Depression: Signs, Causes & Treatments
At Peaks Recovery we help and care for a great amount of clients suffering from a depression disorder, which can come in various shapes and sizes. Our team wanted to have a deep conversation about the complex dynamics of depression and how we provide hope towards overcoming it.
- What is depression?
- Depression and women
- What depression can look like
- Depression and men
- Pharmaceuticals, connection, depression
”Depression is the inability to become fulfilled despite our best efforts.”
welcome to another episode of Finding Peaks I’m Jason Friedman Chief clinical officer here at Peaks recovery centers uh I’ve got a few guests with me today first up Lauren atencio Clinical Director of our men’s program at Old Ranch Road I have Chris Burns president and founder of Peaks recovery and a new guest Chris’s beard joining us today yeah so I would like to welcome Chris and the beard to the show um I don’t have the ability to do that so oh you didn’t get the memo to bring your dinner okay she likes it though it does look good um so today uh we I wanted to Circle back around a few uh months ago we had on uh Dr Stephen alardi who wrote a book called the depression cure and we spent a lot of time talking about um his book and kind of how he uh abused and understands depression um and I think we had some really good discussions about it um and he comes from a very academic and research-oriented world and I kind of wanted to to humanize maybe or not human eye not that he wasn’t a human but like I wanted to to put some actual real conversation in around depression and so that’s what I’d like to do today um and I think you know I was talking uh to our CEO Brandon uh earlier today and I think we’ve had uh you know a fair amount of our clients now are coming in um with their primary issue coming into Peaks being major depressive disorder and it’s certainly something that we’re seeing more and more of uh as we continue to grow in our business and and really try to treat all mental health issues substance use and mental health uh under one kind of uh curriculum and under kind of the guise of suffering and certainly um as I was talking to Brandon earlier uh I talked about how uh certainly all depression leads to suffering but not all suffering is depression and so I think I wanted to start with maybe uh defining depression and um and Lauren maybe I’ll look for you for that like how what what signs and symptoms do you see of depression and I’ll add a few and then Chris will go to you yeah I think is something that Society kind of puts in a box sometimes too like this is what it looks like you won’t get out of bed you won’t do this you won’t do this and I think there’s different levels to depression that people don’t consider right there’s this high level high level functioning depression where I can go to work I can get everything done and I’m still feeling super empty inside and so when we go to signs and symptoms right it’s not always sadness I think sadness can be a big part of it but I think that’s where people kind of mistake as well um but it’s also just feelings of emptiness right numbness um a really really big lack of energy lack of caring about anything inability to connect with others just due to our own narratives about ourselves and it kind of shows up in a lot of different ways and it is very situational for whatever clients kind of present at the time right some of our clients don’t even know that they have depression and they’re like yeah it’s just you know every time I walk into work I just don’t care I don’t feel anything and it’s like that’s depression so let’s talk about that more yeah and I think to add on to what you said certainly other things we see is irritability and that often isn’t linked necessarily to depression but it doesn’t feel good to be depressed and um and so irritability tends to be there and a big part of depression too could be passive suicidality or just being suicidal but you know when we’re kind of screening clients as they’re coming in I like to ask a lot of questions like do you sometimes wish you wouldn’t wake up in the morning or do you sometimes think the world would be better without you or there would be less pain in the world or everyone might be sad for a minute but then everybody’d be happy that you were gone and oftentimes that is absolutely one of the signs of depression and also honestly some of the first steps to being you know fully suicidal too are some of those um kind of more passive thoughts and that sort of thing and and that is this sort of thing that um is I think really important to address and uh walk through and Chris I’d love to hear kind of your feedback on on what you’re hearing from us clinicians I I love that you guys are the experts for sure um you know what I see with depression is is like this this inability to become fulfilled despite our best efforts um and I watch people and you know when we first started Peaks we didn’t have the mental health awareness that we have now and I remember sitting with guys and they would say Chris you know and I would go through the full gamut of community-based resources to try and turn the light on I’d say you know when I first got into recovery they were like hey did you call your Mentor did you call your sponsor you should go to a meeting did you meet with your therapist you go to group were you honest did you eat did you sleep all of these things and as a young professional most certainly when I started Peaks having been into the field for five years I used to go through the Rolodex of tools and with folks with depressive episodes they were like did that did that did that yeah and it didn’t work yeah and I learned very