Depression - It Must Be Treated, WAWWA | Episode 194

This is Hans Hansen, MD, and I'm the host of this podcast. This series is about pain, addiction and depression. I hope to bring value to not only healthcare providers, but also to those that are suffering from pain or addiction or depression. 

The pain addiction and depression mechanisms are virtually the same. The neurobiology centers of the brain, a part of the brain right behind the ear. They communicate with the prefrontal cortex, which is where pain is interpreted, where addiction has its feelings and where depression lives. 

This is the important thing that a lot of people don't understand. They take depression as a moral failing, or a family shame. It's not. It is part of reality. 

Well, what is reality? Reality is, everybody gets depression, everybody across the board, including animals, and other creatures that are amongst us.

Sometimes we'll recognize it. Sometimes it's well covered. Sometimes it's part of an individual's personality. I call out the personality of pain, personality of addiction, personality of depression.

To have depression is to be normal. Clinically, when depression interferes with activities of daily living, quality of life, or sleep capacity, it leads to secondary symptoms like pain, dysphoria, and people just not feeling right.

It's then something we've really got to look at, sometimes treat, sometimes aggressively. Because pain, addiction and depression are intimately an evolving exercise that can lead to significant outcomes, even harming yourself or others. 

Depression in Infants

Depression is what I'm going to talk a little bit about today. Depression can be broken down. Sometimes people are born with it, you can see it in infants or very young children. You can see kind of the funk. And sometimes they grow out of it. 

Depression in Teens

And then there's the adolescent and teens. In the adolescent and teens that tends to be more of a problem. Especially the influential teens with a primitive brain. The brain fully develops at 25 to 28 years. Sometimes not completely, sometimes indirectly related to other problems, the teenage brain can lead to disaster. It's very sensitive, we all know motivation, drug use, alcohol use, loss of socialization, which we see across the board. But with teens, they're so influenced negatively by social media, where everything is perfect. Everybody has a perfect snapshot, that they unrealistically believe that if their life isn't Instagram, Snapchat, TikTok, or something like that, that they're not successful. They (believe inaccurately) that they are not successful as an entity, and they're not successful in life. 

They can be bullied. Teenagers and others in that kind of age group sometimes don't have that filter, that discrimination, that leads them to truly understand that what they're doing isn't necessarily wrong. It's part of the growing process, the aging process, the mellowing process, as they move from teen adolescence into adulthood. 

Depression in Adults

Adult depression is a little different. Again, socialization is a problem at any level of depression. You can have memory disturbances, you can have sleep disturbances, concentration, feeling tired, it's going to affect at least 5% of the population across the board. And we don't just see it in America, we see worldwide. So this is one of those things that we're born with neuro biologically, it can be biochemical. It can be traumatically-related, traumatic brain injuries. PTSD is very real. It's also related to what you're born with, a genetic predisposition, or your ability to beat up on yourself. Sit on the internet, substance abuse and that sort of thing. It affects personality. It can lead to shame, socialization issues, you can pull back from your family and other loved ones when you shouldn't.

It can be organic, of course. But it can also be treated. If it's related to an illness, treat the underlying cause: Alzheimer's, anxiety, diabetes, exogenous obesity, and feelings of self worth and loneliness. 

And the quality of life can be directly affected by self perception. It isn't you. Be very open with your healthcare provider. If you have a lack of interest in stuff and you're finding yourself pull back or you're not eating or not eating right, or eating too much, or something's not right there, or your sleep is a mess, or you're thinking about substance abuse, and all things that were enjoyable once. are not really enjoyable. 

Sleeplessness is not a pill, it's interference with activities of daily living quality of life, and it has to be diagnosed.  So that's a sleep study, I would guess.

Now, I think depression that often gets overlooked is pre and postnatal. There's an organic base for that, because it happens so commonly. So depression is real, the brain is a living and an important organ. 

Manic Depression and Psychosis

Now, let's go to one side here, and I'm not going to go into too much of this right now. But there is a psychotic disease. I don't think that many people would deny that they've seen somebody psychotic at a certain time. Manic depression can lead to psychosis. Drug induced, medically induced, the biologically induced; there can be all sorts of organic reasons. 

