hey there everybody and welcome to this episode of the week by week guide to depression treatment this is part 1 of 14 and i'm your host dr dawn elise snipes in this series i'm going to explore one potential treatment path for somebody with depression depression looks different for each and every person so no one treatment path will look exactly the same but this gives you a general idea of what treatment might look like this particular video explores what the initial session will look like as a helpful hint over the next few weeks i will be
going over a lot of stuff for more in-depth information about particular techniques or issues in-depth videos can be found on the youtube channel at doc snipes dot com slash youtube the first thing that i do when people come into treatment is you know get to know them and then we start talking about what their symptoms are i typically don't get too hung up on the dsm or the diagnostic criteria because depression may look different for every person and there are a lot of symptoms that occur with depression that are not in the diagnostic manual so
i start by asking for each symptom the person has when it started is it something that started a week ago or three years ago what was different before it started what do they think causes it what makes it worse and what makes it better even if just a little bit or for a short period of time this will give us an idea about potential causes of the symptom about potential things that the person already does or skills they already have that we can build on and about things the person knows already don't work i also
encourage them to watch the video what causes that symptom on the youtube channel to learn more about what causes each of the symptoms that we're going to start talking about physically when somebody is depressed they may experience sleep disturbances likewise people who don't sleep well often develop depression many of these symptoms can either cause depression or be caused by depression and it's important to understand that and recognize the reciprocal nature eating disturbances are another issue that come up sometimes people have no appetite sometimes all they want to do is eat junk food and that kind
of makes sense because when we are under stress sometimes our body says you know what now's not the time to eat we need to worry about fighting or fleeing not resting and digesting other times our body is experiencing imbalances in neurotransmitters and foods we eat that are high fat high sugar foods tend to cause the release of dopamine and serotonin and endorphins which are feel-good chemicals i always look at what is the behavior telling me another symptom is gi distress some people may experience constipation when people get depressed it's often a slowing of their whole
system including their gut so we want to look at constipation and pain pain in the gut can be made worse because of changes in the gut bacteria because of the depression or because of what they're eating and generally pain can be made worse when people are depressed because when we're depressed our pain tolerance actually often goes down things that may have been not painful or not you know notable before they were depressed now are are painful to them we want to recognize that that actually is a legit symptom of changes in in neurochemicals in the
person when people are depressed they often don't move a lot and they often sleep a lot more which can also contribute to muscle imbalances and pain so we're going to talk about pain because pain also can cause depression low energy can be caused by sleep disturbances poor nutrition or chronic pain or a lot of other things and we want to recognize that when we have low energy it's hard to get motivated it's hard to feel like you've got any get up and go which can contribute to feeling depressed you know you just you want to
sit on the sofa all the time different than low energy which is just not having the energy not having the gas to go is slowing and that is like moving into a 60 mile an hour wind when people are depressed it often feels like it takes 10 times more energy to move to walk to take a shower than it did when they weren't depressed addiction also often comes up because when people are depressed they often try to self-medicate in some way and make it go away this can be behavioral addictions like shopping or gaming it
can gambling it can be chemical addictions it can you know and in there we're also including nicotine so addictions may get worse addictions also alter the neuro chemical levels or the brain chemicals which can contribute to mood symptoms impulsive behaviors some people don't have enough energy to even think about it other people occasionally have these little spurts of energy and they engage in risk-taking behaviors or impulsive behaviors in order to feel something you know that's the brief moment where they have this adrenaline rush and they're like oh my gosh that's incredible and immunity when your
immune system goes haywire it can contribute to systemic inflammation people who have autoimmune disorders are well aware of this but any time your immune system is triggered it can trigger associated inflammation that inflammation has also been associated with an increase in depressive symptoms likewise depression and stress can trigger an increase in inflammatory cytokines in the body and an increase in immunity in inflammation all of these symptoms have a back and forth affectively well of course the person is presenting for depression so they're depressed they may also experience apathy or low motivation they just they don't
