our clients eliminate their
pain but we can help them identify
problem solving strategies to mitigate
their pain and help them address their
cognitions surrounding pain if they're
having cognitive distortions like I will
always be in pain I can never feel pain
free or you know any of the
all-or-nothing or exaggeration things I
can't tolerate this we can help them
work on their distress tolerance skills
and their distress distress tolerance
verbage and change what they're telling
themself you know this is agonizing I'm
going to die that's not gonna help you
feel any better thinking of it on a
scale of one to five and how much better
it feels today then it felt yesterday
can help you get through it that's what
I do a lot of times when I when I've had
surgeries I had foot surgery one time
and instead of focusing on how much it
hurt that day I was just focusing on how
much better I felt each successive day
and you know I rapidly actually did feel
a lot better but I had a good surgeon -
anger resentment jealousy and B guilt
that whole family of anger emotions
pushes people away and asserts dominance
or control but excessive anger can
exhaust our stress response system
contribute to negative thoughts we start
seeing everybody as
against us impair our relationships
which could help buffer our depression
and it can even actually cause physical
harm like hypertension and metabolic
disorder we want to help people identify
what is causing their depression if they
are feeling depressed my grandfather I
would say had concurrent depression and
anger issues you know he just he was
angry at the world and he felt hopeless
and helpless and he was in pain all the
time
bless his heart you know if we would
have known then what we know now but he
just he had a hard time seeing the good
in anything because he was in so much
pain and he was so he felt so powerless
helping people change their cognitions
and focus on what they do have control
over in order to address their anger
anger is a natural emotion and if there
is a threat people need to figure out
what am I going to do to address it to
improve the next moment if there's
something worthy of being angry about in
in terms of something that may prevent
you from achieving your rich and
meaningful life then what are you gonna
do about it I'm not saying suppress the
anger I'm saying accept it embrace it
say okay I feel like there's a threat
right now I'm angry what do I need to do
that's going to help me achieve my goals
and is staying angry going to do
anything to help me achieve my goals
encourage people to pay attention when
they're angry what do they notice you
know and and a lot of we have angry days
when you have an angry day think about
you know what did you notice that day
did you notice the clouds did you notice
the birds chirping did you notice
whatever for me
I noticed the best on the baseboards I
noticed the dishes in the sink
I noticed the fingerprints on the window
I can be a little bit
obsessive-compulsive sometimes but I
notice the things that irritate me when
I'm in a bad mood unless I make a
conscious choice to say you know what I
I'm going to spend 10 or 20 minutes
focusing on the good you know and trying
to get myself out of that negativity
spiral help people identify what their
anger triggers are so they can prevent
them or minimize them and develop a plan
to address triggers to feel safer and
more empowered
for example if being on Facebook and
having somebody put something nasty or
on Instagram put something nasty on your
on your wall or on your whatever they
call it on Instagram if that triggers
your anger what one of the things you
can do is make your profile private and
only allow people you know your trusted
people to post on those because
generally your friends are not going to
be hateful and if they are you can block
them but there are strategies that you
can use to keep yourself feeling safer
since you can't control other people
you've got to control yourself and
you've got to control your environment
so your space online so your space at
home so your space at work feels safe
and you feel empowered in those areas
anxiety is the other half of flight or
fight or flight chronic anxiety worry or
just good old fashioned stress will
exhaust the stress response system
causing neurochemical hormonal
imbalances and increasing muscle tension
and pain when our HPA axis is elevated
our body's going now's not the time to
reproduce when it says that because you
know it's time to fight or flee then it
alters our levels of sex hormones and we
already saw that altered levels of sex
hormones can contribute to depression
the body under chronic anxiety adapts to
his excessive stress by often shutting
down a lot of the receptors for the
cortisol because it says I cannot be
this revved up all the time I can't run
this hot all the time or I'm just I'm
gonna break and that causes
glucocorticoid Riz
distance or hypercortisolism which is a
bad thing
anxiety also makes it harder to sleep
