The first step to effectively destigmatize depression is to understand it. Joining Whitney Lauritsen in this conversation to help us with this topic is Sarah Zabel. Sarah tells the story of how she took care of her body when she was experiencing SAD (seasonal affective disorder). She talks about the pros and cons of herbal remedies for and self-medicating depression and correcting deficiencies, as well as her thoughts on psychedelics and ketamine. Tune in and learn the answers to some of the most common questions about depression. What causes depression? Do antidepressants work? Can you control feeling SAD (seasonal affective disorder)? How does depression manifest in the body? How is depression related and stress, inflammation, circadian rhythms? How does depression cause disability? All these and more in this deeply informative episode!
This episode is sponsored by Zencastr. Visit zencastr.com/pricing and enter promo code “wellevatrzen” to get 30% off your first three months.
Listen to the podcast here
Spiral Upward And Destigmatize Depression With Sarah Zabel
My guest for this episode, whose name is Sarah, and I are going to talk about depression. It has become something that more people are leaning into and talking about more openly and with confidence but is still something that has hesitancy. Maybe there’s still shame around depression. Maybe some people feel unsure whether they are clinically depressed. They’re like, “Is everybody depressed? Is this a normal human experience? Is this something to be concerned about?”
One place I want to begin with you in our conversation, Sarah, is around your experience with Seasonal Affective Disorder, often shortened to SAD. It is a timely topic for us, given that we’re recording this as we move from fall to winter. Many readers will be tuning into this during the winter time when it’s common based on the weather changes, light changes, and timing of when the sun is out.
A lot of things during the winter time can trigger depression even though it’s often seen as such a joyous time. Something that’s come up in previous episodes of this show around this time of year is how sometimes, it’s not the most wonderful time of the year, as some of the songs go. Sometimes, it can be a tough year. You were beginning to tell me offline about your own personal experiences with SAD.
It’s embarrassing because I wrote an entire book about depression. Yet, when I started suffering from Seasonal Affective Disorder or SAD, it took me about six months to realize it. I saw all these symptoms appearing, and I attributed them to something else. The normal human experience includes feeling sad, feeling down, or sometimes not being able to get out of bed. For me, the normal human experience also can include gaining weight and not feeling like doing anything.
I moved up here. I’m in Northern Idaho. I’m in the Idaho Panhandle, which is probably about 100 miles from the border of Canada. It is pretty far up north. I came here during the pandemic. I moved into my house at the end of 2020. In the second winter that I was here, the sun goes down early, so I have all these dark days. There was a change in my life.
I had been looking after my father. He was very elderly. He passed away at 96 from Alzheimer’s disease. For a couple of years, I had been looking after him, and then he moved into a nursing home in September 2021. I’m here by myself and enjoying the lovely winter, but it gets dark early. On the first week of November, daylight savings time had started or ended. I don’t remember which way it goes, but it had switched. The sundown was at 4:20 PM. In early November 2021, six weeks before the shortest days of the year, at 4:30 PM, it’s dark. I’m thinking, “What have I done?”
Throughout that winter, I couldn’t get out of bed in the morning. I slept and stayed in bed forever. I was gaining weight. I didn’t want to do anything. That’s a symptom. They call it anhedonia. I’m kicking myself because I realize this now, but at the time when I was suffering from it, I didn’t. I love to ski, but you couldn’t drag me out to ski.
The things that I usually love to do, you could not get me to do them. When I got out of bed, I was sitting around eating, drinking, and not doing much. My mood was so low and did not want to do the things I usually enjoy. It wasn’t until it went away in March of the next year that the sun starts coming up at a reasonable time, and you get twelve hours of daylight. That’s when I started looking back and realizing, “All that stuff I had written about was me.” It is everywhere, and I’m grateful.
We also had a moment to talk about some amazing women like Simone Biles and Naomi Osaka, who were open and honest about what they were going through. It affected their careers. Simone Biles dropped out of the Tokyo Olympics, and Naomi Osaka from the French Open. That’s a career hit for them, but they were open about saying, “My mental health is challenged. I need to do this. I need to take care of myself.” Doing that and being public about it is so great and forward-leading.
