Latest / The Virtual Couch / Smiling But Sad: Decoding Persistent Depressive Disorder, Dysthymia, “Eeyore Syndrome” w/BONUS Medication Analogy and Thanksgiving Talk Topics

Transcript

Smiling But Sad: Decoding Persistent Depressive Disorder, Dysthymia, “Eeyore Syndrome” w/BONUS Medication Analogy and Thanksgiving Talk Topics · The Virtual Couch

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okay, let's be honest, sometimes the world of mental health feels a little bit
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like trying to crack a code of an overly complicated spy novel because you will
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walk into your therapist's office and you're thinking, I think I'm a little sad.
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And then suddenly you are navigating through PDD, which surprise is not PMDD.
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One is a persistent drizzle of sadness and the other is an
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emotional thunderstorm that happens to be synced to a lunar calendar.
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And then somebody throws in ODD, not the odd that you're thinking, but we're
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talking oppositional defiant disorder.
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So now you're wondering if your toddler might be staging a coup.
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And don't even get me started on OCD, DID, NPD, and BPD, because if you say
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them all together, they start to not really sound like diagnoses, or you
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suddenly just realize that you're being invited into some sort of secret society.
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And I am sorry, but If you are a child of the 90s or maybe in your early 20s in the
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90s like myself, most likely your brain just screamed, are you down with OPP?
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And don't even dare look that up, what that means now that you have
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the internet or else you will D.
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I.
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E.
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thinking that you were singing that out loud, maybe with the kids in the car,
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because I guarantee that you did not know.
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That that was what it meant.
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And before you know it, you're starting to spell out H E L P in
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metaphorical Morse code , because all you really wanted was to feel G O O D.
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But, at least you know one thing is for sure, the DSM, or the Bible of
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Mental Health Diagnoses must stand for definitely so many meanings.
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And that is where we come in.
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To untangle this alphabet soup one letter at a time.
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You're not crazy, you're just stuck in the middle of a very
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confusing game of Scrabble.
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Or words with friends for the modern day audience.
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And since this is a mental health related podcast, yes.
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People I played with several years ago, there is an app that helps you come
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up with words based on your letters and sure, maybe I used it just a time
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or two, or actually a lot, which this confession, because the very need for it
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came from a little bit of an intrusive thought, would technically qualify
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as a form of OCD, or P OCD, or pure OCD, but the confession itself seems
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a little bit more like scrupulosity, which does sound like a fun board game.
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Hey everybody, we're heading to the cabin this weekend.
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Somebody make sure and grab the scrupulosity.
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I've always wanted to play.
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And that tangent, my friends, is definitely a form of
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my own very lovable ADHD.
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Hey everybody, welcome to episode 432 of The Virtual Couch.
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Hey everybody, I am your host, Tony Overbay.
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I'm a licensed marriage and family therapist and host
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of a few other podcasts.
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I would highly recommend you go check out Waking Up to Narcissism.
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Especially the, the episode that I did last week, and I will include that in
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the show notes, and I will just leave it at that, a little bit of a mystery
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there, but a funny thing is when I first started writing down notes for
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this episode, it was quite a while ago, a long time ago, and what I was
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really thinking I would be talking about is a condition called dysthymia.
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And it's something that isn't mentioned a lot.
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It's it's in the world of depression, but it's a very, persistent,
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consistent, sad or depressed feeling.
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But then when I finally sat down to write some notes to cover in this
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episode, I learned that all the way back in 2013, dysthymia was changed to
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persistent depressive disorder or PDD.
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And that was with the release of the DSM 5.
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And today's episode, We're going to cover some different takes on depression
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and , I think could really help anybody listening who maybe has felt down or
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sad or lacks motivation or, Maybe more significantly has for quite some time,
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or this might help you understand somebody that you care about a bit
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more, which might provide you with more opportunities to connect or empathize.
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And if I'm being honest, this one goes out a little bit to
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the psychology or therapy nerds, especially heading into what in the U.
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S.
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is Thanksgiving, where you will be around a lot of extended family.
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And right now there might be some challenges talking about
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a lot of things coming off.
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What was a pretty pretty intense election cycle.
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Think of this as my gift to you.
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Some fun facts that you can share around the Thanksgiving table as well.
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So we will talk about those feelings of melancholy that you might have been
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experiencing for a long period of time, what to do about it, but stay tuned as
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well, because I want to talk a bit more about how medications work in the brain.
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And I am not a doctor, although people have written it on, checks when I used to
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get more checks, but I am going to explain things the way that I understand them.
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Fact checked, of course, by the internet because what actually
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is a serotonin reuptake inhibitor and why this constant need to
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reuptake things in the first place.
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And while dopamine and serotonin definitely have better PR teams on their
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side, how about this this norepinephrine how does that come into play?
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And one more thing that I think is really fascinating The time when
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this type of depression was viewed as a personality disorder and then how
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significant it was when it was suddenly changed to a mood disorder because those
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are two very, very different things.
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So first, let's go back to this DSM just in case you've never heard about it.
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So the DSM, it stands for the Diagnostic and Statistical
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Manual of Mental Disorders.
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And that is a comprehensive guide.
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It's published by the American Psychiatric Association or the APA.
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And it outlines standardized criteria for diagnosing mental health conditions.
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It was something that I was supposed to get to know.
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Oh, so well back in grad school.
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And I did own one kind of put a period there, but the latest edition was
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the DSM T R the text revision, and it was released in March of 2022.
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And I did a little bit of research on when is this DSM six going to come out?
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And who knows, because it takes a long time to put together all the
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information, but it's significant because with each release of a diagnostic and
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statistical manual of mental health disorders, then , the names change, the
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diagnoses change, the criteria change.
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And as somebody who works a lot in the world of narcissistic traits and
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tendencies and emotional immaturity, there is a part of me that really
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anticipates some changes there where we're going to talk a lot more about
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emotional immaturity and what that looks like maybe on a spectrum.
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But you've got the DSM, and then this isn't to be confused
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with another diagnostic tool, which is the International
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Classification of Diseases, the ICD.
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And that is a global diagnostic tool.
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It's developed by the World Health Organization, and that
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one covers all health conditions, both physical and mental.
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So the ICD 11, that's the latest edition, and that was adopted by the World Health
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Organization member states in May of 2019.
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And then it came into effect on January 1st, 2022.
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And if you are keeping notes, it beat the latest revision of
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the DSM by a mere two months.
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So I can only imagine someday we'll see a harrowing lifetime movie on the intense
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few months that led up to who can get this revision out sooner so that, I don't
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know, so they can release it sooner.
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But in the mental health field, do you DSM or do you ICD?
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And to me, it definitely feels a bit like the mental health world's
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version of things like the metric versus the imperial system debate.
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You know, in the U.
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S., we proudly cling to the DSM, the Diagnostic and Statistical Manual, to
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diagnose these mental health conditions.
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And meanwhile, the rest of the world is out there using the ICD, or the
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International Classification of Diseases, because again, it covers everything,
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physical and mental health alike.
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And I think that explaining the difference is important.
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Like Trying to describe distance to somebody who uses kilometers
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while you're stuck in miles.
