Depression

Dr. Jay-Sheree Allen, joined by NYC based Psychiatrist Dr. Claudine Jones-Bournes have a candid conversation about depression. 

In this episode you can learn a little about the signs and symptoms of depression as well as treatment options. 

Some major takeaways:

• According to the WHO, depression is the leading cause of disability worldwide and is a major contributor to the overall global burden of disease.
• Globally, more than 264 million people of all ages suffer from depression.
• Depression is different from usual mood swings and short-lived emotional responses to challenges in everyday life. Especially when long-lasting and with moderate or severe intensity, depression may become a serious health condition. 
  
  
• At its worst, depression can lead to suicide. Close to 800 000 people die due to suicide every year. Suicide is the second leading cause of death in 15-29-year-olds.
  
  
• It is totally normal to have a bad day or couple of days, but if this feeling is overwhelming and impairs your ability to function for more than two weeks, then talk to your doctor about the possibility of depression.
  
  
• The signs can vary from person to person but some common ones include general malaise, lack of energy, losing interest in things that have been important, feeling hopeless, constantly worrying or having thoughts of harming oneself. 
  
  
• Lifestyle interventions are great — but they sometimes aren't enough. In those cases, we recommend therapy, antidepressants or maybe even a referral to a specialist for more treatment options. 
  
  
• If you or someone you know is struggling, please see a doctor. You can start with your regular doctor, a primary care physician and just let them know. If you are in a crisis, please feel free to go to your nearest ER to get help urgently.

Transcript

spk_0:   0:05
Hey! And a welcome to the millennial health podcast. I'm Dr J. Cherie Alan, a board certified family medicine physician who's passionate about the health of my fellow millennials. And no, we're booked and busy, but your first wealth is your health. So I'm taking some of my most important health messages and bringing them here to you on this podcast. So last episode we talked about the top 10 health issues affecting us as millennials. And number one on that list was depression. I made a promise to you, and I'm keeping it. So today's episode is all about depression. But I've decided to bring a very special guest to join us. Dr. Claudine Jones, born a psychiatrist from New York City who happened to have been my big sib in medical school.

spk_1:   1:06
Hey, I'm

spk_0:   1:07
here. Are you having

spk_1:   1:09
J? I'm so excited to be on the five cast.

spk_0:   1:12
Thank you. Thank you so much for joining. Ah, so you have come such a long way from our days in medical school. We are fully fledged in our careers. I'm in Family Med. You're in psychiatry and I'm so happy we can come together and talk on this Really important topic. But first, I'd like for you to tell us a little about your background and how you even became interested in psychiatry and

spk_1:   1:44
background. A little bit shorts. I could dive right into depression. But like you mentioned, we were, uh we weren't classmates. We were lives. Little something big said that my Harry someone to me, Harry. And if anyone went to med school, if you didn't go to med school, the way it was structured when we went there was you did, ah, like book classes at first. And then you did all of your, uh, on the on the job training your third and fourth year. So your first and second, you only did book work and honestly, not toe offend anyone else. A specialty, But everything else board the mess out of me. I don't know whether I'm a narc elect or what, but I could not stay anybody's class. Uh, maybe it talks about me, but But it might also talk about the subject of psychiatrists. That's one of the classes that I was the most enthralled and happened to be my behavior health classes in my psychology classes. And I said, you know what I think of all the things that is grabbing my attention. This is I think this is the what's for me. Um, you know, coming from a background being an African American, Uh, there's so much stigma around mental health. And so whenever I would tell people I want to be a psychiatrist, it always world down to don't want to be a real doctor or some other ignorant stuff someone would say, And I had some of that internalized eso I said, You know, I'm not going to say the 100% would be a psychiatrist until I do my rotations, DEMAR rotations. And I loved it. So I was basically hooked, and another thing was that it was a need. Like right now, psychiatry seems to be, ah, hot specialty for people trying to do the rest trying to apply the residency. But before, I don't think it was as exciting or sexy. And, um, I saw that there was a need a void in that specialty, and I felt like I was equipped to meet that void. And also there's a thing about when it comes to stigma and when it comes to kind of trying to bridging the gaps of stigma. There is some validity to seeing someone that looks like you in the office and that being helpful, I think, for any special

spk_0:   3:52
team, absolutely,

spk_1:   3:53
especially in psychiatry. There weren't enough that weren't enough people of color in the specialty. I would say even our year that I graduated, I was the only person of color in my class that went into psychiatry. And if you count everyone in my class of a black eye tree in general it was about two or three of us. And so this is just to, you know, give you an example of, like, you know, this is the, you know, historically black, uh, college medical school. And we're only putting out two psychiatrists a year or three or four. You know, not not as money as like nowadays, some of the top universities are putting up upto 10 to 20 applicants in the class. Uh, the psychiatry. So it is. I think it is a growing fields, and I think it's very exciting. Ah, and I didn't get to grow to appreciate, like, how exciting and how many options and everything that just was available to me once being a psychiatrist. So I'm very happy with my choice.