It’s a good thing to get people to think about what’s going on in their own lives and admit them. It doesn’t matter how healthy you’ve been in the first 30 years of your life or whatever. Things happen, and our mental health is something that can be challenged. For me, it was losing sunlight. It makes a big difference in you, your body, how your body works, and how your brain works. That leads to mental health challenges. It is not a matter of will, weakness, or strength. I learned that depression is a physical process. When you start hitting some physical levels of different substances in your brain, that’s when things like depression or anxiety can start happening. It happens to all of us.It's not a matter of weakness or strength. Depression is a physical process. Click To Tweet
Thank you for leading off with that because removing the judgment around it is so important. There are factors that are not always within our control. There are things that can happen to us so subtly that we don’t even realize it. It’s often not until a point where it gets bad that people even consider addressing it. Another thing I know you are interested in and is timely as we’re recording this in October 2022 is you were sharing about some articles that came out. It was about serotonin and how it led people to misunderstand antidepressants and how they work. Is that right?
Yes. It was weird. A couple of people came up to me. Knowing that I had written and spoken about depression, they said, “Did you hear that serotonin has been debunked and that people are taking antidepressants that don’t work?” I said, “Huh?” I looked into it and there was an article in a very prestigious journal. There was a team, which was the United Kingdom. They had done a review that looked at the serotonin hypothesis of depression. There is this theory that maybe depression comes from not having enough serotonin in your brain.
Serotonin is a neurotransmitter. It’s a signaling chemical that is in our brains and our bodies. Our Bodies use serotonin and so does the brain. Serotonin happens to act on a lot of areas that are very relevant for depression, like appetite, mood, and sleepiness. Serotonin is one of the active chemicals that is affecting how we experience those things.
Back in the 1960s, someone had come up with a theory that depression is caused by there not being enough serotonin in your brain. That was a theory that was around for a couple of decades, but by the 1980s, it had been disproved. People saw that we can artificially lower serotonin in people’s brains by what we feed them. It comes from the diet. Even though we can see that they have less serotonin in their brain, they don’t get depressed, so it’s not that.
The way it came around was back in the 1940s and 1950s, antidepressants were discovered. They were discovered not because somebody was chasing down, “What happens with serotonin?” but because they were in from several drugs that were intended to treat something else. There was a drug they were testing to treat tuberculosis. You have all these sick people dying of tuberculosis and you give them this drug.
First of all, they are still dying of tuberculosis. It didn’t help tuberculosis at all, but for some reason, they are weirdly happy. It switched a lot of them into some euphoria. These sick and dying people taking this drug are, all of a sudden, happy. The drug companies thought, “Maybe we should try this as an antidepressant,” and it worked. There’s another drug that was originally developed to be an antihistamine, but turned out to be an antidepressant.
You have these medicines that when they try testing them, they find out, “These are antidepressants.” Antidepressants start getting prescribed. People are taking them and benefiting from them. 60% to 70% of depressed people who took these drugs were getting over their depression. These are wonderful things.
It was getting big in the ‘50s. People were getting the drugs that were doing well on them. Around the early ‘60s, that’s when someone said, “The way these drugs work is by affecting serotonin in the brain.” That was the prevailing theory for a while, but then, around the ‘80s, that’s when they realized, “The drugs do affect how the brain processes serotonin, but stepping aside from the drugs, we can show that depression is not caused by lower serotonin.” They could artificially lower someone’s serotonin in their brain and nothing happens. They don’t get depressed. That’s not it, but the drugs still work.
Over time, the drugs get refined. They come out with different varieties that have fewer side effects. They’re trying to get them more potent. They tended to be about the same effectiveness but had fewer side effects. Those are most commonly prescribed. The fact that in 2022, somebody comes up by and says, “Lowered serotonin doesn’t cause depression,” is confusing. Everybody knows. It was proved back in the 1980s that no serotonin doesn’t cause depression. Antidepressants do affect serotonin levels and that does lead people to get better.
I say everybody knows because one of the things that came up with a discussion around that article is that there are a whole lot of medical schools and other areas of institutions of higher learning that apparently are still teaching that serotonin theory of depression. It is weird because the scientific community or medical community has known for decades that’s not what causes depression. The drugs that affect the serotonin levels in your brain are the most common ones used as antidepressants, and they work. They are antidepressant.
There have been community tests where the people who show up with the first episode of depression haven’t taken any drugs. They’re newly depressed. They take these antidepressants that affect serotonin levels and a little more than half get better from that. They go into remission. Their depression is alleviated by those drugs. A little less than half don’t. They have to go onto further steps before their depression is going to be treated.