quickly um through running peaks in my early time in the field that it wasn’t a light switch and that depression as as you pointed out shows up in a variety of different ways I’m actually called to kind of even higher level depression where people don’t see it and I Dr alardi’s approach really speaks to me on this because I remember having you in the gym and I think I’ve mentioned this in the show you know for a couple weeks and you look at me and you say Chris I think I was a little bit depressed yeah you know and so I would have never thought you were depressed yeah nor would you right but when we get a little bit of sun on our face in the morning allow that to rise on our face get a good sweat in and get some authentic connection I think we can grow up and out of that and so I think it shows up in a variety of different ways but in my experience until the Psychotherapy TMS pharmacological combination we hadn’t seen the results I think that we’re seeing today and I love that we have a lot of these resources that we really used to look at and throw shade at TMS that’s crazy they’re putting a thing on your head and you know that’s not holistic and um but it’s sad when you’re in the midst of somebody with major depressive disorder I can remember being in a group with three women who had major depressive disorder about six months ago and it was a group of 10 women and I found myself in that room and I’d never done this before in a in a group or a circle whatever my accountability situations are called and I just found myself moved to tears because the room was so depressed and the only thing that I could do to move through that was to meet him where they’re at yeah and a lot of those women were actually doing really well today happy to report which is really cool that is really cool and I think you you bring up a really interesting thing uh a point I think I’ve had a lot of conversations with people too where you know maybe they are irritable or they have trouble getting out of bed in the morning or they don’t want to get out of bed or don’t want to wake up ever again and and I’ll say to them hey um that’s not usual like that that’s actually called depression and and it usually is surprising truthfully like it usually involves kind of some kind of coming out of a denial process because some of those signs and symptoms are so subtle and if you think about like postpartum depression too like a lot of women coming out of childbirth and that sort of thing and having all the hormones like they kind of feel it like malaise and not feeling like they want to do anything and I don’t have any interest anymore and I don’t why don’t I feel anything anymore and it’s called depression and and it can be um so challenging and difficult to walk with people through that process um of kind of coming out of denial and like being like you don’t have to live like this like there’s a solution here yeah but it could also shift the negative self-talk too because before I know I’m depressed I just think there’s something wrong with it yeah well and that’s where I was going to go right like this is where we put shame in the conversation of for me what I’ve seen with my clients is shame is the biggest driver of depression because when I can’t get out of the bed when I can’t eat when I can’t do the things that I need to do and everyone around me is telling them up telling me I need to do them I then turn it Inward and I say I’m bad this is my fault I’m not good enough I don’t matter I’m not worthy and all of these narratives start to just keep like getting reinforced with our clients and so then they move to those maladaptive coping skills I’m not worthy so I’m going to use substances I’m not worthy so I might act out in you know different self-injurious behaviors but or like even the suicidal thoughts right the shame in the background is just fueling it and telling us every day that we’re not good enough and our depression is going to win every time when we do that and so I think a big thing that I focus with on with our clients and I don’t know our clinical team really focuses on is the shame part how do you get in front of that narrative how do you do one thing today I tell my clients all the time if you got out of bed today that’s a win yeah I don’t need you to do anything else today I just need you to get out of bed and I think we again going back to this societal view is like we have we make these big goals but we didn’t even start at the bottom let’s start with the small goals let’s figure out what the signs and symptoms of your depression are so we can start to cater to them you know not necessarily shame them they’re not bad you’re they’re your way of surviving it’s literally your body can’t take a lot of what’s going on so it shuts down your nervous system just kind of collapses and so being able to just validate this experience for our clients yeah you are going through this and let me tell you there’s nothing wrong with you that’s that first step into being like maybe I can wake up in the morning then maybe I can go to group and then maybe I can you know brush my teeth tonight it’s these little little things that everybody leaves out that I think we really try to reinforce in peaks of like we’re not going to force you to do all these things we’re going to meet you where you’re at and we’re going to help your depression just kind of perk up a little bit I like that that’s really cool too it’s a it’s an interesting way to really like individualize care and each person is going to come in with a potentially a depressive a major depressive disorder and it’s going to look different some people can’t get out of bed some people can’t sleep you know and it’s complete opposite