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And I feel that I have an advantage just as a runner because I've run enough
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five and 10 Ks and even 50 and a hundred Ks to convert the kilometers to miles,
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and I did once learn that to get to Fahrenheit, you basically double whatever
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the temperature is in Celsius and you add 30 and it's actually pretty close.
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But you can't quite do the same thing when it comes to trying to
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explain mental health diagnosis.
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So when it comes to the DSM versus the ICD, it isn't so straightforward because
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you might tell somebody that they've got generalized anxiety disorder in
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DSM lingo, and they'll nod until they realize that their ICD using doctor or
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mental health professional calls it F41.
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1.
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Same condition, different branding, kind of like yards and
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meters or inches and centimeters.
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Both systems get you to the finish line, but the conversion can leave your
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brain kind of sprinting in circles.
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And like the metric system, the ICD is a global standardized and frankly
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it does make a fair amount of sense.
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But here in the U S we stick to our DSM because well why not make mental health
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a little more uniquely American, right?
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So back to today's topic of dysthymia.
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Or also known as Persistent Depressive Disorder.
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So the goal of the change, as much as I could tell, was hopefully to simplify
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and clarify diagnostic criteria, but also to do a little bit of diagnostic
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housecleaning by combining two of these previously very distinct diagnoses.
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So the first was this Dysthymic Disorder.
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So this was chronic, low grade depression, lasting at least two years.
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Or one year for kids and adolescents and then chronic major depressive
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disorder, . So the hope is that by merging both of these conditions into
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this persistent depressive disorder, the DSM five would start to emphasize that.
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really the chronic nature of the symptoms instead of the severity or
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the intensity at any given moment.
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And then this update also hope to reduce confusion and then provide
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more of a cohesive framework for treatment and for diagnosis.
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And I think that's really helpful because you first need to really try
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to understand what is going on in order for you to start looking at treatment
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options, but I'll be honest, I'm still stuck in this world of dysthymia.
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And I think it's largely because of the population I tend to work with.
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And maybe it's also because I don't take insurance.
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So the need for an official diagnosis hasn't really been as pressing.
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And as a big acceptance and commitment therapy guy I found that a lot of the
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people that I work with that, although definitely not all feel a little bit more
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judged when they're given a diagnosis.
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And that judgment often leads to shame and there is no place for shame in my dojo.
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It might walk in, but it is not going to be walking out on its own two legs.
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But with that said, I've also worked with plenty of people who feel that
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receiving a diagnosis has been incredibly validating and it's helped them feel less
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crazy and more understood and less alone.
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And it's given them more of a sense of being seen as something that they
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can tangibly Google to learn about and process and to begin to navigate.
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And.
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With that concept in mind, I do have to say, I think it's really fascinating
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when I hear the number of people that I'm working with that have worked with other
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therapists or a doctor, and then , they talk about experiences where they've
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gone in and they have turned to Dr.
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Google, sure, and they bring that into the therapy office and how some
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therapists are very offended and they're saying, well, let me try to understand
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where you're at and then I'll be the one that can make this diagnosis where in
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reality, it's the world that we live in.
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If that person has never doctor Googled anything, I don't know.
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I don't know if I believe that person or not.
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That's a me thing.
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Sure.
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But.
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I think it's one of the best things that you can do is if you're walking into
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your mental health professional, even your doctor and you're saying, of course,
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I've been looking this up and this is what I found because now here's our muse.
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Can you help me make sense of this?
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Maybe calm down from it, or maybe this is a place to start because you
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will understand that that is where that person . Is that in their mind?
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So I just think that's a really fascinating concept.
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So if you are looking things up because you're the only one that knows what
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it feels like to be you, well done.
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Yeah.
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And then take that in to your mental health professional
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and, be open and honest.
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The therapist hopefully is trying to provide a safe place for you to be open
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and honest, but I also want to talk about the origin story of dysthymia because we
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can explore whether the rebranding in 2013 was a win for visibility or understanding
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or whether the new PR department did it.
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Basically a disservice because either way, we'll look at how this change
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might have helped people get the help they need and more importantly,
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the help that they deserve.
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So I first want to go to this Encyclopedia Britannica website and having just
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turned 55 just a couple of days ago, when I think of encyclopedias, I'm
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literally thinking of the physical, hardbound books that every family had a
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set of, that had a letter on the spine and within that book, you could read.
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It held everything that you ever wanted to know about things
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that begin with the letter.
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I know, well, you name it.
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And now, warning.
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This is purely for conversation around the Thanksgiving table.
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Because if you are under 30, ask which set of encyclopedias your
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parents or your grandparents own.
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Because back in the 80s, owning a set of encyclopedias was more
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than just a practical decision.
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This thing was a statement.
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Because having a full collection of world book or encyclopedia Britannicas
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on your shelf was kind of like telling the world, or at least your neighbors for
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sure, we are a family of intellectuals.
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Thank you very much because they were status symbols.
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I mean, you probably displayed them in the living room like
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a trophy of academic ambition.
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Now, they might take a look at the kids then and say, I guess it's
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not just the books themselves.
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And I believe we were world book folk.
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I think the rich people had the encyclopedia
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Britannicus, but I don't know.
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Encyclopedias were expensive.
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A full set could cost several hundred dollars, which I looked up that
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that is easily the equivalent of a few thousand dollars today, but
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thankfully they had installment plans.
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They had door to door encyclopedia salesmen.
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That is a true thing, but that made it possible for middle
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class and even some lower class families to afford this investment.
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And they were looking at like an investment in their children's
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education, but they weren't just books.
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Because they were essential for learning.
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Teachers leaned on them as trusted sources.
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Because if you had to write a book report, and you couldn't get to a library,
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or didn't have one anywhere close, you were turning to the encyclopedia.
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It's such a trip to think about that.
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So they would assign reports and projects that sent students running through
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their volumes for facts and figures.
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But then also, it was a little bit easy to get caught for plagiarism.
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Theoretically.
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Not that that ever happened to me.
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Writing one, I think about a Fox or something when I was in middle school, but
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for kids, the encyclopedia was basically an analog Google, except it weighed
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a lot and it required you to actually flip pages, meticulously crafted and
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they had these durable bindings and then the high quality glossy paper, and they
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were designed to stand the test of time because I think it's so interesting.
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Again, who knew that the internet was on its way here.
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Many families pass down their encyclopedias, like heirlooms,
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ensuring that the next generation had access to this amazing treasure
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trove of knowledge, which would now be outdated and still 50 pounds.
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But let's get back to today's topic of dysthymia are also now
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persistent depressive disorder or PDD.
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. Because the condition's a bit like depression's quieter, longer lasting
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cousin who never, ever, ever really leaves the party and just keeps
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kind of making really sad comments.
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Because PDD is defined as having symptoms of depression that stick
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around for at least two years, or again, just one if you're a child or a teen.
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And while the name Persistent Depressive Disorder might feel new,
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it officially made its debut in 2010.
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2013, but the condition has been hanging out in the human psyche
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for a very, very long time.
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So let's take a brief stroll through history because long before modern
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psychiatry, the ancient Greeks had their eye on this condition of dysthymia.