It’s weird and unfortunate that some of the headlines swirling around are that antidepressants don’t work anymore. They work as well as they’ve ever worked. Their efficacy and effectiveness never depended on a theory. They were observed first and then somebody tried to fit a theory, “This what’s happening.” He was wrong, but they work as well as they’ve ever worked. The theory has gone away. Other theories have replaced it, but they still worked as they’ve ever worked.
That’s helpful to hear because certainly, it’s easy to see a headline and believe it. We have to become aware of how the media will sensationalize things in order to get our attention. It’s nice that a lot of people are becoming more aware of the media’s role and discussions on health, and how a lot of us are concerned about our health.
It’s easy to taunt us to read an article, buy a magazine, or pick up a newspaper if a headline catches our attention, but it can be incredibly dangerous. It is learning to read an article and understand what fact is versus what opinion is or what is something that’s being used and sensationalized. A lot of people haven’t been trained to even understand how to read something health-based. This has been something I’ve been growing more passionate about because I’ve seen so much happen in the wellness world.
There is so much misinformation spread around. Many anecdotes are being used as they’re the same as scientific studies. It can be confusing and frustrating. It can be dangerous because what if somebody sees a headline like that and decides to stop taking antidepressants? What if that’s what’s keeping their brain working in a way that’s healthy or important for them to be able to function? That makes me uncomfortable. That also leads me to something else that we were speaking about generally before we started recording. It was the impact of the pandemic on depression and how they’re collecting data on that. I would love to hear more about that from you.
The data is starting to come in. Depression and anxiety soared during the pandemic. When I say the pandemic, I have to include the pandemic restrictions. I’m living in a northern latitude in the United States. That affects the sun. That affects my exposure to sunlight. During all of 2020, people lived restricted lives.
There are the things that normally keep us healthy, like exposure to sunlight, getting exercise, dieting, or interacting with people in a positive way. Those things that we normally have in our lives that keep us healthy were interrupted. With those things being squished down, we don’t have so many opportunities to get outside, control what we eat, or get some exercise. Instead, we get so much stress piled on us.
People are worried about their health. People lose their jobs, so they’re worried about their futures or their finances. People who own businesses are watching them crumble around them. This is happening over a period of about a year. If you think about when we started going into some restrictions, which was March of 2020, and then when they started lifting to an effective extent, it was more than a year for most people. It’s different around the country, but for about a year and during all that time, stress and health impacts are piled on.
The things that we normally used to keep our health and ourselves in a positive state are denied to a lot of people. It is no surprise that depression and anxiety both soared. They went up high. There was initial data collection at the end of 2020 and 2021. It showed the rates of depression. Early numbers in the US showed about triple. I’m saying that these are not necessarily diagnosed cases of depression. These are people who are sending out surveys and questionnaires and coming to the opinion.It is no surprise that rates of depression and anxiety soared during the pandemic. Click To Tweet
There are a whole lot more people showing probable depression and probable anxiety in early 2021 or late 2020 before the pandemic got started. There were a lot of reasons for what was going on. There were huge amounts of stress, but also, people were denied the lifestyle factors that they had used. Whether they knew it or not, it was helping to keep them healthy
Last winter, in 2021, was difficult. I realized late that I was very symptomatic for SAD. I was in the Air Force for 31 and a half years. I’m thinking particularly of an assignment in Stuttgart, Germany. I lived there for about two years. Stuttgart has the same weather patterns and the same latitude as where I live. I never had a moment’s difficulty, but I had a different lifestyle then.
I was working outside the home. I went to a normal office. I’d say it was 9:00 AM to 5:00 PM, but it is Military, so it is 7:00 AM to 5:00 PM. I was interacting with people. I had to keep a certain diet and exercise to get by. I never had a moment’s difficulty there, but here, when I was living a pandemic lifestyle of not getting out, where doing any work I did was remote, and I didn’t have to get up in the morning, I had this completely different lifestyle. That’s where I got hit with these problems.
We saw that during and following the pandemic levels of depression and anxiety went high. There are lots of reasons for it, but a lot of it has to do with increased stress. A lot of it has to do with not being able to live our lives and control our lifestyles as we used to do before the pandemic. They might not be the ones that realize it. It might be a loved one or someone who lives with them who looks at them and says, “Not to be accusatory or anything, but you’re behaving a little differently now. Things seem to be a little bit off.”
