Amanda Newman (00:00):
Before we begin today, please be advised that we'll be talking about sensitive content, including depression, suicide and trauma.
(00:07):
How can you break the cycle of negative thoughts? Can you treat depression without medication? Which types of depression affect women the most? All that and more on this episode of The Healthiest You. You are not alone in fighting the unseen battle in your mind. Nearly a quarter of women are living with depression, and finding freedom from it looks different for each person.
(00:33):
Welcome back to another episode of The Healthiest You podcast, where we focus on women's health and wellness. I'm your host, Amanda Newman. Whether you're on your way to work or enjoying a cup of coffee, take this time to focus on your health. In Part One of this podcast series, we're going to talk about depression symptoms, treatment options and coping strategies. Here to start our conversation today is Dr. Samantha Cerimele, psychiatrist with Lehigh Valley Health Network, part of Jefferson Health. Dr. Cerimele, welcome to the show.
Samantha Cerimele, MD (01:04):
Thank you. It's so great to be here.
Amanda Newman (01:06):
So, women are twice as likely compared to men to have depression. Why is the risk higher for women?
Samantha Cerimele, MD (01:13):
So, depression in general is typically due to several different causes. In addition to a genetic predisposition, there's psychosocial stressors, and also women can be sensitive to hormonal changes associated with puberty, menopause, pregnancy and menstruation as well. Additionally, women who have had a history of trauma or sexual assault could be more predisposed to depression as well. I also would be remiss not to speak about the cultural implications that women kind of face in society. So, women are much more likely to be the primary caregiver of their kids, also their older relatives, and still be expected to work. They often work for lower pay and sometimes they have less respect in the workplace or in different areas of society. So all of this together can really lead to the reason why women do have depression at higher rates than men. There's even some studies showing even without all of these cultural and societal factors, that there are some genetic changes in women specifically that can contribute to depression that men don't seem to demonstrate.
Amanda Newman (02:16):
OK. So you mentioned a few different causes of depression. Is there anything else that can lead to this condition?
Samantha Cerimele, MD (02:22):
Yeah, definitely. Women and also men, personality style, substance use and medical illnesses, among other factors, can contribute to depression.
Amanda Newman (02:31):
And could you touch on which are the most common types of depression affecting women?
Samantha Cerimele, MD (02:37):
The most common type of depression affecting women is something called major depressive disorder, and that's something that we're going to be talking about a lot during this episode. Women also experience postpartum depression, which is depression that starts after the birth of a baby. They can also experience PMDD, which is premenstrual dysphoric disorder – you could kind of think of as a much more severe and disabling form of PMS [premenstrual syndrome]. So those are kind of the main types of depression that we see in women.
Amanda Newman (03:04):
So as we're talking about depression, we know that there may be emotional or physical signs that someone may have this. So what are common symptoms you should not ignore?
Samantha Cerimele, MD (03:15):
Yeah, so definitely feeling that there's a lack of interest in activities you used to enjoy. Of course, a persistent, low and sad, depressed mood, changes in sleep. So sometimes people sleep a lot, sometimes people have insomnia, and they don't sleep enough. Likewise, changes in appetite. Sometimes people overeat and sometimes people have a lack of appetite. They could even lose weight. Feelings of hopelessness, helplessness, worthlessness. I have patients who talk about feeling like they're a burden to the world or to their family – feelings of guilt that come along with that. As well as suicidal thoughts, and that can kind of have a really big range. So some people might have the feeling that I wish I went to sleep and never woke up, or I wish I was never born, I just wish I wasn't here. Kind of the thoughts of escaping. That can kind of range to thoughts about maybe I should really do something to end my life or to seriously harm myself, to thoughts about, OK, I have a plan, I have things that I would like to do to harm myself. So anything in that range at all is something that I really think you shouldn't ignore and you should certainly seek out support from your clinician.
Amanda Newman (04:27):
That's really scary, just to be sitting in the darkness with these thoughts by yourself.
Samantha Cerimele, MD (04:33):
Exactly.
Amanda Newman (04:33):
So if you are experiencing some of these symptoms, what are the first steps you should take?
Samantha Cerimele, MD (04:40):
Yeah, I think the very first step is really just recognizing it, because you can get really caught up, like you said, in that darkness and just kind of sitting with that and kind of stewing and kind of just getting into this place where you don't really have the motivation or desire to do much. So if you realize that that's the very first step, it's just realizing, hey, something is wrong. And then the next thing I would do is get support. And for a lot of people that might be reaching out to your loved ones – family, close friend – just for that social support. Letting them know, hey, I'm really struggling and I just need someone right now. That could certainly mean calling a crisis hotline like 988, the suicide hotline, or calling your therapist or other trusted clinician. You can always come right to the emergency room.
(05:26):
If those thoughts get to the point where you're thinking about hurting yourself, certainly we recommend that. But before that, there's lots of ways where you could reach out for support and help as well.
Amanda Newman (05:35):
And how is depression diagnosed?