spk_0:   4:55
And I love that you're saying that because I think there some steam on the medical and but that also exists on the end of our patients and even feeling afraid Thio approach a psychiatrist Or how do I even get in touch with a psychiatrist, you know? So I really love that we're having this conversation. So not just the medical side, but to break down the barriers and let patients. No, you're accessible. You understand? You're fun and kind of take away some of the stigma that, unfortunately, psychiatrist

spk_1:   5:29
is everywhere. So that's why I always like Thio do like sessions like this whenever I can just talk to people about talking to people about general's psychiatric conditions and kind of break down some of that stigma through education. But also I'm talking to people that can relate with them that you can trust and that I feel would trust me, because I think that makes a difference to hearing it from someone that you feel like you can trust you could relate to. You're more apt to hear the message, no matter how much education is being pushed forward, I think, Yeah, I think when someone that you could relate to it is relaying a message that that happens to be the key factor.

spk_0:   6:08
So tell us now, little about depression. Are you seeing this in your practice? And what's going on with this year is number one on this level. What is the number one affecting? My life

spk_1:   6:23
is bread and butter for psychiatrists, like it is the most common. So we have to know Ah, how to treat depression howto diagnose depression. You know what what to say about it that you have to You have to get that down because it is the most common thing. And like, um, I'm looking at some stats from the n I am age. And they said an estimated 17.3 million adults in United States at least had one major depressive episode, so it effects. I mean, you might just rounded up and say it effects like one in 10 people.

spk_0:   7:00
It's Smith, and even globally, I'd seen them stats globally to I think around 260 million people, I think, is the World Health Organization's number.

spk_1:   7:11
And the biggest thing is I was actually spoke about. The other podcast was just, um, how they are. They worded it. But

spk_0:   7:20
the W. H. L said depression is now the leading cause of disability worldwide and is a major contributor to the overall that little bird.

spk_1:   7:31
And that's that's the thing that the reason why it is such, um, such an important illness toe understand is because it affects every part of your life. So just think about something that affects every part of your life, and it's also so common and also debilitating. You know, it could be catastrophic. That's why those numbers came out the way it did, what it was like. Major depression has the highest burden of disease, and I don't think people appreciate you know how the debilitating it is, especially if you haven't experienced yourself or if you're associating major depression is just like just feeling down sometimes is a little different.

spk_0:   8:12
So speaking of that, tell us, what exactly should we be looking for? What is the

spk_1:   8:18
symptoms are, you know, things that I think most people could can can relate to in terms of like when they hear depression, you think of low mood and feeling sad. So that is one of the criteria, like you have to have low moved. But the

spk_0:   8:34
other ones are

spk_1:   8:34
not as straightforward and and honestly, um, someone could have almost every symptom of depression and not even know that they were depressed. Sometimes when they figure out what's going on, it's like a car hit them like Oh, man, that's what was happening I thought something else was going on diagnostically. You have to have it for at least two weeks. But I could tell you just 11 day or two days of feeling depressed is enough. You know, if it comes on,

spk_0:   9:04
it's going to say that two

spk_1:   9:06
weeks is a lot to deal with. But diagnostically you look for two weeks and, um, we're looking for I think you have to have a I don't want to get into specifics because you all are diagnosed in anybody. But let me just get into what the symptoms are so low. Mood is one, um, changes in sleep, and it's not just decreased Lee sleeping too little or sleeping. Too much changes in appetite. Both, uh, eating too much, eating too little then we also have changes in concentration. You're not able to focus things that kind of foggy. You're not sure what's going on. That's a symptom. Ah, we call it an adonia. And what an adonia is essentially is you're losing pleasure in, or enjoyment and activities or things that used to do that you once enjoyed doing so. Not, You know, you don't want to go to the class anymore. You don't want to hang out with friends anymore, or when you do hang out with them. It's not as fun or enjoyable. You know, you don't even want you want to just stay in that kind of that withdrawn that was drawn stuff. Another thing is guilt. Feeling really guilty, blaming

spk_0:   10:16
yourself? Yeah, I think that's a

spk_1:   10:18
lot of growing associate with unless they're really down and in the throes of it that it really comes out. But feeling really guilty like this is all my fault. Everything is my fault. Um, hopelessness and helplessness comes along with that, Um when then we also have suicidal ideation, so thinking about having thoughts of wanting to kill yourself and and and some, and for some people, it doesn't come in the form of I want to kill myself. I wantto do this. That or the third to myself. Ah, lot of people, it comes in the form of I would be better off dead. We would still call that kind like suicide ideation, depending on who you talk to, they would still call that suicide ideation, so that also account even if you don't want to actively kill yourself. Having these deep desires t want to be dead is it's also a criteria for depression. Low energy. Uh, low energy is a big is a big one.

