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[Music]
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hi i'm kyle kittleson with med circle
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joined today
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by clinical psychologist dr romini dr
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romney wonderful to see you thanks for
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being here
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thank you so much for having me now when
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most people or at least when i think of
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mental health i think of
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depression and we hear that term used
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all over the place
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uh severe depression though is much
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different than
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what we would consider just a standard
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mild depressive state
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feeling severely depressed can be
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debilitating but it's not always caused
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by
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major depressive disorder which is what
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many people assume
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from your perspective as a psychologist
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can the signs of severe depression get
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misdiagnosed or lumped together under
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major depressive disorder it they can i
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mean i think that's a tricky bit to
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remember when we get to the more
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severe levels of depression depression's
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on a continuum
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okay so at the milder levels of
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depression
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you might see somebody whose energy is a
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little lower than usual they might be
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sort of feeling having negative thoughts
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about themselves there
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they definitely can see a change in
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their mood they are
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you know feeling something's wrong
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something's not right
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and in those milder levels of depression
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you're much more likely potentially to
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see either
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if not a misdiagnosis a co-occurring
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diagnosis that depressive symptomatology
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may fit better with for example grief or
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an adjustment disorder
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or even a personality disorder it might
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be co-located with anxiety
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when we start creeping up to the much
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more severe levels of depression
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what we see is much more of what we call
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the vegetative
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symptoms of depression and by vegetative
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we mean things like
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real impacts on appetite sleep
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concentration and people who have very
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severe depression
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you might see really major stealth care
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deficits that they actually
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literally stop eating properly they
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might just shove like three whatever
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it was close to them in their mouth and
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and go back to sleep
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people who are severely depressed might
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be what we call very hypersomnic they
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might sleep
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all the time like 18 19 hours a day
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their sleep cycles may be completely
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distorted their windows blackened
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very little contact with the world and
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then again
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augmented by these terrible feelings of
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worthlessness just a
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slowing down an absolute apathy they
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really don't get anything done they
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won't bathe
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they probably don't change their clothes
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they won't brush their teeth
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they cannot function they will not be
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working they likely don't have any human
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relationships
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at this severe level of depression
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you're almost getting into the point of
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danger right the person
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who is so not taking care of themselves
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they may very well not be taking their
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medications
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either for depression or anything else
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any other health conditions they have
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they because they're not eating
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adequately if they have some other
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health condition i don't know like
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diabetes
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they could be making that worse um
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if there's anyone else in their purview
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honestly even children or pets
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those may not be getting taken care of
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properly
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but it's just literally a person who
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cannot
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function when we have that severe a
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depressive
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presentation odds are that that is a
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major depressive episode
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now it's conceivable something else may
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have been happening
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in that other per then that person's
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life for example
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they may have endured a major loss right
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so maybe there was the loss of
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and it's horrific like an entire family
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or something like that
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and you might see that kind of massively
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major grief reaction
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but we would still be addressing the
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severe depressive symptomatology
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the research is actually very
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interesting the effectiveness of
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antidepressants
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at the mild to moderate range of
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depression
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researchers have actually been there's
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two camps there there's some groups that
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believe that
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any effect we're seeing in milder
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depression is more of a placebo effect
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pharma people often think that they
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actually do work in mild to moderate
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depression
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but when we get to the moderate and
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severe levels of depression
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medications matter and so that's one
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thing to remember is that some of those
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mild depressions might be more sort of
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reactive to circumstance
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those severe depressions may be more of
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what we consider the genetic
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depressions the more biological
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depressions they may not even be
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reactive
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medications and at the most severe cases
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if the person is
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non-responsive to any medication they
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might even trying to try to use
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treatments like
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ect or even some kinds of brain
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stimulation stuff like tms or that kind
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of thing so
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it is much more debilitating and i think
