00:00
So each time we are
talking to our patients,
we really want to make sure
that we find out how they feel.
00:08
And people really
do confide in us.
00:12
People are not afraid
to tell us that,
"Oh, I can't get out
of bed in the morning.
00:20
It's really hard, I used to be able to
get up and get dressed and get to work.
00:26
And now my alarm goes off.
00:29
And all I can think of
is I just can't do this",
that kind of negative self talk.
00:36
Unbelievable changes where
they are able to tell you,
"This is not the way I am,
this is not who I used to be."
You also will see that they
have decreased interest.
00:49
So what other things
do you like to do?
"I don't know, I used to like to do
this, but I'm not doing that anymore.
00:56
I used to take long
walks with my dog
but I just don't
have that energy."
And then, when you get closer into
how they feel about themselves,
they might be able
to say to you,
"You know,
I used to be a really good mom.
01:12
But lately, I can't even get
up and make dinner for my kids.
01:16
I feel so guilty about that.
01:18
I'm so ashamed of myself."
Guilt and shame come as part and
parcel of this depressive disorder.
01:27
Because remember, this individual
is going through an emotional,
physical and mental change,
that they are not able to change,
they are not able to stop.
01:40
It is not within their capacity.
01:43
You know,
oftentimes we hear people say,
"Oh, you have to snap out of
it, get over it."
If a person has a depressive
disorder, there is no snapping,
there is no getting over it.
01:55
So their drop in energy,
this kind of lead feeling like
they can't move their legs,
they can't get on a treadmill.
02:06
It's not that they
don't want to.
02:08
I've had clients who actually I have
said to them, just try to get up
and walk to the door and come
back and use your step counter
to show you how many
steps you've walked.
02:22
And just be really proud of
having walked those many steps.
02:27
You have a disorder.
02:29
And this disorder
takes away your energy.
02:32
It's not you, it is the disorder,
and we can treat that disorder.
02:38
If they tell you they
can't concentrate anymore,
they are completely foggy,
you can let them know,
when we are getting help,
when a person is able
to take the medications
and get the therapy,
that lack of concentration
will start to lift a bit.
02:58
Now if there's somebody who they say,
well, I've never been able to concentrate,
that lack of concentration is probably
just amplified by this depression,
it is never going to go away.
03:10
And we don't make promises
that we can't keep.
03:13
We don't say, "Oh,
you're going to be just fine."
We say, "You know
what, let's try this."
Let's see how it feels.
Let's take one small step after another
and move from depression into a
more stable and positive attitude.
03:34
So the person might also
have a change in appetite.
03:38
And that might be that
they've gained a lot of weight
because all they
want to do is eat
or that they've lost a lot
of weight because in truth,
they cannot get out of bed.
03:49
They sleep all the time,
we call it hypersomnolence.
03:54
So if that person is sleeping all the
time, and they're not eating,
what happens to our body?
Remember,
a psychiatric diagnosis,
a person who is got a
psychiatric disorder,
it doesn't just affect
one part of their body.
04:11
It is their physical health,
it is their emotional health
and it is their mental health.
04:18
And when we're not fueling our
body, when we can't eat,
we end up being even more tired.
04:26
So we have to help them understand
that maybe for a little while,
they have to be in a hospital.
04:33
We're going to take
care of that for them
until they start getting
their strength back.
04:39
That because they
have no strength,
they might have something that
we call psychomotor retardation,
where you find that every
movement they make is really slow.
04:52
You can't hurry them,
you can't rush them.
04:56
If they see something
coming towards them,
they might really just
be moving so slowly.
05:04
Can you imagine how this might
affect someone who is driving a car?
Let us think about
for one minute,
this person has lost interest
in where they're going.
05:18
They feel guilty and worried
about the way they've treating
their family and the
people they love.
05:24
They're in their car, they have no
energy, they're driving to work,
it's really hard to concentrate,
they haven't eaten
any breakfast.
05:35
And now, there's somebody who
suddenly runs in front of their car
and they have this
slow response.
05:44
And then...
05:47
they're not going
to hit the person,
they're going to be able
to stop just in time.
05:51
But what does that do
to their entire body?
Depressive disorders
affect our whole system.
06:00
And we have to be able to notice
when a person needs our help.
06:06
Because once they get to a place where
it doesn't seem like there's any help,
there's no way for them to do any good,
that they are a burden to everyone,
we have to worry about suicide.
06:21
And when we think that
this person might be
contemplating killing
themselves by suicide,
and we no longer
say commit suicide.
06:31
Now we say you're going to
kill yourself by suicide.
06:35
And the reason is we don't want anyone to
have a commitment, that's a positive word.
06:40
Suicide is not positive.
06:43
Suicide is a permanent solution
to a temporary problem.
06:47
And it's our responsibility
to assess for suicide,
and keep that person safe
to focus on that person
and their problem
in this moment,
and to evaluate what we've done
before what they've done before,
and how to move them out of that very
critical thought of killing themselves.
07:14
So let's think about
a clinical picture.
07:18
When we are thinking of somebody who
might have a depressive disorder,
we really want to think
back and determine
what might biologically
predispose them for this.
07:33
And that might be a
genetic predisposition.
07:36
We might say to them, "Has anyone
in your family ever felt this way?"
And they might say, "Oh,
my mother never got out of bed.
07:43
My father had to do everything.
07:45
My mother cried all of the time.
07:48
And my grandmother,
she also took her life
when she was in her 50's."
We automatically want to think,
"That's something."
If they say my mother was very
depressed for a long time,
I think she was on
something called Lexapro.
08:08
We want to think about that.
08:10
Because if Lexapro
worked for mom,
chances are it's going to work
for this person in front of us.
08:17
We want to think about their
early childhood experiences.
08:21
ACES's or having a childhood
experience that is adverse,
adverse childhood experience,
that puts a person in
early life into a category
of being at high risk
for mental illness.
08:38
And depression is one
of those diagnoses,
that if a child has a
stressful early life,
depression, and that feeling of I can't do
anything that powerless, hopeless sensation
might become not something that
they think they're going through,
but really something that they have no
control over and that will never leave.
09:02
Remember what I was saying that
when a person has depression,
they are in capable of knowing
that tomorrow might be better.
09:14
It is not within their
lexicon, they can't imagine.
09:18
And that is why suicide
becomes their alternative.
09:22
We have to be able to
intervene at that point
and start working them step by
step, small steps
to get them back to believing
in themselves and in life.
09:34
Traumatic events also are
very high risk factors.
09:38
And so we want to be able to identify if
this depression is existing on its own
or if it is something that has
come from a traumatic event.