really care about much of anything or what we call anhedonia and that's feeling numb not feeling super depressed not feeling you know super happy super anxious just not feeling guilt anger and anxiety are also very prominent symptoms in people with depression and in treatment if somebody's experiencing these things we talk about what's triggering them and will process some of those issues but right now we're just trying to get a picture of what depression looks like for the person cognitively or mentally people who are depressed often have difficulty making decisions and thinking clearly now this can
be caused by insufficient sleep poor nutrition depression itself a variety of things but these things also make it harder to do your daily activities which can contribute to feeling hopeless helpless and depressed pessimism can cause depression if you've always been sort of a negative nelly then that can contribute to feeling helpless and hopeless a lot of times when people are depressed though they can start feeling more pessimistic because when they're depressed they notice more of the negative stuff they notice more of the stuff that's out of their control and it can contribute to feelings of
depression ruminations a lot of times when people are depressed they have thoughts that bounce around in their head and you know there's a lot of reasons for this but what's important to recognize is those thoughts are generally critical negative pessimistic and they tend to be very overwhelming and loud that negative inner critic or that those hecklers in your gallery tend to be a lot louder when when you're depressed environmentally i found that for a lot of people they're outside represents what's going on on their inside so if they're disorganized or disheveled that gives me a
clue that that that may be how they're feeling inside because of all the things that we've talked about already people may be experiencing difficulty at school or work and resulting financial difficulties difficulty in these areas contributes to stress and distress and often worsens depression relationally people who are depressed often withdraw from others they can't take the input from other people they don't have the energy to deal with their own stuff let alone anybody else's stuff they may withdraw from others because other people may try to cheer them up which makes them feel rejected or misunderstood
or other people may withdraw from them because they just can't take being around somebody who's so depressed they may experience impatience or irritability again because they are overwhelmed when people bring stuff to them when when life happens it can feel overwhelming and it can trigger that fight-or-flight response low self-esteem is very common in depression a lot of times because of the depression the person is not doing the things they think they should or the way they used to and it makes them feel bad about themself now people with low self-esteem from long ago can also
develop depression partly as a result of that so yin and yang toxic relationships also tend to cause depression and may flourish when somebody is depressed because people who are depressed may tolerate toxic behavior more because they just don't have the energy to address it once we've identified what each symptom looks like for that person when it's started what makes it better what makes it worse etc then we're going to identify what recovery from each symptom looks like and for a lot of things when we talk about psychology we use what's called a likert scale and
an anchored likert scale has words that go along with each point on the scale so for somebody's mood one may be miserable two may be okay three is happy four is really excited and five is unbelievably ecstatic we don't expect them to get to five a whole lot but that gives us an idea of where we are starting so people can rank their moods or rank the behavior on a regular basis so we can track its progress we will work to define goals for people's symptoms that are smart specific measurable achievable rewarding and time limited
for example i will have more energy as evidenced by being able to work out go to work and do at least 90 percent of my normal adulting tasks without getting completely worn out or feeling weighed down now this is a goal the person is setting for three months from now not for next week this is ultimately where they want to be i will sleep better as evidenced by getting at least seven solid hours of quality sleep each night i will get motivation back as evidenced by doing the things that i need and want to do
most days it's important with goals not to set extreme goals that are a hundred percent of the time because generally we can't do things a hundred percent of the time so if you set a goal that's like that then you're setting yourself up for failure the next thing i do in this first session with the person is create a support plan change causes crisis and crisis causes change it doesn't matter what the change is it can be a positive change like getting healthier or bringing a new baby to the into the family but that causes
changes which can be stressful it may not be like an overwhelming crisis but it can be stressful change takes a lot of energy and work and i encourage the people that i work with to recognize that they're going to need at least 15 minutes in the morning 15 minutes of the evening and about 30 sometimes 60 minutes some other time during the day so when they get up at lunch time and before they go to bed possibly that's not a huge time commitment but people who are depressed have very little energy so this still feels
