Episode 112 - A Doctor's Primer on Depression and Treatments for the New Year
Depression, Antidepressants, and the Question We’re All Asking
We’re kicking off the new year talking about something most people don’t expect in January: depression. While the world leans hard into “new year, new you” energy goals, habits, optimism we decided to go a little off script. Because for a lot of people, the start of the year doesn’t feel hopeful. It feels heavy.
The holidays are over. The days are still dark. The distractions fade. And what’s left is whatever you were already carrying. So instead of pretending everyone is energized and motivated, we’re asking a more honest question: what do we do when depression shows up and what role do antidepressants really play?
Are We Overprescribing Antidepressants or Just Finally Paying Attention?
One of the most common complaints people voice is that “everyone is on meds now.” It can feel unsettling, even alarming. Are doctors just handing out prescriptions too easily? The truth is more complicated. Yes, antidepressant use has increased. But so has depression.
We’re living in a world with constant stimulation, less face-to-face interaction, less time outdoors, poorer sleep, highly processed food, and phones that never stop buzzing. Add in seasonal darkness, grief, trauma, parenting stress, financial pressure, and isolation and it’s no surprise that more people are struggling.
The real question isn’t whether medication exists. It’s how severe the depression is If someone has the occasional blues, medication may not be necessary. But if depression is keeping someone from getting out of bed, working, engaging with family, or staying safe, intervention matters. At that point, medication isn’t a shortcut it can be a stabilizer.
As a frontline primary care physician, I see this daily. When someone is deeply hurting, the goal isn’t to dismiss them or tell them to “just try harder.” If there’s something that can help reduce suffering and restore function, it deserves consideration.
Medication isn’t always the answer but sometimes it’s a lifeline.
Why Depression Is Hard to Spot Even in Yourself
One of the challenges with depression is that many people don’t realize they’re depressed. They just know something feels off. That’s why good screening matters. During routine physicals, I ask questions like:
Do you feel down or unmotivated?
Are you anxious?
Have you lost interest in things you used to enjoy?
Everyone experiences sadness and stress at times. But the key question is whether it feels overpowering or outside your normal range. Clinically, depression isn’t just about feeling sad. It often includes changes in sleep, appetite, energy, concentration, motivation, and even thoughts of worthlessness or death. When several of these persist for weeks, it signals something deeper.
And because depression overlaps with anxiety, ADHD, and bipolar disorder, it’s important to look at the whole picture not just one symptom.
What’s Actually Happening in the Brain
Depression isn’t a character flaw. It’s not weakness. It’s not a lack of gratitude. It’s a brain-based condition involving complex systems that regulate mood, motivation, energy, and emotion. Certain regions of the brain like the prefrontal cortex and the limbic system play key roles in how we experience stress and emotion. Within those systems, neurotransmitters act as chemical messengers.
You’ve probably heard of a few:
Serotonin, which helps regulate mood and emotional stability
Dopamine, which drives motivation and desire
Norepinephrine, which affects energy, alertness, and fatigue
When these systems aren’t functioning well whether due to genetics, stress, inflammation, hormones, or life circumstances depression can emerge. That’s why treatment varies so much from person to person.
Why Antidepressants Aren’t One-Size-Fits-All
The most common antidepressants SSRIs work primarily on serotonin. Others, like SNRIs, affect both serotonin and norepinephrine. Medications like bupropion target dopamine and can help with motivation and energy. Each class has strengths and trade-offs. Some people experience weight gain. Others notice changes in libido or emotional blunting. Some medications help with anxiety but worsen fatigue. Others boost energy but increase restlessness.
This is why finding the right medication often takes time. It’s not guesswork it’s informed trial and adjustment. Every brain is different. And while genetic testing sounds promising, in real-world practice it often creates more confusion than clarity. The best outcomes still come from a strong doctor-patient relationship, careful monitoring, and honest feedback.
Medication Isn’t the Whole Story But It Can Be Part of It
Depression doesn’t exist in a vacuum. Lifestyle matters. Diet, exercise, sleep, and connection all play significant roles in mental health. Research continues to show links between highly processed foods and increased depression, while whole foods, movement, and regular aerobic exercise can improve mood.
Sleep hygiene, mindfulness, meditation, and social connection aren’t “soft” solutions they’re foundational ones. And sometimes, medication provides the stability someone needs to actually make those changes.