ends of the spectrum some people don’t eat some people eat too much you know it’s so interesting how it shows up in a variety of ways and I love that we’re in this position now and I think you really share like a hopeful view because what it says is not just the trauma work is going to help with your depression but it’s certainly going to release some some tie downs per se and some roots and repair those a little bit so the quality of life goes up and then you have the opportunity to look you know with the psychiatrist from the pharmacological side and then we have the TMS side and so it’s just a really cool way that I see you and your team walking people through this journey because as I’ve said on the show before and I’ll say it again my goal for each and every client is to have more hope than they can remember having when they leave Peaks I tell every family that’s my goal it’s not my team’s goal they probably kill me for that but that’s what they do yeah and I believe that’s possible even in the depressive side of things and Dr alardi’s stuff is pretty key in that as well it is and I think I mean you hit on such an important Point too is that irritability can certainly lead to isolation and kind of like with shame um you know not struggling to get out of bed and then being all by yourself like that literally is going to compound depression and that is that is um I mean that’s kind of the the terrible irony of depression is like the symptoms actually tend to worsen just based upon their own uh presentation like if I don’t know if I want to get out of bed in the morning then it’s harder to get out of bed and then if I don’t think I’m safe for human consumption today then I’m going to isolate and I don’t want to really be around anybody and then I’m going to not eat or eat everything I can get my hands on and I’m just gonna feel terrible to myself and continue on this spiral and I think um what I think Dr lardy brought to our team and what we continue to implement all the time more and more in our program is that in a similar way we can kind of reverse that pattern like you know in my years of doing counseling with people struggling with depression um you can’t go sit in therapy and be cured from it like it’s that part helps but like it’s gonna be there there has to be this implementation of behaviors in order to um treat it um and and to kind of reverse that spiral down like in and you alluded to me uh when I when I went to your gym when I lovingly call the pain cave um uh like you know you and I I think I’m that second or third week like we had been working out four times a week talking uh getting outside running um and then all of a sudden I’m like wait I feel different and I think it just started spiraling in this other direction and I think um that’s the key part and that’s and and again depression tells you don’t do anything like just the solution is to not move and not do anything and so it feels counterintuitive to begin to try to get some exercise and to try to talk to people and try to share it um but I think that’s how we kind of begin to unwind it what do you see with the men Lauren as we kind of build the that aspect like some of those Concepts that we’ve got from Dr alardi yeah you know I think we have and Dan I know was on here recently um but integrating this new kind of just fitness program within our within our curriculum um you know us clinicians trying to be outside as much as we possibly can with our clients whether that’s doing mindfulness walk snow though that’s doing a session outside but just trying to promote kind of being outside moving your body um but also a lot on the back end too is like that encouragement of it um I was sitting with a client yesterday and Dan walked by and he was just like you killed it yesterday you did so good in the workout and this is a client who doesn’t talk a lot to anyone but his whole face lit up right so it’s the part of like we move our body and we do these things but we’re also getting recognized a lot of clients don’t you know they don’t have people in their life who are promoting like good job getting out of bed today it’s more like why didn’t you get out of bed today and so being able to just kind of have us on the back end of well we’re going to take this walk and if you still feel bad at the end of it then we’re going to try something else and we’re always going to keep trying until you find the thing that maybe will you can Implement into your daily routine and it will help you kind of get out of that whole that depression kind of puts us in yeah I think that’s why the Aftercare planning is is so important because what you all are alluding to is like connection really matters and safety really matters specifically you spoke about the men’s and Crossfit and things of that nature I was out of out of the office I was camping for like a few days and I came back and I had missed a women’s CrossFit workout um but I came back for the crossfit workout and I get there right when it starts and every single female is working out and I’m locking up to a couple of them that I wouldn’t have expected and I said oh my God and she was like absolutely I had a great workout last time and she’s moving through it they’re moving through it so well but they’re doing it together and so it’s my experience and my opinion specifically with depression and um early recovery it’s so important to ensure because I most certainly was depressed in my first year recovery but I had a great person to my right and a great person in my left and they just wouldn’t allow me to sit there said we’re going nobody ever said you to me everybody said we are we’re we’re doing this together we’re part of this we’re doing it and