Samantha Cerimele, MD (05:37):
So depression is diagnosed by a clinical interview. Any physician, clinician who's trained can really diagnose. So it doesn't have to be a psychiatrist or a therapist. I think the vast majority of people with depression are diagnosed actually by their primary care clinician. So basically that person would interview you, they ask you about the variety of symptoms that we talked about already. And then basically if you meet criteria for five out of the nine symptoms of depression, your diagnosis would be major depressive disorder. So there's no blood tests, there's no brain scans. It's really just about talking to your clinician.
Amanda Newman (06:16):
If you are diagnosed with depression, what treatment options are available?
Samantha Cerimele, MD (06:20):
There are lots of treatment options available. So that's why I'm really happy you invited me here because we get to talk about it. We kind of talked about being really scary, sitting in this darkness. And it can feel really hopeless at times to have depression and kind of helpless about, like, how do I get out of this? So right now, the most recommended treatment is a combination of psychotherapy and medication management. So, that's psychotherapy – there's many different types, and we'll get to that a little bit later in the episode – and medication. The most common type of medication, the first line, is something called an SSRI. That stands for selective serotonin reuptake inhibitor. You might've heard of the common ones like Lexapro, Zoloft or Prozac. These are medications that you take every day. It helps with mood and also anxiety. Now, depending on the type of depression you have and your other symptoms, there might be other treatments recommended. But that would be the treatment for major depressive disorder.
Amanda Newman (07:15):
So you had mentioned medication. However, some women, they may not see improvement of their symptoms with that medication or maybe they just don't want to take any medication. So what other options are there? What about maybe trying transcranial magnetic stimulation? Could you talk about how that therapy works?
Samantha Cerimele, MD (07:33):
Yeah, so that's something called TMS, transcranial magnetic stimulation, and that's something that is a neuromodulation. So this is really helpful for people that depression is just not treated well with medication. Or, like you said, they might have some side effects that they're not able to tolerate. So what happens is the patient will come on into our clinic. You come in for a long course of treatment, it is a time commitment. So you come in for about four to six weeks. It's five days a week where you come to the clinic. You sit in a nice comfy chair, they put a helmet on you and you're awake the whole time. The treatment itself lasts from about 3 1/2 minutes to 20 minutes, depending on where you're at in your treatment and how you're doing. And during that treatment, there'll be kind of magnetic pulses that are delivered to the specific area of your brain that's responsible for depression, and that's just not really acting properly to control our mood. So with the course of this treatment – again, it's four to six weeks, five days a week – people do notice that their mood tends to lift a little bit. That cloud with depression kind of goes away. The interest and joy in life starts to come back. People have been really happy with it so far. My patients that I've sent for TMS have really been impressed.
Amanda Newman (08:49):
That's great. Are there any sort of side effects that could come with TMS?
Samantha Cerimele, MD (08:53):
Yes, there are. So, some people experience scalp discomfort or pain because, remember, you're wearing a helmet where they're delivering magnetic pulses, so that pain, discomfort or a headache could happen. Sometimes people have some facial spasms or lightheadedness, but those are the most common ones that people do experience.
Amanda Newman (09:14):
Another option is cognitive behavioral therapy. So how can this improve depression?
Samantha Cerimele, MD (09:20):
So, cognitive behavioral therapy is a type of psychotherapy or a talk therapy where a patient would come in and see a trained therapist. Cognitive behavioral therapy focuses on the connections between your thoughts, feelings and behaviors. And I kind of drew a little triangle because that's how we draw it for our patients. So really this is helpful because people who are suffering from depression have what we call cognitive distortions, which means we're kind of viewing life through a lens that is clouded or has a filter of depression. So cognitive distortions could be overgeneralization, like everything is bad, everything will go wrong, or a negative attention bias where you're only looking at the negative outcomes and really not paying much attention to the positive things that happen in life. These are really, really common with depression. So what cognitive behavioral therapy can do is kind of help you to reframe, kind of see things for what they are instead of seeing them through that lens of depression.
Amanda Newman (10:16):
OK, so reframing is a technique that's used with CBT.
Samantha Cerimele, MD (10:19):
Exactly.
Amanda Newman (10:19):
OK. So following a treatment plan is essential, but having a mental health toolkit can also be helpful. What are some healthy coping strategies you can implement at home or in the office?
Samantha Cerimele, MD (10:33):
Yes, this is extremely important as well, and certainly shouldn't be used in place of, but definitely along with, other therapies. So absolutely maintaining a healthy balanced diet, getting purposeful movement. So an exercise regimen is wonderful, but if it's just walking, getting outside, doing whatever you enjoy that makes your body move is very important. Maintaining social connections. So loneliness is a big factor that contributes to depression. So maintaining the social connections and just doing the hobbies that you like doing. A big symptom of depression is losing interest and not wanting to do your hobbies. So sometimes we kind of need to force ourself to engage in these things and kind of trick our brains into thinking we're not depressed. And the more we kind of engage our bodies in these things, it kind of does help to lift us out of depression.