spk_0:   11:18
Speak on it. I can't tell you about the number of patients I've seen that come in and they're just like, I don't really know what's wrong, but I just have no energy like, could you check my thyroid like, could you? You know, And you know, you definitely and you know, from my standpoint, in the primary care studying, I want to do due diligence and rule out, you know, other physical causes of, you know, low energy or fatigue, you know, But honestly, when I put the whole history together for some people, I'm like because

spk_1:   11:59
some people may not be familiar with that

spk_0:   12:01
So that's a screening tool that your doctors will use for depression. There are a few others screening tools out there to Edinburgh and stuff there's quite a few, but in our clinic were we use the P H Q nine most

spk_1:   12:15
and the the other sentence that I also want to mention Waas feeling slowed and, for some people feeling like agitated or restless, those those those over it. And aside from the symptoms depression, something that goes hand in hand with depression is a anxiety. And for some people,

spk_0:   12:32
they find it

spk_1:   12:33
easier to say they're anxious than to say that they're depressed for you. They're both,

spk_0:   12:37
Yeah, I'm going to

spk_1:   12:39
and it's in, It's in. It's a fine line that some people are depressed because they're anxious and some people are anxious because they're depressed. So I think that that goes hand in hand as well. But whenever someone comes in with depression, always assess for anxiety because that yeah, that almost most the time of companies it to an extent I'm really much a proponent of making sure that all of all of the people that I see you're recommending treatment for get the medical workup before. I really delve into deep with the medications. So if you're if you are, if you meet criteria, yes, I might start medications for you. But even with the medication started, I need you to check. Like you said, check if your thyroid is fine. Check if you have diabetes. Check if you check if you're anemic. Name. Had vitamin instabilities you would not believe. With. What? Ah, Vitamin D, vitamin B 12. Yes, magnesium. Looking into those I always rule out always without the medical causes first. So that's I think that's the keystone of treatment is too well what medical then you get into. We may or may not recommend medications based on what's going on. The best treatment of choices. Medications with therapy, especially if you have moderate to severe depression. And that's usually determined by some type of rating scale. Like we have. You answer a few questions, see what you are on the scale and then say moderate to severe would not. That's just for us. Tow. Have a gauge

spk_0:   14:09
now that we're talking about treatments to There was a statement that made it to the pressed a few weeks back that I definitely wanted to address as well, especially with us having this conversation. You as a psychiatrist and myself is a family physician in primary care. You know, there was a celebrity who mentioned that your primary care doctor should not be managing your anti depressive. If you happen to be on that, I don't

spk_1:   14:45
think that because, uh, I'm in New York City. They're psychiatrists everywhere here, where

spk_0:   14:50
I am in and rule Rome and soda. We're not We're not saying there are

spk_1:   14:55
hardly any psychiatrists around. And who do you think are gonna write these prescriptions when people need them? That has to be someone to to, you know, fill these medications for them and honestly, in these places where they don't have an abundance of psychiatrists, primary care physicians have been and will continue to be the ones that prescribed these medications. In fact, I think primary care specialists prescribed more antidepressants than we do.

spk_0:   15:24
Can I insert like a clap here or something? And I do want to jump in and say that we do receive adequate training on managing depression in our patients. We absolutely do. And I would really hate for people to continue to suffer and goal without the help that they need.

spk_1:   15:45
Because, like you said, everyone has everyone who is a primary cancer Precious has a certain level of training to to treat the basics of of most of religious president and depression is included. So you all have enough training to start SS arrived. But But you also do have enough training to know like, Oh, this person is not responding and I don't know what to do next. I need to consult a psychiatrist

spk_0:   16:14
girl when I say I Q booked. And that's what we owe that person where I

spk_1:   16:21
live under a rock that's under a box that's like in a time capsule. So I don't even know who said this. But whoever said this also doesn't know about all the initiatives. I mean, all the initiatives that are going on will be called integrated care.

spk_0:   16:38
And trust me, we know to do that appropriately. So it was more just the P s a out there for all of our listeners that please don't shy away from whatever doctor you have contact with. We are more than willing to help you. And if we're not the person you need, your doctor will certainly get you to the help that you doing. All right. But, Kaladze, you so I know we've had quite a spirited conversation here on depression, but what are some big pearls or the major takeaways?