that felt so nurturing and eventually by about a year or sober I started getting some sun on my face and started to grow up and out of kind of that depressive state but it was more about Community Connection for me sustainably for a long period of time that really helped pull me through that and I was running this morning right I’m running this morning and I decided to run down to the ranch because I’m training for this Marathon I’m feeling really spirited and I run out of my house and I never run in this direction I always go left so the Sun hits me here well I go right and I go and I’m running down to the ranch and I’m crossing powers and you’re so exposed by the sun um and it hit me or maybe it was coming back either East and West no it was coming back and it hits me and it barely like I can’t even see and oftentimes when I’m running into the sun like that it’s almost blinding but what always happens for me and I have no idea why two tears just go and in that moment I remind myself that today is going to be a good day and it’s just a little bit of sun on your face yeah getting ready to go do what you love I kind of want to go back to the connection thing for a second of what you said because this is kind of what I have seen within the men’s program as well is that you know I think the last time we talked I was on here we talked about the age differences as well and it is just so interesting to see that like you know our our younger clients can come in and say like I’m depressed and then our older clients can say like wait I might be too you know and and being able to see them connect on this way of like oh he can say it I can say it too he doesn’t get shut down if he talks about his feelings I can talk about my feelings too and I think it just creates this safety like you said of you know I can sit in the middle of the room and share my deepest darkest secrets and I know everybody in here probably experience the same exact emotions and feelings I had and so it almost it kind of going back to what you said it just like normalizes depression a little bit we sometimes feel like we’re so alone in this struggle and to be able to come into a program and see that we’re not I think that’s one of the most freeing things for our clients yeah yeah it really is yeah so the other aspect um Lauren you mentioned at the beginning is the pharmaceutical kind of intervention um as well and uh I don’t talk about it a ton but I used to work for a pharmaceutical company back in the early 2000s actually Lauren you were probably a baby and you were probably in elementary school or something but like I do think um uh the company I worked for I sold uh there um it was I was in the Neuroscience Division and so we we had an antidepressant that we sold and so um pharmaceutical companies are big and they are good and they know what they’re doing I went to school I went to um a one-month school to learn about how all the drugs work and I went to a whole other like two-month school to learn how to sell um so I remember um being taught about how um you know it we have two little some people have too little serotonin in their brain and then um this particular medication goes and it blocks these pumps at the end of the neuron that take the serotonin back into the neuron and so because it blocks those pumps it leaves more serotonin in the synapse and that creates uh less depression and and um I’ll never forget what they said at the end um they said that’s our Theory uh because we you know we can’t see what’s happening in the brain and we can’t see the little neurons and we can’t we just have these this Theory but we believe that’s what this particular medication does and so off I went to all the doctors offices and sold it and all this and then um and then literally I think two weeks ago there’s this big meta-analysis uh that came out about um depression and what this meant analysis of like 2000 some studies about antidepressants showed is that they don’t think it has anything to do with serotonin and they don’t know um what is effective in treating depression truthfully and like I had to take pause for a second and be like everything that I that I taught and that we have been taught as a profession like this meta-analysis was like we actually don’t think so and we don’t know what’s helping and and it’s what brings me back to this like behavioral intervention piece um because the other thing you learn in pharmaceutical schools in or just in any program is like placebo-controlled studies and what that means is where you give some people a particular medication you give other people a sugar pill and you compare those and the reason they have to do that is because the people you just give a sugar pill to improve 30 percent on their own just from getting the attention and being around a psychiatrist and having you know a nurse hand this person a pill that alone creates an effect and so to me all of this kind of just speaks to hey we it isn’t mad you can’t just go get medications and I’m not here to say take meds are done I’m no doctor by any stretch of the imagination but I am saying um similar to what I said you can’t just kind of go to therapy and consume therapy and expect not to feel depressed you can’t go to a psychiatrist and get a pill and expect not to feel depressed either and in fact it’s it’s likely a lot of these factors but some of it is just this behavior and this connection and this movement and this eating different and this um getting Sun literal sun and vitamin D and that sort of thing so um I don’t know like they I’ve been thinking about this for a couple weeks now and it’s hard to kind of conceptualize what that all means and it’s a disruption yeah I’m sure well I