like a lot we talk about what things can you eliminate or simplify to free up time and energy for this change and that may mean things like preparing meals ahead of time or getting pre-prepared meals for a little while so you don't have the dishes and you don't have the prep time and all that stuff so you have more time you can focus on working your recovery plan how can you alter your environment to stay motivated and remind you to use your new skills for change there are a lot of new behaviors and habits that
i ask people to do and those behaviors and habits can be programmed into your your mobile device you can get an app that people often use for medication and get push notifications for things like meditation then i ask them to think about who in in your life is supportive and how can they help you and how will you let them know about plans and what you need from them don't expect them to read your mind and know that you need them to do extra work around the house or help you watch the kids or something
else it's important to articulate to other people what they can do to help it's also important for the people to identify what they can do to help themselves feel safe in general feel safe when they're triggered and feel safe so they can work on their assignments so they're not afraid of becoming overwhelmed or spiraling and then they're asked to identify three strategies they can use to cope when they begin to spiral when people are experiencing depression you don't expect them to start treatment and never have another spiraling episode and i believe it's important to create
this safety support plan ahead of time to help people feel empowered so they have tools at their disposal that can help them endure what's going on it's not going to necessarily make them feel wonderful but it helps them endure it so they feel safe they don't feel like they're going to be completely overwhelmed the next thing we do is talk about which two or three symptoms do you want to focus on changing first because when you make positive changes in any area of your life it often makes reciprocal positive changes in other areas and you
can really only effectively focus on two or three things at a time we will talk about how we're going to measure that whether we're going to measure the frequency how often each occurs how long particular episodes last or the intensity or quality of each again on one of those like likert scales and each time the behavior or or symptom occurs the person is also going to know what triggered it what helped stop it if anything and what did not help so we continue to get information about what is helping what doesn't work what triggers it
so we can address those in session another thing i ask them to do is a feelings awareness worksheet now this is something they're going to do between sessions in order to start identifying early warning signs of distress so they may be able to take action sooner than waiting until it's a big crisis you know waiting till it hits them from quote out of the blue i ask people to identify what particular feelings look like for them and what triggers that feeling what thoughts what activities what people and even what sensations like what sounds my the
ceiling fan over my bed makes an awful humming sound and it annoys the crap out of me and that can trigger my irritation so i know that that's a sound that will trigger irritability in me and i encourage them to look at and identify what anger anxiety depression and happiness look like for them and what triggers those emotions another thing they're going to start doing beginning tomorrow you know beginning the day after this session is morning and evening mindfulness and this is the 15 minutes in the morning and 15 minutes in the evening in the
morning they're asked to inhale for a count of four envisioning energy and light filling their body hold it for a count of four and feel that energy spread and then exhale for a count of four and envision fatigue darkness and brain fog leaving their body on their breath you know they can even envision their breath coming out a color that represents fatigue repeat this four times in the morning this deep breathing helps increase oxygen and get people get people going so to speak after they do this they will do their mindfulness inventory and it seems
long on these slides but it really only takes about 10 minutes they'll think how do i feel physically what are my needs physically right now what things might make me more vulnerable to emotional distress today what physical things do i have going on that might make me cranky or more prone to be irritable and how can i cope with them was it easier hard to fall asleep how well did i sleep how many hours did i sleep do i feel rested if i woke up a lot why what will i do beginning today to address
anything that is waking me up in the night if i did not sleep well how does that impact my energy concentration productivity mood and patience with others affectively or emotionally and cognitively or mentally how do i feel am i happy and clear-headed or depressed and foggy-headed or something in between what are my needs what might make me more vulnerable to distress today if you wake up in the morning and you're just in a you know awful mood you know that you know that you're already kind of at your precipice and it's not going to take