The Part We Can’t Ignore
There’s a reason antidepressants exist. I’ve stood in a room with a friend who was on the edge literally and watched what happens when help is refused. That experience leaves an imprint. It’s a sobering reminder that depression can become deadly.
So whatever your opinions are about medication, this matters: when used appropriately, antidepressants can save lives. There is no shame in needing help. Depression doesn’t mean you’re broken. It means you’re human.
And sometimes, the bravest thing you can do for yourself and for your marriage is to take your pain seriously. In Part 2 of this conversation, we’ll move from the biological lane into the relational one how depression shows up in marriage, the lies it whispers, and how couples can navigate it together. Because mental health doesn’t just affect individuals.
It affects us and how we love….
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Greetings and salutations, everyone.
Fellow intelligent spouses out there, we're kicking off the fresh new year 2026 by talking about antidepressants.
That's a.
1:15
Speaker 2
Little bit of a departure from the normal goals and starting fresh and excitement.
Why did you choose depression?
1:25
Speaker 1
Well, let's look at it.
Everyone else wants to talk about new year, new me, new you, new US.
Goals, goals, goals.
Yeah, we teach them too on this podcast, But we thought we'd be a little bit outside the box and talk about something that we haven't talked about.
1:41
Maybe tap in a little bit more into the medical side of things that I do and things that I've learned about.
1:50
Speaker 2
I think it's actually a good choice because think about it, Christmas time, New Year's time, that's the darkest time of the year, the shortest days.
And there are greater levels of depression this time of year and it's more obvious.
2:05
I think sometimes we can mask those with all of the lights and singing and excitement and events.
And so why not?
Let's see what you got.
2:15
Are We Over-Prescribing or Just Better at Diagnosing?
So, Heidi, Yeah, I want to ask you, people complain a lot to me about there's so many people on so many drugs.
2:24
Speaker 2
Yep.
2:25
Speaker 1
With depression, Yep.
Are we pushing too many drugs or are we just getting better at diagnosing depression?
2:34
Speaker 2
Well, I would say neither can I give you my opinion.
2:38
Speaker 1
Yes.
2:40
Speaker 2
There is a high correlation between smartphones and depression and anxiety, and I think we don't get out in nature enough.
We don't interact one-on-one with each other enough.
2:55
Speaker 1
But it's easier to have a scapegoat.
Those doctors, All they want to do is prescribe drugs, that is.
3:01
Speaker 2
That could be true.
3:02
Speaker 1
That could be totally.
3:04
Speaker 2
Irrelevant, right?
But if the depression is so bad that you're going to end up in a psychiatric ward or that you're not getting out of bed to go to your job or you're not interacting with your family, it's time for an intervention.
3:20
I mean, if you just have a little bit of the Blues, I would say that's overkill.
But I think we're living a lifestyle.
This is my opinion.
Most of us are living a lifestyle with the kinds of foods we eat, with the way we spend our time in technology, that levels of depression are significantly rising, especially I would say for teenagers and even children, and of course as adults as well, that it is requiring a bigger intervention.
3:53
My opinion, right or wrong, what do you think?
3:54
Speaker 1
No, I think that's true.
I think there's a lot of things that go into this.
I think that it's all above.
I think, yeah, we might be prescribing too much, but there's also more depression.
We're getting better at diagnosing it.
All I know is when I see someone coming in who is really hurting, I don't want to kick him to the curb emotionally.
4:15
And if there's something that I know can help him, I'm going to do it right.
I mean, it's just why not?
And if that's over prescribing, then maybe somebody needs to sit down with me and tell me what to do.
4:31
Yeah, I actually struggle some with seasonal affective disorder, which is a just.
If it's dark outside, it's Gray.
I just don't feel the best.
Yeah.
You know, a lot of people out there, a lot of you are secretly depressed.
4:49
You may know it, you may not know it.
4:51
Speaker 2
Or your spouse.
4:52
Speaker 1
Or your spouse.
Some people just don't know what they don't know.
And so we're trying to educate, uncover, to lead you into new things maybe you haven't thought about before.
And that can be scary.
5:10
But I am a seeker of truth, and you are too, I think, my love.
Yes.
The only thing scary about knowing what's wrong with me is not knowing that anything is wrong with me.
5:20
Speaker 2
Yes.
And that has the worst outcomes probably.
5:23
Speaker 1
Honey, as a frontline primary care physician, I do see a lot of people with depression in my office.
5:29
Speaker 2
Right, you do.