think too like to go off of that I think that is one of the really incredible parts of Peaks and I mean I guess just treatment in general right like that we can prescribe medication and we can see how it works with your depression while you’re getting clinical work so you’re not just sitting there like is this going to work is this med going to work is this med gonna work it’s hey I’m going to try this med and I’m going to try clinical work and I am going to give this my all in this setting because I know it’s a safe contained space and if it doesn’t work I have people all the time to help me through it medical medical is great I just kind of assessing you know our clients needs but they also are really great with communicating with clinical what are you seeing what are you noticing where do we need to look at and being able to just kind of see the collaboration of medical and clinical to be able to say hey my client’s way more depressed than when he came in I want you to hear me when I say that and they do and so it’s just about collaborating and figuring out what’s the best for our clients coming in and really making sure too that we I see a lot of times especially with the depression talk and TMS and medication and therapy oftentimes I see clients getting vast improvements through a myriad of resources and sometimes I I always I’m always quick to correct them but I’ll hear clients say yeah TMS is a game changer it’s saving my life and I’m like what about the two sessions a week with Lauren that you’re actually emptying the tank and working wholeheartedly I think you ought to he’s like oh yeah that too I’m like yeah see that matters it all matters together and the connection I think is is the big red bow that kind of goes over the top and I think that hits it right on the head Chris that like it it does take all like as many tools as we can have on our tool belt um to because again I think medication is an actual important component I don’t know I don’t know how that all works and I don’t think we anybody knows how it works like this something’s working there um for sure and I think you know having other alternative options like TMS can be very beneficial in the therapy and then the community and then the next like that that’s what it takes I think to really wrap around and treat major depressive disorder I wish there were other options quicker easier faster that isn’t quite the American way but like that probably is how we’ve gotten here is that that’s what we expect and that’s what we want when really this is a much more complex and and more difficult problem to walk through yeah I love it too and once you get that somebody safe and connected then they’ll walk with you to go do the sun thing on your face yeah but before that you’re like go get some sun and they’re like get out of my room you know but when you’re like Hey we’re gonna go grab some sun today and we’ve known each other for a couple weeks and we’ve built this relationship and they’re like all right let’s get some stuff so well I think that goes back to the quote that you guys always say nobody knows nobody cares what you know until they know that you care well and I think that is such a huge part of the depression concept is like no one cares about me and I don’t care about me right like I feel so less than first of all probably I don’t deserve love and I don’t want to put people in my life who have to suffer with me and so it kind of showing them that you know depression is not you it is this part of you that we will explore and will connect with and we’ll understand but who you are as an individual is very different from your depression who you are as an individual is someone who can light up the room and not say anything so although you think your depression is bringing you down we actually see those other parts of you that you just can’t and I always say the clients let us fight for you until you can fight for yourself and that is just kind of again going back to the Rapport building going back to just sitting there and saying how’s your day right just being very very intentional within the process because like we’ve been saying connection is the piece here they just people just want to know that someone cares someone’s willing to just say hi to me today and I don’t think anybody’s born into this world depressed yeah I’m gonna leave that all right with with that I appreciate that correct um with that uh I think we’ll go and wrap wrap this up I appreciate the discussion um I do want to be clear sometimes like when we talk about depression like it’s kind of it’s a little depressing this is the most upbeat topic to come in and talk about but I figured yeah hey who doesn’t want to get out of bed today yeah um but I want to acknowledge that and it is it is real and for families out there um I know it can be frustrating if you have a loved one who’s struggling with depression that’s hard and you can be like just buck up or like Get over to like come on buddy um that doesn’t tend to work like like real clinical depression is hopeless and and Powerless and um and it can feel like you know you have a car sitting on your back and I don’t care how hard you try it’s hard to overcome that and so I just want to speak to that part that that sometimes it does require um good professional competent help um and so with that I thank you guys uh for joining me in this episode um please find us on uh Spotify probably an Apple iTunes and Facebook Instagram uh Chris is in his Snapchat videos Tick Tock videos snapchats of different things I’ve been off my game in the last few weeks but oh Chris is coming back
um and uh tune in uh soon please feel free to email us and uh ask any questions or offer feedback