much to trigger irritability so what can you do to cope during your day so when life happens it doesn't bring on extra distress and you don't spiral environmentally what are three positive things in my environment right now what things might come into my environment today that cause me distress and how can i best deal with them planning ahead for any obstacles that you might have encounter relationally how do i feel about myself what relationships do i have that enhance my life and this can include your pets what can i do to nurture them what relationships
might trigger or make me more vulnerable to distress today and how can i best cope with them so if you know you've got to interact with a person at work that typically gets on your very last nerve how can you best cope with this so it doesn't cause extra distress in the evening you're going to do deep breathing again but this time inhale for a count of four envisioning cool blue entering your body and helping you relax hold for a count of four and feel that soothing feeling spread then exhale for a count of four
envisioning stress darkness and irritability leaving your body on your breath if you've got kids in the house this can be a fun activity to do with them and everybody gets bubble stuff and you try try to see who can blow the biggest bubble in order to blow a single big bubble you have to exhale a lot of breath very very slowly in the evening the questions are a little bit different again physically how do i feel and what are my needs what things made me more vulnerable to distress today so you're doing a look back
how well did i cope with them is there something i will do differently next time affectively and cognitively how do i feel you know emotionally and mentally what are my needs what would make me happy right now how well did i cope with my feelings today how good was my concentration and is there something different i will do tomorrow to improve the moment environmentally what are three positive things in my environment right now what things came into my environment today that caused me distress how well did i cope with them is there something different i
will do next time and finally relationally what are three things i did well today this plays on your relationship with self or your self-esteem what relationships do i have that enhance my life remember those pets again and what can i do to nurture them i also ask people to get a physical because there are a lot of physiological things like low testosterone estrogen imbalances hypothyroid anemia low vitamin d you know there are a lot of things that have relatively simple fixes that can contribute to depressive symptoms and no amount of talk therapy is going to
address those things i ask people to schedule their physical as soon as possible so that we will have the results including the blood work back by week six i encourage them to make sure that they get their blood pressure and their oxygen saturation evaluated vitamin d and b12 levels liver and kidney functioning their sex hormones gonadal hormones and thyroid hormones so like testosterone estrogen and thyroid hormones assess for anemia and if there might be a chance that they have an undiagnosed autoimmune disorder to also ask the doctor if it would be appropriate to look for
those autoimmune markers finally i ask people to think about their housing and their finances when you don't feel like you've got house safe stable housing it adds stress it adds distress which makes it harder to recover and con contributes to feeling helpless and hopeless i encourage people over the next 12 weeks to start thinking about what they need to do in order to make sure that they feel as safe as possible in their own four walls so they can relax and what do they need to do if anything to ensure the stability of their housing
so they know that they've got a home i ask them to do the same thing with their finances because we need to have enough money to pay the rent to keep the lights on to get medication to get food all those things and without those things we are at much greater risk of experiencing distress and depression so i encourage people over the week to evaluate their housing and their finances to identify if there's anything that needs to be addressed in this first session people have identified their symptoms and the causes they've defined the overall overall
what recovery looks like for them we've worked together in session to develop a support and safety plan now throughout the week they're going to use worksheets to gather baseline data on their two or three symptoms that they're going to start addressing they're going to do the feelings worksheet to identify what feelings look like for them begin practicing morning and evening mindfulness and bring those mindfulness worksheets to session because we'll process them in session we'll look for themes we'll look for trends we'll look for triggers and we'll look for improvement as you start keeping these mindfulness
journals it will provide a whole lot of information and then they're going to schedule a physical and assess their financial and housing stability so that's a lot to do in the first week but when you really look at it there is the feelings activity assessing finances and housing and scheduling that physical so none of those should take too terribly long beginning practicing morning and evening mindfulness so that's your 15 minutes in the morning and 15 minutes in the evening this show was produced by mr charles snipes and presented by dr donnelly snipes you can learn
more about depression treatment boundaries and mental health at doc snipes dot com slash youtube they can be reached at 1633 west main street suite 902 lebanon tennessee 37087 or by email at support doc snipes dot com