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So you have a Pocrates who is one of the OGs of medicine, but he described
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it as a melancholic temperament.
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And this was as far back as 460 BCE, and that's where he used the Greek word
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dysthymia, which meant despondency.
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So you've got somebody that just looks like they are
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just checked out, despondent.
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Now you fast forward to the 19th century, and you've got a German psychiatrist
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named Carl Friedrich Fleming, and he then dusted off the word dysthymia,
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and in 1844, he used it to make a distinction between mood disorders, And
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then other mental health conditions.
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And you've got 1863, Carl Ludwig Kahlbaum took it a step further
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and he described dysthymia as a chronic form of melancholia.
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So basically it is this long haul version of feeling down.
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So by the time that the DSM II rolled around in 1968, Now, you've got long
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term depression and that was labeled as neurotic depression, which is
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such a trip because I think if you hear the word neurotic now, I would
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imagine it comes with some baggage, some real negative implications,
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but here's the thing, neurotic depression was considered more
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of a personality disorder.
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Then a condition with treatable symptoms.
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So when things shifted with the DSM three in 1980, when chronic depression got a
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bit of a glow up and became dysthymic disorder, a term that acknowledged
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the condition as a disease was the way it was viewed, rather than this
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intrinsic flaw in your personality, a disorder, a personality disorder.
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And then in 2013, the DSM combines the stomach disorder with another diagnosis.
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Chronic major depression, and that gives us that persistent depressive disorder.
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So here's where it gets really interesting, . What
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is a personality disorder?
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Because I work with people that are, trying to determine if they
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or their spouse has things like narcissistic personality disorder
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or borderline personality disorder.
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Or antisocial personality disorder.
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So personality disorder is a mental health condition that affects the way
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a person thinks, feels, and behaves.
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But it's not about having a bad personality, but it's rather, it's
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about the patterns of thinking and acting that do cause these problems
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in relationships or in your work or in your daily life, because those
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patterns are typically long term.
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They are ingrained, they're factory settings, and they don't
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typically change much over time.
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Even if they create challenges, . They're different from temporary struggles like
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stress or sadness, and they're more deeply rooted and they're consistent over time.
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So people with a personality disorder probably don't even realize that
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their patterns are causing problems because that it feels normal to them.
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So I I came up with a, Couple of narratives.
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So what is it?
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What is it not?
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Meet Alex.
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So Alex has always had trouble keeping friendships.
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Alex often feels that people really don't care about him.
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So they push people away before they can get hurt.
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So that pattern has been with Alex since they were a teenager.
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They find it hard to trust others.
17:02
They often feel angry or misunderstood.
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Alex has been told that they're too sensitive or they're difficult,
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but they don't really understand.
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They don't see what's wrong.
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Because this is just how they've always been.
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And they start to feel like, I just don't understand why
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nobody really understands me.
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So one day, Alex is talking to a therapist who helps them understand
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their consistent fear of being hurt or abandoned and how that might be
17:22
something deeper, a personality disorder.
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So this therapist is going to try to explain that these patterns
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can be worked on with help, but it takes time and self awareness.
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But the problem is that if that is the case, it is just, it is
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what it feels like to be Alex.
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It's not this thing that comes and goes, or something that Alex
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is aware of and tries to work on.
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It's this continual feeling of not really understanding.
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Because when I go into this world of emotional immaturity, or even on this
17:48
spectrum of narcissistic traits and tendencies, that narcissistic person,
17:52
or that incredibly emotionally immature person, Will not and cannot take
17:57
ownership for anything that they have done that they view as wrong because
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then they immediately go to this.
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If I admit this, my whole world falls apart and then you will leave me.
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So I didn't do it.
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You did it.
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Or, well, if I did do it, it's because you told me to do it
18:12
and you may not remember it.
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But in that real time, that narcissistic person, that emotionally mature person
18:18
is creating that new narrative in real time because it cannot be that they did
18:21
anything wrong or you will abandon them.
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There's our personality disorder because it does not matter what you say or do,
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they will not have that aha moment or that epiphany and you will drive yourself
18:31
crazy trying to explain to them that but it's okay, it is okay that you did
18:35
that, but they're saying, but I didn't.
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And I think that's why the significance of moving something that is this
18:41
chronic long term depression away from it is a personality disorder into
18:46
it's a mood disorder back to Alex.
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, Alex's struggles are not about being mean or bad.
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It is about long term patterns and how they see the world,
18:53
how they interact with others.
18:54
And those patterns have made life harder for Alex in this scenario,
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now, what Alex's situation isn't.
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Alex doesn't just have a bad day or a personality quirk.
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For example, somebody having a bad day might snap at a friend, but they
19:05
usually apologize and they move on.
19:07
A personality disorder on the other hand involves patterns that are so
19:09
deeply ingrained and don't change easily, even when they cause problems.
19:14
That personality disorder vibe is not about being a bad person.
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It's not about choosing to act a certain way.
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It's about patterns that have been shaped over time.
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So it just becomes reactionary, involuntary, and it often
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starts in childhood.
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Or it becomes unpacked in the early teenage years,
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now with awareness and support, though, people like Alex can work on patterns
19:32
and try to find healthier ways to cope.
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But the challenge there is that.
19:38
They may just be learning how to interact with the world, but still
19:41
not understanding why the world can be so difficult versus wanting to get
19:46
rid of this discomfort, this pain, and just not really understanding why.
19:50
When you get somebody in your office that really does want those tools.
19:54
Then they will often still have a fair amount of the, yeah, but we have,
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you don't understand, but at some point when it clicks, they just want
20:01
to read everything, do everything.
20:03
They just want to be better.
20:05
They want to be the very best versions of them that they can be.
20:07
And often I find that if people are incredibly emotionally immature, or even
20:11
on that narcissistic trait and tendency scale, they're coming into therapy
20:16
because they just want validation.
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They want you to tell them that, well, it sounds like that's all you can do
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and you're doing everything you can.
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And what is so fascinating about that.
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As a practicing therapist, is you're aware of somebody that's coming in
20:30
saying, , tell me what I don't know that I don't even know, and I'll
20:33
still admit that it's going to be difficult, and I may not follow through
20:36
on the homework, and I'm going to come back in, and I'm going to assume
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that you are disappointed in me, Mr.
20:40
Therapist, because I'm not getting better.
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Give me that person all day long, because we're going to figure this out.
20:46
Or it's the person that comes in and they're continually telling you about
20:51
their struggles, their challenges, but how, no, I already did that.
20:54
No, that's, I do.
20:54
I do all the meditation.
20:56
No, I've read that book.
20:57
I am familiar with that.
20:58
Because at that point then, anything that you're providing because they're not truly
21:01
being curious becomes this attack surface.
21:04
And at that point, Then what they're really looking for is validation.
21:08
And that is often what comes from a session like that.
21:10
And people will say, but you need to push them more.
21:13
Well, have you tried that?
21:14
Have you sat in there in a therapy office and listen to this person and really tried
21:18
to understand and get to know them and hear their familial patterns and see where
21:22
they are struggling in their relationships in their life and want to help so
21:25
desperately, which is a me thing as a therapist, but then that person is going
21:29
to continually, you don't understand.
