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Melanie Cole (Host): According to the World Health Organization, depression is the most common illness worldwide and a leading cause of disability. While sadness and feeling down are pretty common; if that persists, and affects your quality of life, it may be time to seek professional help. My guest today, is Vicki Angstmann. She’s a primary therapist in Geriatric Behavioral Services at Gibson Area Hospital. Vicki, let’s start with a working definition of depression and while you are telling us that; tell us a little bit about the prevalence and the societal impact of depression in the country.

Vicki Angstmann, MA, LCPC (Guest): The technical definition is it’s a mental health disorder that’s characterized essentially by a depressed mood or a loss of interest. And it’s specifically one that interferes with your daily activities. So, we all feel sad. We all feel down in the dumps. But if it persists for a couple of weeks where it’s difficult to get out of bed, difficult to go to school, go to work, that sort of thing; that’s when we need to look at maybe getting some help. Depression is a very treatable mental health disorder and the economic detriment is that people don’t go to work. People stay home and so it has a great economic impact. And not to mention the cost of insurance and compensation that way. Does that make sense?

Host: It does. Is there still in your opinion, a stigma around seeking help for depression?

Vicki: There is a stigma not just for depression, but all disorders related to mental health. And people are afraid to get help because just people might think they are crazy. We don’t like to use that word crazy, because it has a negative connotation, but what are people going to think. If I seek help, will I end up in a hospital, will I not be able to do things that I want to do like if I don’t want to go to the hospital, but I’m being forced to go to the hospital. There’s an incredible stigma. Part of it’s the mystery of the help and not knowing what that looks like, but a lot of fear and what people might think of me and how does this affect me. Is this kind of on my permanent record? You know we all talk about permanent records in high school or that sort of thing. Is this diagnosis going to follow me the rest of my life?

Host: And what a shame for the people that are suffering from depression. How does it differ from anxiety or sadness or grief? How do we know that it’s truly depression as opposed to just feeling sad or blue?

Vicki: Well the biggest thing is how long it continues. In order to be diagnosed with a major depressive disorder it has to continue for about two weeks where it is consistently every day for two weeks. We all can feel sad and wake up and like I just kind of feel blue today or I feel down today, but it may not last two weeks. That two-week timeframe is the big thing and how long it - basically how long it lasts. Grief is something that can be definitely a stressor for a depression that by having these life events happen; can cause you to feel depressed and of course, losing someone or something that’s close to us is a stressor for a depression.

Host: As we are going to talk about some of the warning signs and symptoms; are they the same for children and older adults? How does depression and even anxiety, how are they different in children, adolescents and older adults?

Vicki: Excellent question. The general symptoms for depression and this can go for everyone that they don’t feel like they want to do anything, they might feel guilty, a loss of interest in activities or pleasure, persistent sadness, crying, irritability, inability to think and concentrate. Now in older adults, oftentimes those symptoms are perceived as the normal part of aging. Oh well, grandma is just irritable because grandma is old, or grandpa doesn’t want to get out anymore because he’s old. Oh, they are supposed to move slower, because they are old. And the forgetfulness and inability to concentrate is often confused with the normal part of aging and oftentimes people are afraid that that may indicate that it’s dementia and depression can often present itself looking like dementia in older adults when really, they have a very treatable mental disorder in depression.

In children, you’ll notice some problems or some difficulty at home. They may be more emotional. They may threaten to run away. They may change in eating habits. They may have a sudden loss in things that they are interested in like Instagram or Snap Chat or video games, things that used to bring them joy. In school, you’ll see that they have a decreased interest in activities, or their grades drop, or they don’t want to hang out with their friends anymore or extreme sensitivity to rejection from peers, wanting to stay home from school or more trips to the principal’s office can all indicate that there might be something going on with a child or adolescent.

Host: Before we talk about what type of help is available; there are a few types of depressions. It’s a big spectrum. Speak about a few of the different types that we might have heard about, SAD, or post-partum. Tell us about some of the different types.

Vicki: There are – we often think of depression as just being kind of like one diagnosis that if you have depression, you have depression. Oftentimes, people who have just given birth might feel a depression or not wanting to get out or feeling sad. Season affective disorder known as SAD is something that the longer the night is, or the shorter the daylight hours, there is more depression. So, the sunlight is definitely linked to that. We see that people get more depressed in the wintertime than in the summer. Some hormonal changes like with teenaged girls or women going through menopause, all of these can affect how we feel and how we react. And there’s many different – you used the word spectrum, that depression can go on a spectrum from mild to moderate to severe. So, I mean it’s just a whole gambit that really, we look at in trying to pinpoint that down and that’s where a therapist and psychiatrist can help out with that.