And maybe that's because you were a psychology undergrad, You just have a little more understanding of it than the normal.
5:36
Speaker 1
Maybe a little.
5:38
Speaker 2
Primary care physician.
5:39
Speaker 1
Yeah, yeah.
So a lot of people don't really know what it looks like because they don't have that language, the right language to ask the right questions.
And a great example of this AI, we've all had an opportunity to experience it, ChatGPT, grok, all these other things.
5:57
It's really brought this to the forefront, and we were talking about this a little earlier today about how AI is not going to give you the right answer if you put in the wrong question or it's not descriptive enough.
6:10
Speaker 2
Yeah, or they don't understand the context in which you're asking the question.
6:14
Speaker 1
So because of that, I think I can rest easy that my job is not going away.
OK, They're not inputting the best questions into ChatGPT in order to get the best answer.
So they still come to see me because ChatGPT told them that their headache may really be brain cancer because of their.
6:33
Speaker 2
It's a possibility.
6:34
Speaker 1
It's a possibility.
When they came in to see me, I drill down on them.
I asked very specific questions.
This is a new language we're learning here, part of what we're doing here on this podcast, teaching you the language to know how to even ask so that you can have a more scintillating live together.
6:54
How Doctors Screen for Depression and Key Statistics
You know, I honey, I ask patients during their annual physicals about I do a screening for depression.
I asked, do you feel down blue, unmotivated, You feel anxious?
Do you not like doing things you normally do?
7:11
And if they say yes to any of these, I asked them, do you feel like this is really overpowering?
Is it something that you feel is not normal?
7:20
Speaker 2
OK.
7:21
Speaker 1
Because it gives them a chance to think about it like, OK, is this normal?
Because we all, every one of us experience depressive symptoms through our lives, anxiety that's just part of life.
But it gives them a chance to think, OK, is this above and beyond what I can handle?
7:39
And a lot of times they say no, but sometimes they say yes.
And this prompts me to go further and to give them a, a questionnaire of sorts, a mental health survey that they can fill out before they leave.
7:56
And that further kind of drills down.
These are instruments that have been validated scientifically.
And that that way I can see, OK, how much are we looking at as far as the pathology here with emotional health, mental health?
8:14
And it helps me kind of weed through the depression through anxiety because sometimes people can have both or they can have one or the other and, and, and parts of the other.
And so if I ask questions that really dig down on depression, anxiety, and then a screen for bipolar disorder and then ADHD, because again, all those have some interlinking with each other.
8:42
And if I stop short and just screen for depression, I might be missing somebody's anxiety or bipolar disorder or ADHD too.
You're.
8:55
Speaker 2
So smart.
8:56
Speaker 1
Well, some of the time.
8:57
Speaker 2
I like that that's looking at the bigger.
8:59
Speaker 1
Picture some of the time.
9:00
Speaker 2
Bigger picture, trying to get a full understanding of what potentially could be going on.
9:06
Speaker 1
Yeah.
So it helps me understand if these Blues that they're going through is something more than that.
9:11
Speaker 2
Right, which is really important these days.
Yeah, there's so much struggle with mental health that the cost is really great.
Yeah.
And you're one of the places where the buck can stop.
9:24
Speaker 1
So that's why we're talking to you folks today, the depression and antidepressants, how they work, some side effects, a little bit about the brain.
I don't want to get too far to the brain today, but just so you can have kind of a beginner's guide to the brain and to the hormones that are affected by that.
9:42
So ladies and gentlemen, are you depressed?
Yes.
No.
Perhaps.
If you are, you are not alone.
9:51
Speaker 2
And if you have a username that doesn't actually show who you are, put it in the comments below.
We'd really like to see in our audience what things we maybe can do future episodes on, what your needs are.
10:10
Speaker 1
You may feel broken, but remember you're a human.
As humans, we sometimes break.
All of us do.
That's not terrible.
It's taking the long term view.
We are human, and depression effects marriage in a multitude of challenging ways.
10:28
Speaker 2
Yeah, we're going to be talking about that in the second part of this episode.
10:32
Speaker 1
So, folks, let's talk about some facts here.
According to Hazen, the author, in a article in the Journal of American Medical Association Psychiatry, states that about 20% of adults have or have had a clinically significant major depression in their lives at one point or another, and around 810% are considered clinically depressed in any given year.
10:57
I would venture to guess that it's probably a lot more than that.