21:31
I did.
21:31
I've done that.
21:32
You don't get it.
21:33
So at some point, it really is a man that does sound like, then it sounds
21:36
like you've done everything you can do.
21:38
And if the person really is very insecure, very immature, and they just are looking
21:42
for validation, then what do they do?
21:44
They walk out of that scenario, they walk out of that session,
21:46
and now they feel validated.
21:48
And so they feel like, okay, it, I am doing everything I can do,
21:50
and it is everybody else's fault.
21:52
And even the therapist agrees.
21:54
But I think what's so interesting is the therapist didn't agree.
21:57
The therapist tried to bring awareness, tried to help with new tools,
22:00
but when they were, yeah, budded for a consistent pattern of time.
22:05
Now at that moment, then you start to realize that to the personality
22:10
disordered person or the person who's incredibly emotionally immature, insecure,
22:14
then they're not being open about the possibility that they could change.
22:19
And so then when you finally say, it sounds like you've done, you're
22:23
doing everything you can do.
22:25
You are no longer telling them what they're doing is wrong in
22:28
their mind, because that is that version of emotional immaturity.
22:30
It's this zero sum game.
22:31
It's right or it's wrong.
22:32
It's black or white, all or nothing.
22:34
And it feels so much better for them to not be argued with or told they're wrong.
22:37
So then when, when they hear This validation, it feels like agreeance.
22:41
So now they do feel like, well, the therapist agreed.
22:44
Now the therapist realized that you are, they are looking for validation.
22:48
It's so fascinating, but back to this persistent depressive disorder.
22:51
What does it even look like?
22:52
So according to the DSM, it starts with a depressed mood that
22:55
lingers for at least two years.
22:56
Let's go with a rain analogy,
22:58
it is a persistent emotional drizzle rather than a full on thunderstorm,
23:02
but those skies are cloudy all day.
23:04
And then kids and teens, they get a bit of a time break requiring
23:07
only a year of mood changes.
23:09
Though, if we're being honest, I think a lot of parents would
23:11
swear that one year in kid time probably feels like two or three.
23:15
And then along with the constant low mood, at least two of these
23:17
symptoms have to join the party.
23:19
So you've got changes in appetite.
23:20
What can be really interesting, it can be either eating
23:22
everything or barely anything.
23:24
Sleep troubles, too much or too little.
23:26
Low energy or chronic fatigue, struggling with self esteem.
23:30
Difficulty concentrating or making decisions, feelings of hopelessness.
23:33
But wait, there's more.
23:34
So PDD often comes with bonus features like guilt and worry and avoiding social
23:39
activities, which is so unfortunate because those are the very things that can
23:42
cause someone to get a dose of vitamin C.
23:45
Aka connection, but basically it can make the idea of even anything
23:49
fun that the person wants to do feel pretty exhausting, which is one of
23:52
those major signs of depression.
23:54
Now, how it stands out from major depressive disorder.
23:57
So PDD is going to share a lot of symptoms with major depressive disorder or MDD.
24:03
But the two just aren't quite the same because if you think of MDD as a sudden
24:06
intense storm that shakes everything up for at least a couple of weeks.
24:10
, whereas PDD is that dreary overcast weather that just lingers, but for years.
24:15
So people with PDD might not hit the severity markers for MDD, but the
24:19
duration of their symptoms is what really makes the diagnosis unique.
24:22
But that said, the two conditions aren't exclusive because somebody who
24:25
has persistent depressive disorder can experience major depressive episodes
24:29
on top of that chronic symptoms.
24:30
So it's, it's like you've got this drizzle constantly, these gray skies,
24:34
and every now and again, you've got a week or two of just a downpour.
24:38
So that already pretty, pretty crummy weather and.
24:42
Persistent depressive disorder might not have the dramatic flair of some of
24:45
the mental health conditions and I think that's one of the reasons I wanted to
24:48
just bring awareness to it because it's just so low grade, it's so consistent
24:53
and it, and the duration is so long, but that impact then can be profound
24:58
because whether you know it is dysthymia or neurotic depression or the current
25:01
DSM name, it is a reminder that chronic emotional struggles, they are just as
25:06
important to address as the acute ones.
25:08
Because sometimes you're just that low grade buzz in the background
25:12
of other people's experience or existence, and then they do start
25:16
to just take you for granted.
25:17
And it's hard because if you're experiencing this persistent depressive
25:21
disorder, then you may not even have the energy or the awareness or the ability to
25:25
then really speak up about what you need.
25:28
And then whether PDD's 2013 rebranding helped or hurt its public image, I
25:33
think the goal is still the same, to help people understand what they're
25:36
experiencing and to get the support they need to feel better, no matter how long
25:39
their emotional forecast has been cloudy.
25:41
Let's look at some of the things that might cause persistent depressive
25:44
disorder, and more importantly how do you treat and manage it?
25:47
And spoiler alert, like most things in mental health, it is
25:51
not as simple as pointing to one thing and saying, this is it.
25:54
Instead, I think it's important to note that depression in all its
25:57
forms, including PDD, is like this stew, I was going to say tasty stew,
26:01
probably not very tasty, Made up of a whole mix of biological and
26:04
social and psychological ingredients.
26:06
And nobody is quite sure of the exact recipe.
26:09
I think that's the most important thing to recognize.
26:12
But researchers have identified some key factors that seem to make
26:14
the pot boil a little bit more.
26:17
For starters, depression of any kind tends to be a team effort between brain
26:20
chemistry, genetics, life stressors.
26:22
I think so much of it goes into the things that you were mapped
26:25
with your, in your childhood.
26:28
So it really does fall into the nature and nurture.
26:30
Birth order and DNA abandonment and rejection, hopes and dreams,
26:34
fears, the things that you've always wanted to do or not.
26:36
If you've had those opportunities to, if you have had a secure attachment with
26:40
your kids, if you had a secure attachment with your caregiver, if you've generally
26:43
had opportunities to, to do things throughout your life at school activities,
26:49
who your friends have been and studies estimate that around
26:51
3 percent of people in Western countries at least will experience
26:54
PDD at some point in their lives.
26:55
So that actually is pretty significant because that means that that percentage
26:59
of people will go through this for at least a couple of years at some point
27:02
in their lives and women are about twice as likely to be affected as men.
27:07
And I, there's some belief that that has to do with everything from hormones
27:10
and social pressures that those start to play into the mix here as well.
27:15
So biologically, there's, evidence that imbalances and neurotransmitters
27:19
like serotonin, that those play a role in depression generally.
27:23
And though the research specific to PDD is still limited.
27:26
What we do know is that genetics seem to loom very large in PDD.
27:30
So if your family tree has some PDD branches, your chances of developing
27:33
it are higher than if we were talking about major depressive disorder.
27:37
And I think what's really fascinating is the more we learn
27:39
about the concepts of epigenetics.
27:41
And again, I will say probably a few more times, I'm not a doctor.
27:44
I have a master's degree in counseling.
27:46
I've been doing this for 20 years and I'm a human being.
27:48
And I love the work that I do.
27:50
And I have a lot of in the chair experience.
27:52
Again, see the aforementioned 20 years.