People should realize that there are good reasons why things are off. It is very likely that they are suffering some after-effects of what changed in the lives we lived during the pandemic. It doesn’t hurt to go talk to somebody and see if you need help. Perhaps you need to intentionally recapture the lifestyle you had before. Maybe that’s enough to do it. You might have also tipped the balance. Maybe you need some more help before you can get back to what your normal life was before the pandemic. Lots of people are going through this.
It’s important to keep that in mind because feeling alone in itself can be so isolating. It can create shame. It’s almost feeding the negative feelings of, “I must be the only one. No one else seems to be feeling this way.” That’s why it’s so helpful to speak publicly about it or to hear other people speak publicly about it. It’s removing that shame or stigma from it.
You’re also pointing out that it is okay to ask for help and to talk to loved ones about it. Maybe ask them if they’ve noticed anything if they haven’t felt comfortable pointing it out to you. It is having an open conversation about it. You also talked about lifestyle changes and the impact of lifestyle on how we’re feeling. That’s so important, too, because our lives aren’t always going to be the same. We have the same job. We haven’t changed our family too much, or maybe we haven’t moved. Any of these big things in our life might feel steady, but if the world’s changing around us and we don’t have control over it, that’s going to impact us.
You’re also pointing out the way you might feel in a different career and the way you may feel in a different part of the world. There are so many nuances to what impacts our well-being. Sometimes, we might not even think of it. Do you recommend doing some journaling? Is there another practice that helped you? When you were, for instance, recognizing that you had SAD but it took you some time to get there, were there some practices that you did? Did somebody else point out what was going on with you? How did you come to that realization?
The first indications were the physical changes in my body. I was learning about depression and what it is to the greatest extent. Science knows what it is like. There are different theories. Nobody knows precisely what it is, but science knows a lot more about it than it used to and it’s startling them out. I was surprised by how physical depression is.
Depression always includes being diagnosed. Depression is going to include feelings of sadness. They call it feeling depressed. Defining something in terms of itself is not always very helpful, but you have a low mood most of the time or all the time for at least two weeks. It is going on for a while and it is almost all the time. It is what I talked about with anhedonia where you don’t enjoy the things you used to enjoy. That’s a necessary criterion. It’s either a low mood or not enjoying anything.
There are also other symptoms. People usually either sleep too much or can’t sleep at all. They usually either eat too much or lose their appetite. They often feel guilty. Their thoughts dwell on death a lot. They’re either agitated or physically slower. The appetite, sleep, and agitation levels are things that we always think of as physical symptoms. That’s where I noticed it first in myself. It was weight gain and I couldn’t get out of bed. I was like, “What is wrong with me here?”
Depression is very physical, so it does affect how people physically. That might be the first thing that people notice Being sad sometimes is normal. How do you tell what’s normal? Especially during a pandemic, things are not good. Why wouldn’t you feel sad? Maybe you don’t take pleasure in stuff because you used to like to go to the movies or go out to dinner and all the restaurants and movie theaters are closed. You don’t take pleasure in things that you used to.
It’s hard to sometimes separate what’s a normal experience of being sad, low, or not feeling great versus being depressed or being something that a doctor would diagnose as depression. It might be that the physical symptoms are sleeplessness or can’t get out of bed. Those are the things that might show up first or might tip you off that, “Something’s a little bit different here.” It is when you do an inventory about, “How do I feel? When’s the last time I felt happy?”
You asked me what I did. One of the first things I made sure of was my exercise program. I got myself up eventually. I got on my treadmill and got some exercise every day. I started working on my diet because I was gaining weight. It was nothing bad, but there was a serious muffin top going on and I didn’t like that. I didn’t like to think that I’m going to gain weight and not be able to turn it around. I got focused on my diet and on my exercise.
I did start not journaling, but I was being specific about what my to-do list is. I would also end a day or a week and think, “I did nothing useful to anybody, including myself, this whole week. What am I doing?” That’s when I would start thinking, “What’s my life about? Am I waiting around waiting to die?” That’s not healthy. Make a list a to-do list as I did and keep it manageable. For me, it was helpful. It was diet, exercise, and a to-do list. It eventually got me to the point out of my SAD enough that I was able to look back and realize, “There was something going on there.”