But the bottom line is we have to be aware on a day to day basis of not only what type of depression we have, but is it related to panic, PTSD, bipolar disease syndrome, depression lead from traumatic disease.

It can be social, in other influences just around you. 

I'm not going to go into the weeds too far on depression, because it is deep. It's one of those subjects that we have to talk about. You can't live in darkness and you don't have to live in darkness. 

Jung and Freud and Depression

Jung, he goes way back and so does Freud. Freud had depression, how did he treat it? With cocaine, and he treated it heavily with cocaine. Jung, in Europe, people with alcoholism used to go to see him. But Jung wasn't a big fan of alcohol treatment, narcotic treatment. 

Some even described their gambling problems. Their problems with seeking out obsessions. Jung looked at it very differently than a lot of other folks do contemporarily.

Medications for Depression

Let's get into medications. There are different types of medications that we can get into and that's going to be a whole other discussion at another time. Drugs can be important, they can be pivotal and they can be a cornerstone. 

The different classes of drugs for the monoamine oxidase inhibitors to the tricyclic antidepressants through some of these unique combinations we have today are beyond a very straightforward conversation that we're going to have here on depression. This is a beginning discussion. I've talked about depression in many different senses. 

I think that the first step you have to take in any discussion of depression is letting folks know that everybody gets it to some degree, from a limited degree  to a significant degree that requires treatment. 

Talk it Over with Your Healthcare Professional

You have got to talk it over with the healthcare professional, don't wait on it. That's really important. Talk it over with a healthcare professional, that is so important. For the darkest side, harm to self or others - we have treatments out there. 

I hear so much about SSRIs, serotonin selective reuptake inhibitors, and SN, that's norepinephrine, SNRIs. I hear some of the new hype about psychedelics like psilocybin mushrooms and use ketamine. I've done a whole bunch of ketamine infusions, and it's very helpful. It's patient selection. 

Unfortunately, so many of the medications are not as effective as we want. Mixed depressive disorder is called MDD. In reality, between, I guess, 60, 70, 80%, depends on what you read, response with the meds, so there are other agents and other things we need to do.

We can't get away from talking about depression without talking about getting up and getting moving, socializing, getting out, exercising. I'm telling you, we talked about it in the science section. BDNF, brain derived neurotrophic factor, we see that elevated with ketamine. We know SSRIs, SNRIs, a combination of those etcetera. We don't even really know how tricyclics work, but they help with pain and sleep. And sleep is key, especially stage four. 

We're going to touch more on depression, situational depression, anxiety, we're going to touch more on medications. I have to do a whole section on medication. Care must be taken to not influence an individual's decisions when they're having discussions with their health care provider. 

Get Help from Your Healthcare Provider 

Go to your health care provider. Listen to those folks. Take your history with you and take in a good open. Take in willingness to kind of do some things and listen to suggestions. Have a willingness for change. 

You know, it is hard to lose weight, it is hard to get active, to exercise. It is hard sometimes to socialize, especially when you're feeling in a funk. You don't feel like it now. Say you just had a bad diagnosis for something or say you've got early dementia or Alzheimer's, or a loved one does. The best thing you can do is keep them moving. 

I'm going to continue with pain, addiction and depression with other discussions on depression later and also add situational depression and anxiety. There's so important to talk about. But we have to take it in small bites. And understand that yes, it's hard to come to conclusions over a podcast. but it is so important for you to work with your healthcare provider and to be very open and open minded. 

This is an informational channel. That's what we do here. It's not medical advice, go to your health care provider, especially with this tough diagnosis. And we'll go from there and figure out what we need to do next. 

Take a look at a few of those older podcasts and default default mode network and other podcasts about ketamine and that sort of thing. Go to pain information.com.We've got a health and history form there. And it's not a bad idea to be organized when you go see your healthcare provider. It is, I think, a good form that I've used for a while. I hope you find some value with it. If you have any feedback, we're loving the feedback. It really helps me.

Wish you the best. Don't hesitate to make a move sooner than later. If you just don't feel right, helpless, hopeless, there's help for you out there.

Above is taken from Pain Information podcast episode #194: Depression - It must be treated, WAWWA" by Dr. Hans C. Hansen MD