27:55
Some of these things will just be my opinion.
27:57
And this is why I love acceptance and commitment therapy so much.
27:59
Because since you are the only version of you that's ever walked the face of
28:02
the earth, you are going to think and feel the way you do because you do.
28:07
And when someone else is telling you, well, this is what you
28:09
should think and should feel.
28:11
A, nobody likes to be shit on.
28:12
And B.
28:13
I forgot what B was, but I think it's probably something like you're going
28:18
through life for the very first time.
28:19
And so ultimately it is ideal for you to be able to figure out
28:23
the things that matter to you.
28:24
But often we do need a little bit of a shove out of the nest.
28:27
We do need a muse to interact with.
28:29
If we don't know if we even like playing sports, then it would be wonderful if
28:33
we had this opportunity to try a sport and that might even cause us to realize
28:37
that we want to be the coach or we want to be a cheerleader, want to be a, an
28:41
equipment manager, or we see the guy who's sweeping the floor and all of a sudden
28:45
we think, I really like things clean, but you, have to be able to do things in
28:49
order to really learn more about yourself.
28:51
But on top of biology and genetics, certain personality traits like
28:55
neuroticism, which is a tendency to worry or be overly emotional and chronic states
28:59
of high anxiety can increase the risk.
29:02
And then, let us not forget stress.
29:04
That is the unsung villain in so many mental health stories.
29:08
Because when, when life keeps piling it on, the weight of it all can make
29:11
PDD more likely to stick around.
29:13
And that's where we'll get into the world of acceptance and commitment therapy and
29:16
even this concept of acceptance that at times I might have to accept the fact
29:20
that there's a lot going on in my life.
29:22
And that means I'm going to welcome all those things in without defense
29:25
in their entirety, because if I'm continually trying to avoid things,
29:28
then that could lead to more of these feelings of feeling stuck or
29:31
feeling hopeless or feeling depressed.
29:33
I get to sit with people often that say, I don't know what's wrong with me.
29:36
And I don't understand why I'm feeling the way I feel.
29:39
, well, let's start from a place of, because it's the first time that
29:41
it's you going through life as you.
29:42
So check that out.
29:43
And you're thinking and feeling the way you are because you are,
29:45
you're not broken, you're human, and this is, how you are feeling.
29:49
But then when we review the game film and we go back a week or two
29:52
or a few months, there's a lot that might be going on in your life.
29:55
So then, of course, this is how you're feeling.
29:58
There, there is nothing wrong.
30:00
So you can step back and look at that in the context of all
30:02
the stuff that's going on.
30:04
Maybe there was a job loss.
30:06
Maybe there's been some financial struggles or of our car crash, or
30:09
is someone in your family that's close to you recently passed away.
30:13
So those things are going to cause us to feel.
30:16
And when you have things that just stack up, then you can start to
30:19
recognize that, okay, this is the first time I'm going through life as me.
30:23
And that is a lot going on.
30:24
And so I am feeling the way I am.
30:26
And that's an amazing place to start from.
30:28
So how do we treat persistent depressive disorder?
30:31
Thankfully, the toolbox for managing PDD is getting pretty well stocked.
30:34
And the two heavy hitters are psychotherapy and medication.
30:38
The psychotherapy piece, , is what I'm talking about now, which I'm a big fan
30:41
of acceptance and commitment therapy.
30:43
And if anything, . If you're listening to this, if somebody forwarded this
30:46
to you, or if you are starting to listen to podcasts or reading books
30:50
or anything, articles online about, about depression, and this resonates
30:55
with you a bit, then just start to go on that, train of thought.
30:59
And if you're open to seeing a therapist, then by all means, that is a wonderful
31:03
place to start and you can bring them this information and say, this is maybe
31:07
resonated with me, but I want to talk about the brain a little bit more.
31:11
And I want to talk about medication.
31:12
This is something I've wanted to talk about for a long time, and it's because
31:15
I wanted to understand this more.
31:16
So I'm going to, tell you a little bit of the way that I understand a lot of
31:20
the ways that the medications work.
31:22
And I will continually say that while people have written the initials.
31:27
when writing a check to me a time or two back in the day, I may have
31:30
even photocopied a couple of them.
31:32
I am not a doctor.
31:33
So please consult your doctor for more information.
31:36
I reserve the right to absolutely be wrong, but let's, let's take
31:40
a little journey into the brains, emotional chemistry lab where
31:43
feel good chemicals like dopamine and serotonin and norepinephrine,
31:46
those are the star players.
31:48
And these are neurotransmitters and what neurotransmitters.
31:52
are, they act as tiny little messengers and they take, they ferry
31:56
these signals between brain cells and these neurotransmitters play a
32:00
huge role in regulating your mood and your energy and your focus.
32:04
But when things get out of balance, it's like the lab goes
32:06
on strike and then that's where depression or anxiety can sneak in.
32:10
We talk about neurotransmitters, I think so often in the world of
32:14
mental health and people just nod.
32:16
Oh yeah, dopamine, serotonin, neurotransmitters, brain.
32:19
Those are all words I know.
32:21
But what are they?
32:22
I mean, what does that even mean?
32:23
How do these tiny messengers work to regulate mood and energy and focus?
32:26
Neurotransmitters they're chemical substances in the
32:29
brain that help the neurons.
32:30
And I think it's so important in my mind to picture the neurons in these little
32:34
nerve cells, and they are communicating with each other, these little signals.
32:38
They're like the brain's little postal service and they deliver
32:40
messages from one neuron to another, and that keeps everything running.
32:44
Hopefully.
32:45
Smoothly.
32:46
So the way the process works is there's a signal that's sent.
32:49
So a neuron, the sender, then it gets an electrical signal and it releases
32:53
a neurotransmitter into the synapse, the tiny gap between the two neurons.
32:58
You've probably seen the little pictures about that.
33:00
And then the message is delivered.
33:02
The neurotransmitter travels across the synapse.
33:04
And it binds to these receptors on the next neuron, the receiver, and it's kind
33:08
of like a little key fitting into a lock.
33:10
And this tells the receiving neuron what to do next.
33:13
Send another signal, suppress an action, trigger a response.
33:17
And then once that message is delivered, then that neurotransmitter
33:21
is either broken down by enzymes or it's reabsorbed by the sender.
33:27
And that is a process called reuptake.
33:30
And if you are a psychology nerd or a therapy fan, you've probably
33:33
heard about your antidepressants or selective serotonin reuptake inhibitors.
33:38
There's that word reuptake and all of that's done to keep
33:41
your brain system efficient.
33:43
Here's something that to me was a bit of a game changer and it
33:46
helps me understand this part.
33:47
So you hear this phrase reuptake inhibitor, but what does that even mean?
33:50
This is a simple metaphor that I once heard and then I've, expanded on.
33:54
And then we'll talk more about the chemicals and how they work.
33:56
I promise, but this will help you understand what the heck
33:58
is going on in your brain.
33:59
Think of it like watering a plant, because if you were to pour water into
34:02
the soil and then immediately take a sponge or a syringe or something and
34:06
suck that water back up, That would be like you were reuptaking the water.
34:10
So the plant would not get enough time to absorb the
34:13
moisture that it needed to grow.