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it is depression at that point
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i'm always fascinated as somebody living
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with depression on
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why i feel depressed certainly sometimes
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i can
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uh point out and go it's because of this
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and i know that
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and when i uh can point that out i
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actually feel really good because i go
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there it is there's the cause there's
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the reason
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but in my life what was that yes it's
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exactly right when you can say like this
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is what happened
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that makes more sense people can almost
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derive more meaning out of like what is
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happening which makes a difference
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yes but many times in my life and
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really three times in my life it was
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i mean i was bedridden i mean i did not
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do anything and i couldn't pinpoint
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why and you mentioned that that could be
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a more genetic depression
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can you speak to like what what causes
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that
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so there's some people that actually
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believe that the onset
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of a first depressive episode and that
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can be very reactive something happens
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in a person's world
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uh they have a breakup they um they lose
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their job
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something goes wrong and they have a
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depressive episode as a reaction to that
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there's actually one hypothesis out
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there the kindling hypothesis that says
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that
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that first oppressive episode almost
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sets up a
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kind of a a sort of a a reset of
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neurotransmitters that makes a person
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more vulnerable
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to ongoing depressive episodes that
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would happen without a trigger
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as though that first episode kind of
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booted the brain into sort of
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depressions and option kind of a place
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then the neurotransmitters came along
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for the ride
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which is why those first episodes of
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depression are so important to
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prevent and why things like stress
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management and all of those
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issues become so important especially in
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adolescence
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because that going into early adulthood
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is when we often see that first
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depressive episode
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all of that said is that there's many
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people out there who experience
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major depressive disorder which is
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recurrent major depressive episodes
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right they have an episode
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there's a break they have an episode
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there's a break that some of the
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episodes
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they can sense yeah there was some sort
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of trigger but as time goes on
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they'll see that they do kind of come
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spontaneously people are trained
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if they're in and they should be in
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therapy and getting psychiatric support
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to start identifying sort of the
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downswing that you can start feeling the
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difference
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the change in the prevailing winds
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because at that point
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it becomes really important to work with
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a psychiatrist and a therapist about
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maybe upping the number of sessions
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maybe changing the level of medication
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so you can be almost responsive to the
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recurrent major depression
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and so i do think you can see a mixed
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bag
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i would this is this is me shooting from
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the hip i'll be frank with you because i
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i think that i mean i don't have the
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sort of the chapter and verse of the
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science in front of me
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but there's one belief that if a
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person's having more of what we consider
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like a
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biological depression genetic depression
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it's really all it's not reactive
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you tend to see more of the kind of low
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energy
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high apathy sleep appetite shifts almost
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like more of those vegetative symptoms
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that seem to speak to more of a neural
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origin to the depression
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rather than the cognitive symptoms of
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depression
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i'm no good nothing's ever going to go
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my way the world is a hostile place
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life is always bad why should i even try
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and so it has a different flair now with
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most people
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depression both of those things come
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together they have both the vegetative
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and the cognitive but
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i think the milder levels you may see a
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little of low energy a little low energy
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but not as much as you see at the higher
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moderate to severe levels which may
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speak to sort of different kinds of
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depressive symptomatology in terms of
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the way the central nervous system is
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working
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interesting i can hide my mild
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depression
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great i show up to work i smile i shake
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hands i'm pleasant i'll attend your
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dinner and then i'll go home and sulk
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and then go to bed and repeat okay
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i cannot hide my severe depression
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it's impossible it's an impossibility so
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are there any people out there
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who could be hiding their severe
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depression be severely depressed and
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their loved ones wouldn't know
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i would find it incredibly incredibly
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unlikely kyle
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unless the loved ones didn't live with
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them i think if you live with someone
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severely depressed there's no way you
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would miss it right
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if somebody didn't live with someone and
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especially if they already had a pattern
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with them where
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they didn't see them that often right
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they don't uh they don't call that much
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that might go i suppose unnoticed it
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would but if you have eyes on the person
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it's an it's unmistakable i mean you see