Host: Tell us about what you can do for people that are suffering somewhere on that spectrum, some form of depression. Tell us about some of the different treatments that are out there.

Vicki: There are a number of different treatments. Psychotherapy which is kind of like – can be a scary word in itself, but we’ll just say therapy where you get – you come in and you talk to a therapist or a counselor and they help you just kind of talk things through and maybe seeing things from a different perspective or gain a better sense of understanding. So many people when they are depressed or anxious, have a thought pattern or a belief that this is how something is and generally, it’s more negative like oh I can’t get a job because something is wrong with me. And talking with the therapist or a counselor helps them to see past that negativity. There’s also meeting with a psychiatrist who oftentimes is our person for prescribing medications and antidepressants and antianxiety medications, which is a wonderful compliment to therapy – talking with a therapist because the two together is really very, very helpful. 

Host: Sure, and those are very effective treatments and you explained it so very well. Tell us a little bit about Tele-Psych, and outpatient therapy and as opposed to intensive outpatient programs and inpatient therapy and when that might be required.

Vicki: At Gibson Area Hospital, we have what we call Tele-Psychiatry, and which is a very beneficial and it’s actually something that is very helpful because psychiatrists are in short supply. So, what Tele-Psychiatry is is actually the patient gets to talk with the doctor over a TV. It’s a very secure, HIPAA compliant. So, there’s no chance anybody can kind of tap into it and hear the conversation. And they get to have that one on one time with the psychiatrist. Now the psychiatrist isn’t even in Gibson City. They may be located in Chicago, St. Louis, Indianapolis, Los Angeles, wherever, but because of that shortage, this is a way that we can get help to our rural clinics. And Tele-Psychiatry is actually something that has been very welcomed by younger adults, adolescents because that’s where they are growing up, that’s where they are connecting with.

Now inpatient is actually where somebody goes in and stays in the hospital, that they at a greater risk for suicide, risk for harming someone else and they just need a higher level of care. What I do is an intensive outpatient program which is kind of like that bridges that gap between outpatient where they see a therapist once a week or inpatient where they are staying in the hospital. Intensive outpatient is something where they come to the hospital frequently, like my program is generally three days a week and we do group therapy three times a day. So, it’s a higher level of care than traditional outpatient and lower than inpatient.

Host: What do you think of some of the herbal remedies. People hear it in the media, and they go to a health foods store and they see St. John’s Wort. Are there some things beyond therapy and treatment that people can look to and not only herbal remedies, but exercise, sleep quality, nutrition, yoga, meditation, fish oil? Speak about how some of these can help as an adjunct to therapy to help with depression.

Vicki: Well I’d really like to touch more on the exercise and yoga. And as far as more of the herbal remedies that you take internally, I would actually prefer to defer that to an MD or the psychiatrist to make sure that there isn’t any interaction with any other medications. But exercise is an incredible antidepressant. It releases endorphins and endorphins are something that is a hormone and some people have referred to it as a happy hormone. So, just by doing exercise, doing yoga, stretching, any of these things helps with endorphins. But yeah, those are all great things to do. Just getting out. Sitting out in the sun with actual sky, actual grass, trees, can elevate your mood and decrease your depression.

Host: That’s great advice, really great advice Vicki, so as you wrap up; discuss some of the barriers that might keep people from getting help. We mentioned stigma earlier. But people are sometimes have the failure to recognize their own symptoms or they are afraid. Speak about that a little and give your best advice for people who aren’t sure if they are depressed or someone that they love is and what you want them to know about seeking help and how it really is the most effective way to get past it.

Vicki: I think you hit on it right there. The stigma is one reason which is a barrier to seek help and failure to recognize that you are actually in depression. I hear that time and time again from patients is I had no idea I was depressed. I had no idea that what I was feeling was actually depression. So, what I would recommend is just to increase your awareness and understanding what the symptoms of depression and anxiety are. Because once you know that, you can do something about it. And I would like to just offer that my best advice is one, increase your awareness, figure out the symptoms of depression and anxiety for yourself, for your loved ones. If you notice that somebody is not acting or things aren’t quite right with yourself or someone else, just gain awareness. Look at – go to like the National Institute on Mental Health on the internet. Go to – talk to your doctor. And there’s all sorts of resources to gain understanding and once you gain understanding; it’s much easier to seek help and you’ll help also to decrease that stigma. The more we understand and the more that we are aware, decreases that stigma and more people are able to get help.

Host: Absolutely true and thank you so much Vicki for coming on and explaining, sharing your expertise and explaining something that many people don’t want to discuss because as you say, they may be too embarrassed or even not really aware. So, it is all about awareness and education. Thank you again for joining us. For more information please visit www.gibsonhospital.org, that’s www.gibsonhospital.org. This is Melanie Cole. Thanks so much for tuning in today.