34:14
I currently travel between offices in California and Arizona, and
34:17
I have a couple of plants in my California office and they have
34:19
been around for quite a while.
34:21
It's mind blowing to me.
34:22
And when I returned to California, the soil of one of my favorite plants is dry.
34:27
. So if I immediately dump a ton of water into the soil, which I've done it, it
34:32
goes right through it and it ends up in the, I guess I don't know if the plant
34:35
world exactly what it's called, kind of looks like a drip pan in the bottom of
34:38
the pot, but then I flooded the plant with too much of what it needs to thrive.
34:43
But now if I poured even the right amount of water, what that would be,
34:47
but then if I immediately remove that water from the soil before I had a chance
34:50
to get into the cells of the plant.
34:52
A, I'm kind of a jerk.
34:53
B, I kind of do think that plants low key know things and
34:57
they probably haunt my dreams.
34:58
But C, the plant would not continue to thrive and it would begin to
35:02
atrophy and eventually it would die.
35:03
And then it also would haunt me.
35:05
C, part B.
35:07
But medications can act like removing the sponge trying to soak back up the
35:11
water for a while so that the water can sink in and nourish the plant properly.
35:15
And then there are these other types of medications that control the rate at
35:18
which the water is distributed to the plant, ensuring that the plant won't be
35:21
flooded with too much of the very thing that actually could provide it life.
35:26
Let's go back to this concept of reuptake.
35:27
So imagine your brain is a big group chat, and the neurons, or the
35:31
brain cells, are texting each other.
35:32
So the neurotransmitters, like serotonin norepinephrine, those
35:36
are the messages being sent.
35:37
And when one neuron sends a neurotransmitter, it releases it
35:41
into that tiny space between the two neurons called the synapse, kind
35:44
of like hitting the send on a text.
35:46
But now once the message has been delivered to the next neuron,
35:48
the receiver, the first neuron now has a decision to make.
35:52
Do we let the message hang out in the synapse for a bit so it
35:55
can be read and digested and understood, or we better unsend it?
35:59
Take it back because we have to save it for later.
36:01
You know what I mean?
36:01
And sometimes your brain is a little bit of a jerk in itself and
36:03
that it's like showing you this letter and it's like saying no, no.
36:05
Go ahead and read this letter because it's awesome.
36:07
It has a lot of great information on how to save your life.
36:10
And then you start reading it and you're starting to get excited.
36:12
I'm like, Oh, this kind of makes sense.
36:13
And then it pulls the letter away.
36:15
And you say, I wasn't done reading it, but it was really good, but your brain,
36:18
it doesn't even think it's being a jerk.
36:20
And it thinks that it has this time limit it has to limit the amount of
36:23
time that it shares the letter or the letter might suddenly disappear.
36:26
So there's this game of kind of push and pull.
36:28
I'd really like to see more of the secrets to life that that
36:30
letter seemed to, to have please.
36:32
And part of our brain is saying, totally, I want you to have more of
36:34
that because I am part of you after all.
36:36
So here, Okay.
36:37
Take another quick peek, but I need to ration how much of the letter that you
36:39
see and it thinks it's right and you think you're right, but unfortunately,
36:43
the part of you that saw the secrets of the universe on that letter can't
36:46
get enough of the info on the letter.
36:47
So, what do you do?
36:48
Start looking for it elsewhere, like in unhealthy ways, like overindulging
36:51
in things like addictive substances, like corn, which I now understand this
36:56
is one of the reasons why my videos are not as popular on YouTube because
36:59
I have not said corn or corn ography.
37:03
But on that note here's today's advertisement
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But we have a weekly group call that is one of the favorite, my favorite
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talking about how to become better human beings, because I maintain that people
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turn to unhealthy coping mechanisms when they feel not as connected in
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their marriage in their parenting, their faith, their health and their career.
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And so we talk a lot about those things and becoming more more present, a better
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husband and father, a better parent.
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Figuring out where I'm at in my faith journey.
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Do I like my job?
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Why am I maybe not as healthy as I would have thought I
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would have been at this point.
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And when you start to shore those things up, then again, that siren
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38:33
Okay.
38:33
Back to the narrative.
38:34
So there might be times or conditions where your brain says, okay, fine.
38:37
You want to read this letter then?
38:40
Yeah.
38:40
You like the letter.
38:42
Here, read it while I plaster it right on top of your face.
38:44
How do you like that?
38:45
Or how about this?
38:46
You can read the letter from the back of your throat as it
38:47
crumples up the letter and it just shoves it down the old windpipe.
38:50
So back to the text analogy.
38:52
Reuptake is the unsending process, but bless your brain's heart, it
38:55
thinks it's doing you a solid.
38:56
So sometimes you might need some medication that will lovingly force
38:59
your brain to let you read the text.
39:01
All of the letter long enough that you can now have the information
39:04
you need, these secrets of life.
39:06
Now, you still need to do something good with the information.
39:09
I've long said that when my ADHD medication kicks in, it feels like hope.
39:13
And then what do I do with that hope?
39:15
Do I write a podcast script about medication or do I play the crap
39:17
out of online bingo or watch YouTube or TikTok videos with
39:20
such intense focus and pure joy?
39:23
That it makes my morning.
39:25
Or both.
39:26
But let's also get a little bit more science y.
39:28
Why is reuptake important?
39:30
Reuptake is a normal and necessary part of how the brain works.
39:32
Because without it, neurotransmitters could build up in the synapse
39:35
and it will flood the whole system, and that would be chaotic.
39:37
So reuptake makes sure that the brain doesn't waste neurotransmitters
39:40
and it keeps everything running smoothly by recycling them
39:42
when they're no longer needed.
39:43
Here's the catch.
39:44
Sometimes the brain pulls back neurotransmitters too quickly, and that
39:47
will mean there's not enough serotonin left in the synapse to regulate your mood.
39:51
Or there's too little dopamine to spark motivation.
39:54
So when reuptake happens too fast or too often, it's like cutting
39:57
off a conversation before the other person has time to respond.
39:59
The message doesn't have enough time to do its job, which can lead to symptoms
40:02
of depression, anxiety, low energy.
40:06
And so why then are so many of these medications reuptake inhibitors?
40:10
This is where the medication comes into play because you've got a reuptake
40:13
inhibitor like a SSRI, selective serotonin reuptake inhibitor, or you've
40:17
got a SNRI, a selective norepinephrine reuptake inhibitor, and so they'll act
40:21
like a pause button on the reuptake.
40:23
They slow the process down so that gives the neurotransmitters more time to stay
40:27
in the synapse and deliver their message.
40:30
So serotonin reuptake inhibitors, they're going to leave a little
40:33
more serotonin in the synapse.
40:35
So that will give you a better chance to improve your mood.
40:37
Norepinephrine reuptake inhibitors, they help boost energy and focus.
40:41
Dopamine reuptake inhibitors, they increase motivation and the
40:44
ability to experience pleasure.
40:46
So in really simple terms, a reuptake inhibitor, it makes sure
40:50
your brain doesn't snatch back the feel good chemicals too quickly and
40:54
it allows them to do their job and then really help you feel better.