spk_1:   17:12
Number one? You You want to rule out a medical reason, so make sure that in addition, to go into the psychiatrist, you also wants the apartment care doctor and got and and received all the labs that you can, Uh, that you know, what we related to to me would be related to mental house. So they should know what they should know what they are. It would be their standard laughs. But I will also acts for a vitamin D a, B 12 and a magnesium. I would I would just add those on if they if they aren't already doing that and also ah, thyroid test. But that that's using standard. Another take home is that even even if you don't identify as being depressed, if you feel like you have any combination of those symptoms that I mentioned with or without, you know you thinking that you have low mood or not, I would I would consider the possibility of it being depression on and talk to your doctor about it. So if you feel like you have decreased sleep or increased Lee, even and you feel low energy and you're irritable and you don't know what's going on, it might be worth talking to your doctor about it, not necessarily going in and say, You know what? I think I'm depressed, but at least having that conversation in that dialogue so that they can they can help you with the next steps. But one thing I don't want, people always think is like if I have a psychiatric illness, that means I have to be on medications. Uh, that that's not true. You don't have to be on medications, and, uh, before you get on any type of medication, I think you should talk with your doctor fully about your options because, ah, lot of cases of depression can be treated with therapy and therapy alone. And with that, you know, don't be scared of therapy.

spk_0:   18:59
Oh my God,

spk_1:   19:01
The biggest day I'll say about there because I have various opinions about therapy, the main two main things that affect whether or not they're people work and I think that's what people will worry about. Like, Well, it works for me. Is it even right for me? First, you have to buy what they're selling. I don't that I don't know if that makes any sense, but, um, you cannot go into the therapist office like this is never gonna work and then expect that this this person is going to make it work for you. You have to go in with an attitude like maybe this will help, like, have some type of inkling that, you know, this is gonna go in that direction. Um, open mine, open mine, that's what. Just open mind. That's a That's a with an open line. And the next thing that I think is even more important than over mine is that you have report and in other words, that you have a good relationship with this person. I think that is actually the number one predictive. Whether or not a therapy will be effective, not how skilled the therapists is not what type of therapy and maybe as long as you have a relationship, a trusting relationship with this provider.

spk_0:   20:11
But I, um, I encourage patients, though you know in having an open mind to not jump Thio, that we don't connect or we don't click or we don't you know, as a defense you know, against like giving it a try. That's the one thing I do kind of caution people about. Like if you don't vibe, you don't fight, You know that's what it is. That's it. If they're not culturally competent, if they're not respectful, you know, if they're not honoring your story and what you come to the table with, like, I completely agree. But don't use it as a reason to say,

spk_1:   20:48
Well of what you're treating depression or any other psychiatric condition. The treatment shouldn't be happening to you, right? You should be active in it. So, uh, you don't have to stay with the provider like you don't have to stick with that psychiatrist. Not not Unless that's like the only psychiatrist around. You might have toe deal with it until you could find someone else. But if you have options, you don't have to let the trap that the treatment be done to you and that maybe that was a Freudian slip trauma, because it can be traumatic that you feel like these things have to be done to you. Like if treatment is going the right way. You want a quarterback? That treatment, You

spk_0:   21:28
are the

spk_1:   21:28
one calling the shots. It should not be these things happening to you. You sure you're the one saying like, you know, I don't think this therapy is going the way I want it. I want to try something else. Or I don't know how I feel about that medication. Do you? Can you give me the guidance of how to win it off and try something else? Like,

spk_0:   21:46
I love that you say that because I encourage ah patients to be their best advocate. Like your doctors will advocate for you. But you will be your best advocate. And that's one of the reasons why I launched this podcast in the first place. Sorry to share this information. Toe allows to be aware, right of the information that's out there and one of the big things is like you. You have a lot of say, it's your body and it's your health. You know what? We really want you to take charge of that and only that. But thank you, though. So much for joining me today. I really appreciate it. And guys, you know, though, my goal here is to share some valuable information and draw awareness to some important health issues today. That, being depression, I encourage you to consult your position. And if you don't have a physician, you know, I'm always gonna put a plug in because I think you need one for personalized medical advice. All right. And I do hope this information was beneficial to you. It's sold. Please subscribe to the podcast and share with your friends. If you have questions or comments, feel free to reach out on Instagram. I'm at your faith, doctor friend. I'll definitely be tagging Claudine as well on this episode. Claudine has some interests that are very interesting. So I'll have you guys check her out on in stuff. You know, I dabble in Twitter and Facebook, but really I'm an instagram. All right. Thank you so much.