It might be whatever helps you. Whether it’s journaling, writing down your feelings, looking at them, and thinking, “This seems a little darker than what I remember my feelings being like.” It could also be getting after the things that have changed in your lifestyle. You’re like, “I do need to clean up my diet. I do need to get out for walks or get outside,” and making yourself do that. It is little things. Depression is a spiral downward, so getting better seems to be a little lifting yourself with a spiral upward. Choose one thing you could do and get that one thing done. On the next day, maybe there are two things. It takes a bit to get yourself back up.
One thing that I saw in the description of your book, Fighting Chance, is depression’s relationship with stress, inflammation, and circadian rhythm. We’ve touched upon stress and a bit about sleep and circadian rhythms. I would love to hear more about the inflammation side of it. Can you talk about that a bit?
Yeah. Depression is a physical illness. I mean that in multiple senses. It affects our physical bodies, but there are physical changes going on in the brain of a depressed person. Those physical changes in the brain lead to the symptoms of depression. There are two bad things that can happen to your brain. In depression, brain imaging shows that people with depression have lost some tissue. They’ve lost brain tissue. There are some types of brain cells that disappear, but mostly, if you think of the processing parts of the brain the neurons, they have fewer connections.
Our brains work. There’s a neuron that gathers inputs from various signals. It fires and sends off various signals to other neurons, but there are fewer connections. Less signaling is going on. There’s a physical change to the brain. There are two bad things that are happening in your brain that eat away brain tissue. One of them is chronic low-level inflammation. The other is the actions of free radicals. They call it oxidative stress. Those factors together are wearing away your brain tissue.
It’s related to stress. It turns out that stress and inflammation are related. We have what they call acute stress when something bad happens. Let’s say you’re attacked by a lion. You get stressed. You run away. Your body goes through certain phases. One of the phases of the runaway part of your body is going to trigger your adrenal glands to produce some substances.
At the end of the cycle, cortisol is a substance your body produces. Cortisol is anti-inflammatory. There are lots of medications that are based on cortisol, and they are anti-inflammatories. The tail end of the stress response has your body releasing these anti-inflammatory agents when you’re under chronic stress.
Think about the pandemic stress where people are worried about their jobs, finances, and health. They’ve got kids who should be in daycare crawling all over them. It is long-term. It goes on for a year or more. There’s this long, low-level, but continuous stress. Your body under chronic stress doesn’t release the anti-inflammatories. It tends to release pro-inflammatory agents. Under chronic stress, your whole body gets a low level of inflammation, including your brain.
Chronic stress makes your brain a little bit inflamed. Over time, those inflammatory agents are wearing away some of the brain tissue. That’s one example of how stress leads to physical changes in your body. Your brain’s part of your physical body. Those changes in your brain start to lead to the symptoms of depression. It’s something that we’ve all been going through with chronic stress. For a lot of people, it’s enough to make the changes in your brain that are going to start you on the path to depression.
That’s so fascinating. One of the big takeaways from this episode thus far is about all these physical symptoms or physical changes. That’s important because many of us might think of depression as a mental or emotional process.
Physicality, to me, is important in destigmatization. You can’t help if something physical is happening to you. You mentioned circadian rhythms. When we see the sun or see sunlight, the body releases certain chemicals and we keep on going throughout our day. It doesn’t happen when you don’t see the sun. Your body’s not releasing those substances.
Physically, you’re changing, but the thought that depression happens only to weak people is not right. It’s a physical illness. It shows up in your physical well-being, but it comes from physical factors. People should not be ashamed of suffering from depression. If you caught a cold, you got to deal with it. It’s only that your brain has caught a cold. It’s showing up in these mood symptoms, but also sleeplessness, agitation, and all the other things that depressed people sometimes notice first before they even notice the low mood.
It’s also interesting because depression has felt stigmatized. That may be led so many people to not learn so much about it and to see the way the media addresses it or maybe the small things they read at the doctor’s office. If you’ve never been diagnosed with depression or you’ve never taken antidepressants, perhaps you’ve barely come across this information. Maybe you’ve only heard anecdotal stories from somebody in the media or through a book. The scientific side of it is so valuable because it’s painting a deeper, richer picture of what exactly is going on in the body. People can help recognize the signs within each other.
Something else I saw on your page for your book is how depression is the leading cause of ill health and disability worldwide. This was something I happened to hear twice. I believe it was in a TED Talk I was watching with Susan David. She is a psychologist. That fact shocked me. She even said that depression, in terms of ill health and disability, has overtaken cancer and heart issues. I hope I’m not quoting that wrong.