Amanda Newman (11:22):
It becomes more natural if the more you do it even though you don't want to. ... Especially if you're like an introvert and going out or hanging out doesn't always sound fun. But if you're struggling, it could really kind of help lift you out of that.
Samantha Cerimele, MD (11:34):
Almost kind of a fake it till you make it kind of a thing.
Amanda Newman (11:39):
Yeah. So when you start to feel yourself spiraling and those negative thoughts, they're just so loud, what can you do to break out of this cycle? Is there a mindfulness exercise or a practice that you could walk us through?
Samantha Cerimele, MD (11:51):
Sure. So there are definitely mindfulness exercises that can be helpful in addition to utilizing those coping mechanisms that you've already found to be helpful, like engaging in your hobbies. Some people know that, oh, I listen to specific music or read a book or talk to this person. But there's mindfulness techniques that we can utilize anywhere. These can be utilized at work, in the car, when you're going to bed. If you want to, we can kind of go through one right now. A simple one.
Amanda Newman (12:16):
That would be great.
Samantha Cerimele, MD (12:16):
OK, perfect. So this is just going to be a breathing exercise, and really it does two things. One is that it kind of takes the mind away from all those things you're thinking about and really focuses in on the breath. The other thing is the breathing itself, focusing on prolonged expiration or prolonged breathing out – again, kind of tricks our body into tricking our brain into saying, oh, we're actually more calm and we're actually more at peace. So what we're going to do is breathe in for four seconds, hold for two, breathe out for six, hold for two. So I can kind of guide us through that while doing the breathing exercise. So we'll see how that goes.
Amanda Newman (12:55):
Sounds good.
Samantha Cerimele, MD (12:56):
So I'll just kind of talk through it.
Amanda Newman (13:00):
OK.
Samantha Cerimele, MD (13:01):
All right. So we're getting ready to breathe in. And one, two, three, four. Hold. One, two. Breathe out. Two, three, four, five, six. Hold. One, two. Again in. One, two, three, four. Hold. One, two. Breathe out. One, two, three, four, five, six. Hold. One, two.
Samantha Cerimele, MD (13:35):
That was very, just a kind of a brief walkthrough. But how does your body feel after doing that?
Amanda Newman (13:39):
Much more relaxed. Especially as someone who struggles with anxiety, I feel like that was really helpful. Or even just the daily stressors of life. Like if you're driving and, you know, people on the road, this would be a really good time to implement this.
Samantha Cerimele, MD (13:52):
Exactly. You're driving on [Route] 22 right now. Might take a moment to engage in those breathing exercises.
Amanda Newman (13:57):
I am going to add this to my habit tracker.
Samantha Cerimele, MD (14:01):
Perfect. But when you're really into stress, depression, anxiety, stress, whatever, that can be, it's quick and easy. I'd recommend doing it for a little longer than we did. I don't want the podcast to drag on for 10 minutes or more listening to our breathing and counting, but you get the idea. You can search for these kinds of things on YouTube. There's also some apps on smartphones that are helpful with mindfulness. So definitely recommend these kinds of things as a coping skill.
Amanda Newman (14:25):
That was really helpful. So thank you for taking us through that exercise.
Samantha Cerimele, MD (14:28):
Sure.
Amanda Newman (14:29):
So some studies suggest supplements like St. John's wort may help with depression. Is that true?
Samantha Cerimele, MD (14:36):
So there are some studies that show that some supplements are helpful. So St. John's wort is a supplement that is shown to have effect for mild to moderate depression, not severe depression. So at the point when you're having things like the thoughts about hurting yourself, you're really, really not functioning in your day-to-day life, it probably requires something more than a supplement. But no, St. John's wort is a supplement that has data behind it. There are some other ones that are being explored too, like SAMe, certain vitamins and minerals that just don't have the evidence to support it. Vitamin D is a supplement that can be helpful, particularly in patients with vitamin D deficiency. So a lot of us living up here in the Northeast, especially fall, winter months, are vitamin D deficient. So if you're not already taking a multivitamin, that's definitely something you can get checked by your primary doctor as well.
(15:26):
But just a word about the supplements. So St. John's wort in particular can interact with many different medications. So vitamins and minerals, supplements are not benign. And if you're taking them, it's definitely important to talk with your clinician just to make sure it's safe with the rest of your regimen. The other thing about supplements is that they're not FDA regulated, so that means that the active ingredient can be different amounts in each formulation you get, or there could be other ingredients that you're just not sure about. So for those reasons, they're a bit lower on our recommendation list. But again, if you're taking any kind of supplements at all, it's really, really important that you're talking with your clinician, really, because of the interactions and the safety concerns about that.
Amanda Newman (16:10):
That conversation with your clinician first is so important because, like you said, depending on what other medications or other supplements that you're taking, that St. John's wort could react with those other medications.
Samantha Cerimele, MD (16:23):
Exactly.
Amanda Newman (16:23):
OK. Since there's more to talk about, we'll be continuing our conversation in Part Two of our podcast series where we'll focus on postpartum depression. Thanks for joining us today, and stay tuned for Part Two coming soon.