11:01
Speaker 2
That's what I was thinking too.
I was just going to say, what are your thoughts on those stats?
11:04
Speaker 1
These are the official data from the National Institute for Mental Health.
OK.
11:09
Speaker 2
But you think they're being conservative?
11:11
Speaker 1
Yeah, I think it's probably a little conservative or a lot conservative, but it's still a lot of people.
And depression really comes in a lot of forms, like just after having a baby, your first year of marriage, possibly a parent or a child dies suddenly or gradually.
11:28
Speaker 2
Situational kinds of depression.
You've talked also about seasonal affective disorder, otherwise known as SAD.
11:37
Speaker 1
Could be seasonally, could be hormonally by month.
11:40
Speaker 2
That's another big one for sure.
11:41
Speaker 1
Especially in women, maybe life just looks a bit drab for as long as you can possibly remember and it's runs in your family for generations.
You may think you may be depressed, but you're not sure.
You're pretty sure you're depressed.
11:58
Understanding Depression's Symptoms and Brain Chemistry
We're going to review what it is defined clinically and how it's treated clinically.
So how is depression to find it's at least two weeks or more having either a depressed mood or a loss of interest or pleasure, and at least four of the following a significant weight gain or loss.
12:19
Insomnia or hypersomnia, meaning you can't go to sleep or you sleep too long.
Physical agitation or retardation.
So you're just hyped up all the time or you just can't move.
You can't get out of bed.
Fatigue, feelings of worthlessness or excessive guilt, diminished ability to concentrate, and or recurrent thoughts of death.
12:42
Speaker 2
That's when it gets really serious that we need to very much pay attention and.
12:47
Speaker 1
Yeah.
So, so the first 2 is either you just feel depressed down blue and or you don't like doing things that you used to like doing, OK.
And then these other ones, you know, the sleeping, the eating, the energy levels, things like that, thoughts of suicide, you got to have at least four of those.
13:08
So in the brain anatomy, the brain is a very complex thing.
So many billions of neurons and interactions.
The main parts of the brain that we're going to be talking about with depression are in the medial and lateral prefrontal cortex.
13:24
And part of that specifically is the anterior cingulate cortex, the limbic system.
We've talked about the limbic system in the past.
That's because it mainly deals with the anxiety that's created stress.
Limbic system that includes the amygdala, the hippocampus.
13:40
The amygdala is really that reactionary emotional center, the hippocampus.
13:46
Speaker 2
Is that where we keep the memories?
13:47
Speaker 1
Hippocampus is where we keep memories from the past that trigger those sudden emotions so they work together in that limbic system.
And the hypothalamus is another part of the brain.
They all play a role in mood levels, mood stability, energy levels, motivation, emotional expression.
14:08
There are places in the brain for all of these things, for these tracks, these neurons.
And sometimes we have more connections than others.
And that's what makes us all unique, right?
That's what makes us all who we are, the special person that we are, the special challenges that we have.
14:28
So there are some hormones, they're called neurotransmitters that play a role in mood regulation.
You've probably heard of some of these.
Big one is serotonin.
It's one of the neurotransmitters that regulates mood and whether the feelings of depressed moods or increased moods.
14:51
Serotonin is one of the main neurotransmitters, but there's others too that are involved.
Another one you may have heard of dopamine.
15:01
Speaker 2
That's a good feeling that comes when you're having a rush for.
15:06
Speaker 1
That's going to be a kind of a serotonin effect.
A dopamine also can do that as well.
However, it is more motivational.
It's going to give you drive.
It's going to give you desire to do things Like, remember we talked about part of depression is we don't like doing the things we used to.
15:29
Yeah, that.
15:30
Speaker 2
Mean it's.
15:30
Speaker 1
Like I I used to love going to the State Fair.
Now I can't stand it.
15:35
Speaker 2
Or being around other people or hosting parties.
15:38
Speaker 1
Exactly.
15:39
Speaker 2
When you don't want to do that anymore, is it because of decreased dopamine which leads to depression or depression leads to decreased dopamine?
15:49
Speaker 1
Yeah.
So that's going to be a lack of that dopamine functioning, whether it's not enough dopamine.
Dopamine that is there is not affecting the receptors like they should.
OK.
There's norepinephrine.
What's that?
That is really a neurotransmitter that helps regulate blood pressure.
16:10
If your blood pressure is really low and you're on the ICU, they they give you norepinephrine, but it also helps with fatigue too.