40:58
Because the concept of like reuptake itself is normal.
41:01
It's how your brain regulates neurotransmitters, but that
41:03
issue arises when it happens too fast or it's too often.
41:06
And that's when we can talk about things like, our chemicals in our
41:09
brain are off and that can throw off the balance of all the chemicals.
41:12
And so medications can help restore that balance by slowing the whole
41:15
reuptake process just enough to let those neurotransmitters
41:19
in your brain work their magic.
41:20
So if I go back to, I'll even simplify that metaphor more.
41:24
Think of it like watering a plant.
41:25
If you pour water into the soil and immediately suck it all back up with
41:27
a sponge, reuptake, then the plant doesn't get enough time to absorb
41:31
the moisture that it needs to grow.
41:32
And so medications act like removing the sponge for a while so the water can sink
41:36
in and it'll nourish the plant properly.
41:39
Reuptake is part of a normal healthy brain system, but if it's too
41:43
efficient or it happens too quickly, then it can cause some challenges.
41:47
And so those reuptake inhibitors, those medications, they do slow things down,
41:50
give your brain the time it needs to use the neurotransmitters to regulate
41:53
your mood and give you energy and focus.
41:55
And it's it's like your brain's messaging system gets a chance to catch his breath.
42:00
And
42:01
and what is so amazing about this whole concept is how cool your
42:05
body is that, yeah, it might not be perfectly handling the system of.
42:10
Of moving these neurotransmitters around.
42:12
But just think about the miracle of that, that intricate signaling system.
42:16
I mean, that's the foundation of the way the brain and by
42:18
extension, your whole body operates.
42:20
So when the neurotransmitters are working well, you feel pretty emotionally
42:23
stable and you're resilient and you have the energy and the motivation to
42:25
tackle like daily tasks and you can focus on what's important without maybe
42:29
feeling as overwhelmed or distracted and understanding that process.
42:32
I think also helps explain why treatments like medication or therapy
42:37
or lifestyle changes are aimed at improving communication in the brain.
42:41
It's not.
42:42
about fixing a broken brain, but it's given it the tools to communicate better.
42:45
So you can feel more like yourself.
42:47
So you got serotonin and I think it's just interesting.
42:50
It's more of a mood stabilizer.
42:52
If you think about it, serotonin, it's like the brain's chill pill helps regulate
42:55
mood and sleep, appetite, digestion.
42:57
It plays a big role in feelings of happiness and emotional stability.
43:00
And then Low serotonin levels are often linked to depression
43:03
and anxiety and irritability.
43:06
So it's like the volume on your emotional resilience gets turned way down.
43:10
Or you got dopamine, which is the one I think we hear a lot about.
43:14
I don't know, dopamine or serotonin, one and two in the leaderboard.
43:18
More, but dopamine is more like this motivation or focus molecule.
43:21
It's all about reward and motivations.
43:23
What gives you that?
43:24
I did it feeling, you know, when you check off the to do list, which I've heard
43:27
about doing before, but if you crush a workout or you, accomplish something.
43:31
So low dopamine can lead to feelings of apathy, low energy,
43:35
even difficulty experiencing any pleasure, the symptom called anhedonia.
43:38
And it's like the brain's reward system that goes offline.
43:41
And so then certain medications can increase the amount of dopamine, helping
43:45
you restore motivation and energy.
43:46
And then you got this norepinephrine, which I think is the one that needs
43:48
a new PR team, but that's kind of like adrenaline is calmer sibling.
43:52
So it helps with focus and alertness and responding to stress.
43:55
And some of the newer, I believe ADHD medications are looking more
44:00
at norepinephrine, but low levels can lead to fatigue, lack of concentration,
44:04
general sense of the kind of the blahs.
44:06
But then too much norepinephrine can heighten your anxiety, make you
44:09
feel a little bit jumpy and on edge.
44:11
But there's a couple other neurotransmitters that
44:13
don't get much play at all.
44:14
One's called GABA.
44:15
And it's viewed a little bit as a calming agent.
44:17
It's like the brain's natural tranquilizer.
44:19
It kind of helps calm the nervous system down.
44:21
It can reduce anxiety.
44:23
And then you've got one called glutamate and that's the, accelerator glutamate.
44:26
It's this excitatory neurotransmitter and it helps with learning and memory.
44:31
And then, so imbalances in glutamate will often.
44:35
Also contribute to depression, particularly when the brain's
44:37
stuck in this low energy state.
44:40
And then now you can look at all of these things and it's, it's a
44:43
symphony, serotonin, setting the tone, keeping things balanced and stable.
44:46
You got dopamine, adding a little flare driving rewards and
44:49
excitement, norepinephrine keeps the rhythm at the focus, the energy.
44:53
Then you got a GABA and glutamate.
44:54
They're ensuring the tempo, make sure that it doesn't get too slow or too fast.
44:58
So when one section is out of tune, it can throw the whole performance off.
45:02
So things like medications, they can aim to restore harmony and they can either
45:05
increase certain neurotransmitters or adjust their activity or help
45:07
the brain use them more efficiently.
45:08
And I want to take the chance here again to say, call upon
45:12
my emotional baseline theory.
45:13
And when people feel so down, so low that they feel like they don't even know
45:16
how to access the tools that they may be aware of, they might be even going
45:19
to therapy, but they just can't do the things that they believe they should do.
45:23
Your emotional baseline may be so low that taking medication might help
45:26
bump that baseline up just enough to access the tools and then the tools
45:30
might be, it might be meditation.
45:32
It might be reaching out and connecting with friends.
45:34
It might be going on a walk, getting to the gym.
45:37
And then once you start doing those things, then you're going to continue
45:41
to raise your emotional baseline.
45:42
And at that point, you may want to then say, all right, maybe I don't
45:45
want to keep taking the medication or taking a medication, got you to the
45:48
place where you could access the tools.
45:50
But I do want to say for those who are reluctant to take medication, if meds
45:54
aren't your jam, there are plenty of ways that are believed to naturally encourage
45:58
better brain chemistry, exercise, regular physical activity, boost dopamine,
46:01
serotonin, norepinephrine, and then it reduces stress hormones like cortisol.
46:06
So exercise is a full brain workout.
46:09
Even a 20 minute walk can make a difference.
46:11
And then sleep rest is so essential for neurotransmitter production
46:14
and regulation, and it clears all the gunk out of your brain as well.
46:18
So you really.
46:19
Would help if you aim for consistent sleep patterns and get enough
46:22
hours to recharge and diet, I don't want to mention that one.
46:27
You can boost it with foods that are rich.
46:28
And it's funny, we're hitting Thanksgiving tryptophan, turkey, eggs, salmon,
46:32
dopamine, you can eat protein, rich foods.
46:35
Chicken, beans, nuts, you got omega threes found in fatty fish, flax
46:39
seeds, those support brain health.
46:41
And then you got mindfulness and meditation.
46:43
There's a belief those practices can even increase GABA and reduce anxiety
46:46
and help calm the brain's alarm system.
46:47
But again, I am not a doctor, but I do believe social connection sure helps.