Those are the leading cause of death in the US and probably around the world. Cancer and heart disease are the leading cause of death, to my memory, around the world. One of the things about depression is it usually doesn’t kill you. It drags on and on. Especially when people can’t get effective help, they’re struggling with it. They’re miserable. They’re leading these unhappy lives for years. If they can’t get effective help or they can’t get rid of the depression, it drags through their lives for a long time.Depression usually doesn't kill you. It just drags on and on, especially if you don't get help. Click To Tweet
When you can’t get out of bed, you’re disabled. You’re like, “I can’t get out of bed. I am not going to come to work.” The boss doesn’t understand. He’s saying, “I don’t care. Get out of bed. Come to work.” The fact that people don’t realize how much of a disease it is makes it hard for people to recognize and admit they have it. It’s hard for them to get effective treatment. It drags through their lives if they don’t.
One thing that’s useful in the conversation that came up about how serotonin is not the cost of depression is the fact that pharmaceutical companies rule the airways, at least in the US. They put their products out there and they’re pushing their products. Their products are very useful. For a lot of people, they might even be life-saving. I don’t want to downplay the use of antidepressant medications, but what gets lost in that vocal presentation from the pharmaceutical companies are the other things that we call lifestyle factors. Diet and exercise matter for depression. Getting outdoors into the fresh air and getting exposed to the beneficial elements of our world matters to depression also.
For whom antidepressants are going to be the final key that helps them get over their depression or get into remission, I hope that they will continue to take them. People should not ignore lifestyle elements either. Especially to the people who are healthy, don’t ignore the lifestyle elements because your health is not guaranteed. If you don’t get an adequate amount of exercise and don’t eat a reasonably nutritious diet, your health is not guaranteed. Keep up with the lifestyle. For people with depression, talk to your doctor. Do what your doctor recommends. Make sure you understand the recommendations and do what they recommend, but don’t ignore the lifestyle. Lifestyle is very important.Your health is not guaranteed. Click To Tweet
I’d love to hear more about the disability side of it. I’m still trying to learn about disability and becoming more aware of ableism or people that don’t take into account others with disabilities. At least for me, when I think of a disability, I often think of a physical disability. Even though we’ve been discussing the physical manifestations of depression, a lot of the forms of depression are invisible. When you’re talking about disability in terms of depression, is it those invisible disabilities, or does it manifest in more physical ways that I’m aware of?
It is all of it. When the World Health Organization measures, “How many years are lost to disability?” They’re measuring people not being able to show up to work or not being able to do their work. They’re measuring the physical impacts. When they say, “Depression is the leading cause of years lost to disability in the world,” they’re saying, “We’re talking physical. We’re talking about people who cannot show up to work or they cannot do their jobs because of their depression.” Depression’s pretty insidious.
Among the symptoms of depression are difficulty concentrating and difficulty remembering things. Imagine you’re trying to do your job. Finally, you get yourself out of bed. You’re like, “I’m out of bed. I’m dressed. For me, that’s a big win in the morning.” Let’s say this is your life. You’re trying to talk to me or somebody else in a conversation on your show and you can’t concentrate. You can’t quite remember, “What did I want to say? What am I trying to get across?” You’re not doing your job well. That’s another level of disability that people with depression suffer from. I do think when the World Health Organization is measuring years lost to disability, they’re talking physical. They’re talking about people who cannot show up to work or cannot do their jobs. It’s high with depression.
I’m deeply fascinated by this. Even that experience of feeling like you can’t get out of bed or you can’t go to work has been discussed so much. I see it a lot on social media. I see it a lot from younger generations, too. I am also curious. How do you define depression when there seem to be a lot of gray areas? Is feeling depressed still depression, or is that just a temporary feeling, if that makes sense? There seem to be a lot of gray areas there.
If it’s temporary, don’t worry about it. Everyone has a bad day. The medical community, in order to diagnose people, they have a standard. There’s a manual for diagnosing depression as well as other mental illnesses or mental health issues. In their standard, they say, “We’re going to take a two-week period. If it’s intense, it might be shorter than two weeks.”