So if people are depressed and they have fatigue, a little boost of norepinephrine can help with that part of the depression.
16:30
This is why.
16:31
Speaker 2
This helps you get out of bed.
16:32
Speaker 1
Medications such as certain medications that increase norepinephrine, so that helps with that fatigue, part of the depression, it's not necessarily going to help you get out of bed.
That's more of the dopamine.
16:48
That's what the motivation to get out of bed is, more of the dopamine.
OK.
And then some other things.
Glutamate.
16:55
Speaker 2
I've not heard of that one.
16:56
Speaker 1
So glutamate is produced in the brain and it is a very inflammatory marker.
So we don't want a bunch of glutamate in the brain, and so there are ways to help with that.
This is more refractory depression that we'll get into, but that does play a role.
17:16
These glutamate proteins in the brain that cause inflammation.
17:21
Speaker 2
OK, which leads to depression.
17:23
Speaker 1
Yes, yeah.
And then GABA is another neurotransmitter in the brain.
The main effect for this is just to just quash everything down.
When we have people who have panic attacks, panic episodes, anxiety, we give them medications that increase that GABA, the effect of GABA in the brain, and that just really settles them down and just removes that anxiety.
17:55
You know, alcohol does kind of the same thing.
The problem with alcohol is it can cause other physiologic problems and of course the medicines we use where the anxiety can cause problems and addiction unfortunately because when you stop it, it causes a rebound reaction that makes you want it more.
18:16
Speaker 2
Maybe we should do another episode on some natural ways to do this later.
18:22
Speaker 1
Well, I do have a few things that the end of, all right.
And then lastly, endorphins.
I put this in here.
It's not normally in the list, but endorphins are important.
Those are hormones created by our brains to kind of feel good.
18:38
You know how when after you work out, you know, heavy lifting, you do something strenuous, you kind of feel really good.
So those are some endorphins.
I like to think of it as more the pleasure hormone, the the dopamine is more of the desire.
18:55
Like I want, I want, I want, I want.
And then endorphins, you're the top of the mountain.
You're now having pleasure.
That make sense?
19:06
Speaker 2
Sort of on a very elementary level, yeah.
19:10
Speaker 1
For people on drugs, the cocaine makes you desire, desire, heroin makes you just feel good all the time.
You're comparing, I think this is a that's a decent analogy, I think.
Yeah.
19:24
Exploring SSRIs, SNRIs, and Bupropion for Depression
And OK, so I'm going to group these up.
These antidepressants, SSRIs, that's the most common one you're going to hear out there.
Selective serotonin reuptake inhibitors and these are the ones, the bread and butter of most antidepressants.
19:42
They increase that serotonin, OK, so that kind of the feel good sensation, but we have to be kind of careful.
So their names like Prozac, Zoloft, Lexapro, these are all SSRI's.
19:57
They help with that anxiety by working on certain parts of the limbic system.
To help reduce anxiety, reduce rumination, getting back to that excessive guilt for things you've done in the past, OCD, obsessive compulsive type, things that all kind of runs together.
20:19
There's a relative serotonin deficit in between these neurons in the synapses, and all this drug does is it doesn't give you any more serotonin, it just blocks it from breaking down so you have more in the synapse.
20:38
Speaker 2
OK.
20:38
Speaker 1
And so.
20:41
Speaker 2
Is it all good?
Well, sounds like magic pill.
20:44
Speaker 1
It can be.
We're all so very different and that's why I tell patients and I, I need to tell you now, I wish that we're all like cars that we could just plug in and know immediately what's wrong and how to treat it.
20:59
And I tell my patients this.
I like, I envy car mechanics in a big way.
I'm so jealous.
I unfortunately cannot plug you in They're.
21:08
Speaker 2
All created to be the same.
21:11
Speaker 1
And so when patients come to me and say, you know, all these doctors are throwing drugs at me, I'm like, yes, there's a reason for that.
It's not that I can't speak for all doctors.
I can speak for this, Doctor.
The reason we do that is because you are an experiment.
21:27
I'm just being blunt.
21:28
Speaker 2
Everyone's.
21:28
Speaker 1
Very.
Every single person is an experiment.
Now we've done studies to show, OK, most people do well with this, with this condition, but there is a lot of crossover and so we try to do our best.
21:44
I will say there are some genetic tests that may help, but I have found them to be mostly useless.
21:52
Speaker 2
And very expensive.