46:52
Spending time with loved ones or even pets can boost your oxytocin, that
46:55
cuddle hormone, the bonding hormone, and help you regulate your mood.
46:58
And then therapy, especially acceptance and commitment therapy, can help you
47:02
change the relationship you have with your thoughts and over time help you
47:05
change your interior landscape of your mind or what it feels like to be you.
47:09
And sunlight and nature.
47:11
Exposure to sunlight increases serotonin.
47:13
Being in nature has been shown to reduce stress and improve your mood.
47:18
Back to dysthymia.
47:19
So we've got dysthymia, officially referred to as persistent depressive
47:22
disorder, and I thought there were a couple of things that were interesting
47:26
to share and then we'll wrap things up.
47:28
. So dysthymia, I think it's just important to note that it
47:30
does tend to be less intense.
47:32
But as we mentioned last longer, often two years or more in adults,
47:36
some people view it almost as a high functioning depression because a lot
47:39
of people with dysthymia appear to be functioning well in their daily
47:41
lives, but they're just carrying this constant low grade emotional heaviness
47:45
that affects their quality of life.
47:47
And some of the things I think are just interesting to share
47:49
while we're here is there's a concept called the Eeyore syndrome.
47:53
Because a lot of people with dysthymia might feel like they, they've
47:55
always just been a little down or they're naturally pessimistic.
47:58
They often assume it's just their personality rather than recognizing that
48:01
it is a treatable mental health condition.
48:03
And so the hidden struggles I think that come with this is people that,
48:06
that do experience dysthymia again or persistent depressive disorder can
48:10
feel overlooked or invalidated because their symptoms don't appear as acute
48:14
or as intense as somebody With major depression and it's interesting because
48:18
it's almost like their perseverance of continuing to do and be, even though
48:22
they feel so down often masks the whole severity of their emotional pain.
48:26
So that'll lead to misconceptions about how hard the struggle actually is.
48:29
So it almost becomes this burden of.
48:32
of this chronicity of it being chronic.
48:35
Dysthymia, I heard it once mentioned that it's this emotional erosion because
48:39
it's this persistent undercurrent of sadness and hopelessness and fatigue
48:43
that can wear people down over time.
48:45
And so then people might start to develop coping mechanisms that reinforce the
48:48
disorder, like avoiding deep connections to avoid emotional vulnerability.
48:52
And then it has a pretty high rate of what's called comorbidity.
48:56
Where it can also be found with other things like anxiety
48:59
disorders, substance abuse there are personality traits that are tied
49:03
to perfectionism or self criticism.
49:05
So a lot of people with dysthymia experience what some people call
49:08
double depression where they might have bouts of major depression on
49:10
top of this just chronic low mood.
49:12
And it breaks my heart because I think what a lot of people they just don't
49:15
understand when somebody has something like dysthymia that some cultures they
49:20
do, they, they normalize chronic sadness, they just say it's life stress resilience
49:24
rather than recognizing it as something that is a mental health condition.
49:28
It's also sometimes known as smiling depression.
49:29
It's a common phenomenon where people appear outwardly.
49:32
Okay.
49:33
But they're battling like this inner turmoil, these inner demons.
49:36
And one of the hallmarks of dysthymia is irritability or emotional detachment and
49:40
that can strain relationships because partners or friends might interpret
49:43
these, the behaviors as a lack of interest rather than symptoms of the condition.
49:48
It, it is believed that it's most likely tied to an overactive stress response.
49:52
And then that leads to these physical symptoms like headaches
49:54
and digestive issues and poor sleep.
49:56
And.
49:57
And then we want to address this because when you start to look at the neurons
50:01
that fire together, wire together, there's some thoughts that maybe
50:03
chronic low grade depression starts to lead to structural brain changes,
50:06
like, reduced hippocampus volume, which underscores like this importance of
50:10
treating it and it's never too late.
50:13
People who live with dysthymia, they learn to adapt.
50:16
They often become incredibly resourceful in managing their symptoms.
50:20
They develop habits that allow them to keep going despite
50:22
these emotional struggles.
50:24
But this is where I think the concepts of things like radical acceptance or how
50:27
people embrace their condition as part of their identity, and they can over time use
50:31
it to be a motivator for personal growth.
50:34
I really think acceptance and commitment therapy is Probably the most helpful
50:39
modality for dysthymia because it fosters a sense of meaning and then
50:43
values driven action, even though you're uncomfortable because you're accepting the
50:47
fact that I am currently uncomfortable.
50:49
So the fact that I'm not trying to avoid the discomfort because it's
50:52
there because this has been persistent and going on for a long time.
50:56
And so now the job is for me to, now that I've accepted it, let
50:59
me figure out what my values are.
51:00
Let me start to find that sense of purpose and then take action on it.
51:03
And yes, it's going to be, it's going to be a bit of a journey.
51:06
We'll call it.
51:07
But I think that it would be really helpful if this ring true to you in
51:11
any way, no, hear me, hear me, you are the only version of you, it's
51:18
ever walked the face of the earth.
51:18
You're okay.
51:19
You really are.
51:20
You didn't know what you didn't know.
51:22
And so the more that you are understanding and knowing, it's still probably
51:24
going to feel pretty overwhelming.
51:25
And that's actually perfectly normal because when we go from, we
51:29
didn't know what we didn't know.
51:30
And now we're starting to understand or starting to feel like maybe I'm.
51:34
I have an idea of something I might be struggling with that I can feel pretty
51:37
overwhelming too, because now you know, you're not really sure what to do.
51:40
And that's one of the longest places to, to live in is this area of, I'm
51:45
just not exactly sure what to do.
51:47
Sometimes I will do things, they'll feel better, but a lot of times I don't.
51:50
And that's normal.
51:51
And you'll eventually move into this category of, you know, I'm actually
51:54
doing things more than I used to, and there are times where I feel good.
51:58
And eventually, I'll just move into this place of I have just, I've changed.
52:02
I've become some, someone new, someone who has now taken this dysthymia,
52:06
this persistent depressive disorder.
52:08
And then it has been the thing that has caused me to finally
52:10
say, I gotta do something.
52:12
And that does become a journey, but I guarantee if you stay on the journey
52:16
that you will find a completely new version of yourself on the other end.
52:21
And sure, there will be times where you'll wish you would have figured this
52:23
out sooner, but then there, you're there and you're, starting to be more present.
52:28
Enjoy more things about life.
52:29
Sure, there will be moments where you'll still feel the old pang of
52:33
this persistent depressive disorder.
52:35
This.
52:36
familiar feeling, but then that very feeling is the thing that
52:39
will cue you in on turning to some value based activity or goal.
52:44
If you have questions, please reach out.
52:45
Please Google low cost counseling near you.
52:48
If you can't afford a therapist and but you definitely deserve to
52:52
be the very best version of you.
52:54
If you're hearing this before Thanksgiving, I hope you have
52:55
a very happy Thanksgiving.
52:56
And if you're hearing it after, I hope it was great.
52:59
And I appreciate you being here.
53:01
I will see you next time on the virtual couch, taking us out per usual,
53:03
the wonderful, the talented Aurora Florence with her song, it's wonderful.
53:08
Have a great week and we'll see you next time on the virtual couch.