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it they're literally their posture
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changes they're
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they're like they're slumped they their
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their faces will often look quite
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unhealthy they might look very unkempt
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the complete loss of energy
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that accompanies severe depression means
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that in many cases
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a person doesn't even engage in the
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self-care so a person will notice like
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wow they don't look that good now a
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person might think they're physically
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ill
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somebody looking at them saying i wonder
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if they're sick you know they have some
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sort of
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medical illness and may not identify it
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as depression
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but i would say other than in the rarest
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of cases and it does happen kyle
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is that some people might be able to
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mask their severe depression
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through things like routine their
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routine is so
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set that they can roll from point a to
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point b
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to point c to point d and get things
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done out all the while they feel like
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they're dying
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inside kind of thing and so it's
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possible and i think that more that
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there's routine
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they're familiar with that routine and
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the less that there are caring people
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who are watching them
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because those people would likely know
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the more that a person might be able to
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get away with it
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tonight during our live panel we're
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going to
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talk to dr romney and our other med
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circle doctors
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and we're going to focus more on
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supporter strategies and treatment
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options for severe depression if you're
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interested in attending that live panel
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use the links below
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or go to medcircle.com for more
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information
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are the signs and symptoms of severe
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depression
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different in a child compared to an
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adult
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yes and so one of the challenges is with
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children and depression
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adults tend to be a little bit more
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consistent in how they present
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emotionally right
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you know we know i know what to expect
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for example i've known you for a long
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time i know what to expect so i could
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probably sense if
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there's a dip or a raise because you're
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consistent
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kids aren't kids are kind of all over
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the map
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you know they'll they'll get
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exaggeratedly sad at something and
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exaggeratedly agitated that's kids
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they're sort of like this big bucket of
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unregulated moods as they're supposed to
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be
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that makes diagnosing mood disorders in
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children
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very challenging because we don't have
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what we call a good baseline
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now in a very young child it gets like
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when we're looking at
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real pediatric depression five six seven
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years of age that's actually not my area
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of expertise but
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we can have there can be patterns of
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depression in children that age
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and you what we always i always tell
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people with children what you're looking
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for
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is change so you know what this child's
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habits are in terms of
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when they wake up how they eat how they
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play how they might interact with peers
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or siblings when they go to sleep
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if there are significant changes in that
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that cannot be explained by an
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environmental condition you're aware of
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for example you've just
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moved or you know something like that
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happened
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that that change should definitely be a
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red flag that pops up for a parent
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that something in the realm is likely
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happening
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and at that point consult with a
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pediatrician or someone some other
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child's child psychologist who can help
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sort of unpack that
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children aren't always great at
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identifying moods like whereas an adult
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might say oh i think i'm really
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depressed
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child's not going to have that
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vocabulary so you're looking more at
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their rhythms
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now as we march up more into puberty and
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adolescence
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the game changes a bit what looks like
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depression feels a little bit easier to
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identify but teenagers aren't exactly
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the most
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you know talkative expressive group
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especially when they're depressed
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and we know under the condition the
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conditions of the pandemic rates of
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depression have been skyrocketing
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in adolescence and so and and what we do
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also see during puberty is hormonal
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changes
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and depression is in part a hormonal
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there are hormonal responses especially
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in girls
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when they have the onset of their uh
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menstrual cycle
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so there are all these little entry
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points we see but we look for
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changes and shifts and patterns now just
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because your child's pattern has shifted
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or changed
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doesn't necessarily mean it's depression
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but something's happening it could be
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bullying at school
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it could be that they're enduring some
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other form of trauma or abuse it could
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be depression it could be anxiety
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it could be any number of things that's
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why it's important to get evaluated
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because when there are changes in kids
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that's really the ringer
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now are there any mental health
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conditions or disorders