21:53
Speaker 1
And highly expensive.
It's about $1400 for the one I'm thinking of.
And it gives you a red, yellow and green section.
And it's very misinformative because the red does not necessarily mean you can't take that.
22:10
But the patient doesn't know that and they think I can't take anything that's in red.
And that is a highly unfortunate and quite frankly, after years of trying it, it has not really done much.
So I don't do it anymore.
22:23
Speaker 2
OK, it's.
22:24
Speaker 1
Not because I'm behind the times, it's because I've already tried it and it's not super helpful.
OK.
22:29
Speaker 2
Good to know.
22:31
Speaker 1
I am waiting for the day though that we can plug you in and find out exactly what you need.
So with these SSR is usually they're pretty well tolerated.
We might have to switch, move to another one, depending on side effects, but side effects that are common to all of these medicines in this group, weight gain, people don't like that.
22:53
Speaker 2
Like it so they don't stay on it.
22:55
Speaker 1
Very.
Now there are some that have less weight gain than others.
Lexapro or esotilipram tends to have a little bit less weight gain than some of the older ones.
Paxil or paroxetine has the most weight gain.
That's why I never use it.
And then fluoxetine and sertraline Zoloft in the middle.
23:13
They also side effects include decreased libido, which.
23:18
Speaker 2
People don't like that either.
23:19
Speaker 1
Don't like that, Maybe not as much as the weight gain.
Nobody likes weight gain, or almost everyone, I should say, don't like the weight gain.
Another thing about the SSRI is emotional blunting.
23:32
Speaker 2
So feel.
23:33
Speaker 1
Anything it could yeah, it can bring you up from your depressed state, but you're just you can't really experience yeah, the highs either.
Another group that it works well, the SNRI antidepressants, this one has kind of a combo.
23:50
Remember, let's go back to serotonin and norepinephrine.
Remember we talked about norepinephrine is kind of activating, so it helps people with fatigue more.
So let's say you have depression and you're just so tired, you just lack of energy.
24:06
So I might look at one of these meds first before I go to an SSRI.
So some examples in this class, Effexor, Pristiq, Cymbalta, Savella, they increase serotonin and norepinephrine in the brain instead of just serotonin with the SSRI.
24:31
OK, so this is going to be better with people who also have fibromyalgia and just that pain, chronic pain, some side effects.
It may also increase sweating.
24:46
Speaker 2
Even in younger people.
24:48
Speaker 1
Yeah, not everyone.
It does affect weight gain, decreased libido like the SSR is.
It's just variable.
It is variable.
Some people do really well on SNR is where they had problems with the SSR is there's one that kind of sits in its own class.
25:08
It's called Eupropion or Wellbutrin, and that increases that dopamine, right?
So dopamine, that's the motivation hormone.
If you're depressed and you can't get out of bed, then we're going to be looking at that one a little bit stronger, OK.
25:25
And it's interesting, sometimes we need to do both.
We need to do bupropion with an SSRI or bupropion with an SNRI like Effexor bupropion.
That's a good tool to have.
25:40
It is a good tool, OK Side effects include it can worsen anxiety because again, you know, you're increasing that motivation that can increase anxiety.
So we got to be careful with that.
25:53
Speaker 2
OK.
25:54
Speaker 1
And it also can worsen some impulsivity.
So if people have problems with being impulsive, that can really amp that up, OK.
26:02
Speaker 2
So you wouldn't give that to somebody who has bipolar?
26:05
Speaker 1
I would not do that if I could help it.
Yes.
26:09
Speaker 2
Or ADHD.
26:12
Speaker 1
No, ADHD would be helpful because it's, again, it's increasing that motivation to do something, but with the caveat that you got to be careful because it can increase impulsivity.
All right, So there's some other ones too.
26:27
There's actually a lot of other types of medications that we can treat for depression and we can augment.
We can use different things.
26:37
Advanced Treatments and Natural Ways to Combat Depression
There's some lesser known antidepressants.
I'm not going to go over.
Let's say you have really hard time getting to sleep and you're depressed.
There are medications for that, but.
26:48
Speaker 2
Weight gain is part of almost all antidepressants.
26:52
Speaker 1
Yeah, bupropion is the most weight neutral if weight is really super important.
26:58
Speaker 2
You said it, it's the most important thing to people.
27:00
Speaker 1
For a lot, yeah, a lot of people.