which contributes to exhaustion hormonal
imbalances and ultimately depression
grief is another one of those feelings
that doesn't fall nicely anywhere it is
sadness and depression experienced as a
result of loss I'm not saying that grief
is bad people grieve you know that's
okay
we want to help them grieve in a healthy
way and move through that process
towards acceptance happiness you can't
be happy and depressed in exactly the
same moment you can have things going on
in your life that make you happy and
things that are going on in your life
that make you depressed but at one exact
moment I don't think it's possible to be
happy and depressed at the exact same
time so if we want to increase those
happy chemicals and increase our
feelings of happiness and increase the
serotonin and the norepinephrine and do
things that make you happy listen to
comedians watch your kids watch stupid
cat videos I do that you know it's it's
whatever will help you feel happier
negative thinking Styles contribute to
exhaustion and highlight what's out of
your control which heightens a sense of
helplessness and hopelessness encourage
people to try to look put on those
rose-colored glasses and try to look at
the positive try to see the silver
lining in whatever's happening and it
will feel fake at first sometimes but if
you if we can encourage them to embrace
the good with the bad
they will be able to notice more than
just the negative in life poor
self-esteem contributes to self-loathing
shame and a feeling of unloved ability
it negatively impacts relationships
which creates that self-fulfilling
prophecy of loneliness and rejection and
it often causes a person to seek
external validation we want to there are
tons of books out there on improving
self-esteem encouraging people to
examine their self-esteem one of my
favorite activities is to have people
write down all the characteristics that
they look for in a best friend and then
when they're finished doing that have
them examine that list and figure out
which characteristics they have in
themselves you know that's an easy way
to do it where people don't feel like
they're boasting because they're talking
about a best friend and then all of a
sudden I turn it back on them negative
relationships can also take a toll on
self-esteem contributing to fears of
abandonment which maintains high levels
of stress and feelings of helplessness
if you feel like you have no control in
your relationship and you never know if
this person is just gonna leave you know
that contributes to a lot of anxiety
when we are unable to develop supportive
healthy relationships then we don't have
that social buffer and we know from
adult attachment theory that while we
don't have the same type of attachment
that we do to our primary caregiver when
we're a child in adult attachment we do
form attachment bonds with multiple
other adults who fulfill similar
functions they help us feel safe they
help us rejuvenate in our life high
stress environments prevent relaxation
and rest increase hopelessness and
increase stress hormones and decreased
relaxation hormones encourage people to
design a low stress area in their home
and at their workplace or at school is
not the easiest to do at work or at
school but if they can it's great there
may be a park bench somewhere that they
can go sit on or something identify ways
to reduce the stress in the environment
in both places in by adding positive
sounds reducing negative noise avoiding
interruptions having good lighting
that's positive uplifting and
eliminating anything that might trigger
thoughts or feelings of a negativity and
adding things that will add positivity
whether it's pictures or smells or
colors or a favorite soft fluffy blanket
whatever it
depression is the cluster of symptoms
created when there is a neuro chemical
imbalance in the brain that's what it is
what causes the imbalance can be
emotional it can be cognitive it can be
physical interpersonal environmental or
some combination of the above and we
want to help people recognize that
depression is a symptom of an underlying
problem with their neurotransmitter
balance and we need to figure out what's
causing those neurotransmitters to be
out of whack
part of the strengths based approach
means helping people see what they're
already doing to prevent or deal with
the symptoms and examining all of the
causative factors recognizing the
reciprocal nature between things like
sleep and environment and mood
are there any questions
all righty everybody that gives you a
fair number of probably unique ways to
think about approaching depression
treatment plans with clients and I will
see you now remember next week we're
doing Monday and Tuesday again because
I've got to go to Chicago again I'm
almost finished with that contract but
so Monday and Tuesday for next week
everybody have a great weekend and try
to stay warm it's supposed to get to 16
here tonight
you
between writing notes filing insurance
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