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that could be confused for severe
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depression
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you know if we think about what could be
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potentially confused with severe
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depression it could be you know one
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thing could be
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um honestly we'd always start always
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start with the biology first
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and work your way down so if a person
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has severe depression
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it is absolutely critical that they see
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a health care provider
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to get a full lab panel and a full
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physical exam
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because it may very well be that this is
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a biological
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origin especially if it represents a
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very
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rapid shift in mood like it's not it's
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they were one way and then they quickly
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became another way and they don't have a
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history of depression
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that could even speak to other other
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ideologies like a person
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having had a stroke or some other
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central nervous system process
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metabolic processes are associated with
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depression all of that needs to be
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worked up
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so if i'm seeing a new severely
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depressed patient
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we need labs we need them to go see a
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physician
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once that gets ruled out the next place
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we always want to go is substance use
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are they engaged in substance use of a
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form especially
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are they using central nervous system
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depressants those would be things like
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alcohol and things like that or are they
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coming down off of stimulants
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like are they is it is it related to
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that so we'd want to make sure we want
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to understand
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what their substance use profile has
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been recently and over their lifetime
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to see if that may be playing a role the
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next step i'd want to assess is trauma
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have they recently experienced any kind
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of a traumatic event or
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has there been an activation of an
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earlier traumatic event in their life
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and because as we know when we look at a
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post-traumatic stress
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presentation while depression in and of
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itself isn't a
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classical part of that presentation you
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might see someone
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having other symptomatology like
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withdrawal avoidance
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you know just sort of almost a paralyzed
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sense in the face
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of that trauma or a new trauma or an
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activation of an old one
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that could bring that up then i'd want
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to look at grief have they
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just recently endured a major loss or
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losses it may be
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not to the loss of a person but it could
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have been loss of a spouse
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or a long-term relationship the loss of
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a parent um
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multiple family members a lot of
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families are dealing with multiple
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losses in grief right now
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um it could also be the loss of a
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business a career
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a home i mean any any number of
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financial losses that culminate in real
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physical losses like you no longer have
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your family home
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those things could be associated with a
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severe depression
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i want to clear the decks of all of that
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first okay
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then we would start looking at other
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co-occurring mental health conditions
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simultaneously be aware of other major
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mental illnesses
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this client may be living with do they
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have a psychotic disorder like
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schizophrenia
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or schizoaffective disorder mood
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symptoms
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and mood presentations including
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depression can be a part of that
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presentation
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you'd also want to look at something
00:16:27
like bipolar disorder does the person
00:16:30
have interspersed with their periods of
00:16:31
mania
00:16:32
also severe depressions you can
00:16:34
definitely see that
00:16:35
the treatment approach there is going to
00:16:37
be quite different than it would be with
00:16:38
somebody
00:16:39
who has just straight up recurrent major
00:16:42
depressive disorder
00:16:44
people sometimes who have severe anxiety
00:16:46
disorders will have
00:16:47
depressive symptoms that accompany that
00:16:49
but then in this case the depression may
00:16:51
be a separate symptomatology from that
00:16:53
you see significant depressive
00:16:55
symptomatology and other
00:16:56
mental health issues like like eating
00:16:58
disorders
00:16:59
but you know i'm always going to come
00:17:01
back to this place which is the
00:17:02
personality disorders
00:17:04
the co-occurrence of other mental health
00:17:07
conditions with personality disorders is
00:17:08
something we know very well
00:17:10
and depression is actually one that
00:17:12
co-occurs with a lot of personality
00:17:14
disorders
00:17:15
the kind of chaos and dysregulation of
00:17:18
the personality disorder
00:17:20
may then kind of throw you off
00:17:23
the path and you may have to be dealing
00:17:25
with both of those sets of issues
00:17:26
so as you can see this thing called
00:17:28
severe depression you got to know a lot
00:17:30
of stuff about the person
00:17:31
before you can really land on it but
00:17:33
here's the bottom line kyle
00:17:34
if a person is severely depressed we
00:17:37
have to obviously we want to make sure
00:17:38
it's not medical substance related and
00:17:40
all of that
00:17:41
once we clear the decks of that if a
00:17:43
person severely depressed
00:17:44
that becomes our clinical central focus
00:17:48
we want to alleviate that depressive
00:17:50
symptomatology if it's severe because
00:17:51
otherwise they're not
00:17:52
functioning and that's usually done with
00:17:55
medication
00:17:56
you know they put medications on the
00:17:58
person it takes a minute
00:18:00
but when a person's severely depressed
00:18:02
it's almost impossible for them to
00:18:04
engage in therapy
00:18:05
they're just sitting there they're
00:18:06
almost not able to talk and engage
00:18:09
they feel like it's what's the point so
00:18:11
you almost need the
00:18:12
uplift the energetic uplift that comes
00:18:14
from their medication
00:18:15
to actually engage them in therapy
00:18:18
really really well said thank you for
00:18:19
all that dr romney uh we could talk
00:18:21
about this topic for much longer
00:18:23
and we will talk more about it tonight
00:18:25
during our live panel
00:18:27
med circle members enjoy in-depth video
00:18:29
series from doctors just like dr romini
00:18:31
and we have an award-winning series that
00:18:33
won the share care award a few
00:18:35
years ago which is basically the emmys
00:18:37
for um for
00:18:38
health content and i will leave our
00:18:41
viewers with an inside look
00:18:43
into that series and i'll see many of
00:18:45
you tonight
00:18:46
dr romini thanks for being here i'm kyle
00:18:48
kittleson remember whatever you're going
00:18:50
through
00:18:50
you got this and here's an inside look
00:18:53
into debunking depression
00:18:56
what would you want someone who suffers
00:18:59
from depression to
00:19:00
get out of this series do something
00:19:03
about it
00:19:04
it is absolutely very treatable you may
00:19:07
not feel like it you might feel hopeless
00:19:08
right now
00:19:09
trust me that is a symptom of depression
00:19:12
what you're thinking it may not be
00:19:14
reality and often it's not if you're
00:19:16
feeling helpless and hopeless
00:19:18
that is your depression do not listen to
00:19:20
it if it tells you
00:19:21
your life is not worth living you're
00:19:23
nobody your the world would be a better
00:19:25
place without you
00:19:26
nobody needs you do not buy into those
00:19:29
voices in your head that are telling you
00:19:31
that you're nobody and that you're
00:19:32
nothing and that it's never going to get
00:19:34
[Music]
00:19:36
better
00:19:46
[Music]
00:19:48
you