Bupropion or Wellbutrin is mainly weight neutral, you know, and we get back to this, the glutamate, which is a hormone again very inflammatory in the brain.
There's ketamine bravado, these are ketamine like medications that go in and block the receptors that that's glutamate triggers.
27:30
So it effectively reduces all the glutamate effect on the brain.
The brain then responds by making a lot more glutamate.
And so the idea for people who have very serious refractory depression, the idea here is to go in and just do a clean slate thing, like a hard reset of your hard drive, you know, on your computer just we're wiping everything out really.
27:58
And some people have done really well with that.
I don't have much experience with that with my patients.
Usually they're at psychiatry when it gets to that point.
But there are some other adjuncts like Liathyrenine, that's a thyroid supplement that can be used as the augmentation to help with energy, with fatigue, with brain fog, cause brain fog is one of the symptoms of a low functioning thyroid.
28:28
And stimulants like Adderall or Ritalin that we use for ADHD can also use as an augment because they increase those neurotransmitters too.
So this kind of brings up all of this stuff.
These are really high level.
28:45
Look at some of these antidepressants and what they do, a little bit about the brain and what it does.
Neurotransmitters.
You know, depression's hard.
Yeah, it's hard.
29:00
Speaker 2
We've had a significant amount of depression in our own family and it is hard.
29:06
Speaker 1
You know, some of it is situational, some of it is genetic, genetic and seasonal.
It is part of human life and we can't feel shame over what we feel like.
We just can't.
29:20
Speaker 2
And a lot of times the benefit of depression is it shows you where something's missing in life, right?
It shows you that there's a gap somewhere, that maybe some changes need to be made.
29:32
Speaker 1
Yeah, a messaging saying hey.
29:35
Speaker 2
Right.
If it's part of your executive functioning, then it serves a purpose in some fashion.
It's just when it overtakes your life.
29:43
Speaker 1
Right.
So you talked earlier about some more holistic things, maybe some more natural, I would.
29:52
Speaker 2
Be really interested to know that what do you have?
29:56
Speaker 1
Well, I will say that the most studied natural supplement I believe is Saint John's Wort, OK, There are some other supplements out there as well.
They have not been studied as as well as that.
30:08
Speaker 2
They don't have the funding that drug companies would have.
30:11
Speaker 1
Yeah Saint John's Wort Sam E is another one.
SA M-E is over counter supplements and there are ways to look up dosing instructions and things online.
OK, diet.
30:26
Speaker 2
Yeah.
30:27
Speaker 1
Diet, diet, diet, diet.
30:29
Speaker 2
There is some research out there by Susan Pierce Thompson, I believe that shows that refined foods contribute to depression and anxiety.
So if you cut those out of your diet, they have seen a significant drop in right.
30:47
So if you're.
30:48
Speaker 1
Depressed and you are eating a bunch of bread, a bunch of desserts, a bunch of soda, the odds of you getting better are diminished.
And now if you choose to start eating green leafy veggies and tomatoes and carrots and crucifer.
31:07
Speaker 2
'S water broccoli.
31:08
Speaker 1
Seeds.
31:09
Speaker 2
Cauliflower nuts.
31:11
Speaker 1
Yeah, then you're you're going to find changes happening, positive changes.
And if you do it all the time, I know it's hard because the other the bad stuff tastes really yummy.
I'm just being honest.
It's a.
31:26
Speaker 2
Lot of people have to take a pill.
31:28
Speaker 1
Yeah, they'd rather eat delicious and take a pill.
But look, sometimes you need to have to take a pill even if you're eating well.
That's true.
And I I don't want to say that it's just all in your diet.
It's not.
31:40
Speaker 2
It probably depends on the kind of depression it is.
Yeah, makes sense.
31:44
Speaker 1
The next thing?
Exercise.
Yep.
Wait, Doctor Hastings, this sounds pretty simple because it is.
Diet.
Exercise.
Regular exercise.
31:55
Speaker 2
Hard exercise.
31:56
Speaker 1
Yeah, hard exercise.
I tell my patients at least 15 ish minutes of aerobic exercise where your heart rate is up.
You know, depending on your age, but somewhere between the one 20s and one 40s for about 15 minutes.
32:10
Speaker 2
It sounds a little low to me for depression, but is that what the research is showing?
32:16
Speaker 1
Well, a lot of people don't get it above 100 my love.
32:19
Speaker 2
So if you just tell them do 15, at least that's getting something right.
32:23
Speaker 1
Gotcha.
Otherwise they say I'm out.
Yeah, yeah, 121, again, depending on your age, if you're 80 years old, yeah, 120 is going to be kind of your Max.
But anywhere in that range, you're getting that aerobic exercise four days a week or more.
That's what we're looking for.
32:39
That's the sweet spot, that aerobic exercise.
And then the third thing is sleep.
Sleep is hard, especially as you age.
They're just some things that change as you age and it is a little bit harder to do, but I try to teach my patients about this sleep hygiene, you know, an.
32:59
Speaker 2
Interesting term.
33:00
Speaker 1
Dental hygiene, right?
Brush your teeth.
We floss.
Supposed to.
There's sleep hygiene too, and that is preparing yourself for sleep and being very, very intentional about your sleep.
Getting your screens off, you know, blackout curtains, whatever at night, shades, eye shades and not eating or drinking for at least an hour before bedtime, things like that.
33:28
Cooling it down so it's a little bit cooler.
There is an app, it's the Calm app.
They have somebody scans.
33:36
Speaker 2
Insight Timer is another one and they have night meditations or night music that help you fall asleep.
33:43
Speaker 1
I like the body scans because you're able to talk to each part of your body and say, OK, it's time to relax now.
From your head to your foot.
Meditation, mindfulness.
We talked about that in depth in the episode about the M word.
Meditation is a game changer.
33:59
It was for me and just socializing with people, friends, going out, doing things.
34:06
Speaker 2
That helps you sleep better.
34:08
Speaker 1
That's another thing that helps that.
34:09
Speaker 2
Helps with the depression.
34:10
Speaker 1
With the depression.
34:11
Speaker 2
Yeah, connection.
34:13
Speaker 1
You know, some people have pets and that's great too.
You know, whatever works that you can trigger that social need, that social desire that we all have to be needed and wanted and to mean something to someone else.
34:27
The Life-Saving Role of Antidepressants and Part 2 Preview
I'm suspecting that you've seen how serious it can get.
And we don't want people to get to that, right, that level of hopelessness where they just can't function or they're ready to end their life.
34:45
And because of that, I would say you're probably a fairly decent judge of is it that they need to make some of these lifestyle changes or do they need an antidepressant for a little while to help them make some lifestyle choices and then they can taper it down a little bit.
35:05
Speaker 1
So I remember standing in the bedroom of a friend of mine with the shots in my hand, ready to go, ready to give it to him.
Yep, to help him down off of his the Cliff and I it was right there.
35:24
And at the end of the day he said no he didn't.
He didn't want the shot and he ended up ending his life, what, a month later?
Two months later?
35:38
Speaker 2
While later.
35:39
Speaker 1
Yeah, and that to me is really sad.
It's a stark reminder that whatever your opinions are on all of these medications, that they're there for a purpose.
They are.
And when used appropriately, they can be, in some cases, life saving.
35:59
Literally life saving.
So to recap.
36:03
Speaker 2
OK.
36:04
Speaker 1
Don't try to remember everything I told you, it's just what I do.
So anyway, there are medicines.
If you have more fatigue with your depression, there are medicine specific medicines for that.
If you have problems sleeping, there's specific antidepressants for that if you have.
36:18
Speaker 2
Lack of motivation.
36:19
Speaker 1
Yeah, the motivation issue there.
All I'm saying is there are classes of medications that you can ask your doctor.
36:27
Speaker 2
Those are some of the intelligent questions.
36:30
Speaker 1
To.
Yeah.
Specific to all of the symptoms that you personally are having, OK, it's not a one-size-fits-all.
It's a back and forth between doctor and patient and hopefully that relationship is really good so that that treatment plan can go really well for you.
36:48
Yeah.
36:49
Speaker 2
I like that.
That's helpful.
So this is depression from the lane that Scott lives in, the biological lane.
And on Friday we're going to release Part 2 where we're going to move over into my lane, which is more psychology and family relationships and talk about how depression may show up there.
37:10
But some of the lies are that we believe when we are experiencing depression and how we can change some of those.
And we hope that you'll TuneIn with us then.
37:22
Speaker 1
If you have any questions in the meantime, don't hesitate to reach out.
Hello at marriageiq.com and check us out on YouTube and Spotify and Apple and Instagram.
37:33
Speaker 2
And we'll see you on Friday with another episode of.
37:37
Speaker 1
Marriage IQ.