We’re trying to separate someone who’s a little down. They lost their job. They’re unhappy about that, but they’re not ill. They’re going to bounce back. They’re going to be okay, but they’re a little unhappy about something. You take about a two-week period. In that two-week period, there are two key symptoms. It’s one or the other. Either you’ve lost pleasure in doing things that you normally take pleasure in doing, or you have a low mood. It’s every day or almost every day. It is almost all the time for at least two weeks. You’re looking for this mood issue to be noticeable and long-lasting. You start with one of those.
To diagnose depression, there’s another list of symptoms, and these are mostly physical symptoms. If somebody hits at least three of those symptoms, then that’s when you’re thinking, “This is very likely what we would call a clinical, diagnosable depression.” That includes sleep. You can’t sleep or you sleep too much noticeably. You can’t eat or you eat too much. It’s this agitation. Everything’s fast. You’re talking fast. You’re doing everything fast or you’re slow. You’re looking at them hitting at least three of those physical symptoms for a period of at least two weeks.
A lot is left up to the judgment of the physician. Those are the guidelines that you’re hitting a mood symptom for at least two weeks and it’s pretty noticeable. You’re then hitting at least 3 or maybe 4 of what we think of as physical symptoms. That’s when they diagnose depression. If you attempt suicide or you’re thinking about suicide, that’ll pop you to the top of the list. You don’t have to hit any other symptoms for them to say, “Something’s wrong here. You need to be treated.”
The method of diagnosing depression is often criticized because it sounds vague or touchy-feely. Here’s a doctor asking a patient, “Do you see this? Have you seen this in yourself?” Maybe the patient’s not self-aware, or it is asking them to report their symptoms so that the doctor can diagnose them. There are criteria for diagnosing depression, but they’re all bad. It’s hitting these levels and stretching out for at least two weeks.
Is there legitimacy to self-diagnosing yourself? You wouldn’t be able to get medication, but there are over-the-counter options. I’m curious how you feel about someone who might take an herbal remedy for depression. Are those safe to take in terms of your mental health? They might be safe for your physical health, but if you’re trying to treat it yourself, is there danger with it?
There are some dangers. There are some herbal remedies. If you’ve ever heard of St. John’s Wort, it’s been tested. It’s like an antidepressant. It’s a plant-based antidepressant. I’d be cautious about self-medicating without a doctor’s supervision. People usually don’t go straight to the psychiatrist unless there’s a suicide attempt or a lot of suicidal ideation. In which case, go to a psychiatrist.
Normally, you’re not feeling up to speed. You would go to your physician. Talk to them about your symptoms. Talk to them about, “I’d like to take this St. John’s Wort.” As long as they’re aware and you have open communication with them so if something’s not working out well happens, they’d be okay with that. It has been tested to be pretty effective.
On the other way to correct lifestyle deficiencies, there are some nutritional supplements that help correct dietary deficiencies. That might be Vitamin D. Vitamin B is also another one that its deficiencies can lead to mental health issues. Those are to be taken in reasonable amounts. People do that. There’s a reason why the FDA doesn’t control those.
If you think, “I might be depressed,” I’d say to talk to your physician. Talk to them about what you want to do and what you plan to do. If he says, “I want to prescribe you this antidepressant,” you always have the right to say, “I don’t want to do that. Right now, let’s keep the communication open. I don’t want to do that yet. I want to try a different approach first.” You have the right to do that, but do keep the communication open.
With depression, we’ve talked about it being so disabling. What we haven’t talked about is the link to suicide, which is the most frightening and horrible potential outcome of depression. Suicide has a little different biology than straightforward depression, but there is a lot of overlap. Anyone feeling they’re constantly dwelling on thoughts of death or feeling like they are likely to make a suicide attempt should talk to the doctor. They should take seriously the doctor’s advice. Short of that, if you’re just not feeling quite well, then talk to the doctor. Don’t be afraid to try some of those vitamins and nutritional supplements. They help in some ways.
How do you feel about psychedelics? As you were sharing that, I was thinking about Michael Pollan’s work, his book, and his Netflix series that talk about the science of psychedelics and how they can support things like depression. How did that come across in your research?
As you saw with Michael Pollan’s book, which I read, too, and enjoyed, there is a resurgence of interest in psychedelics. Early tests do show people with depression improving with psychedelics. The medical community loves to do these blind tests. It might be that people are charged with, “I got to take a psychedelic. My dad took LSD, but it’s been illegal for so long. Now, I get to take it.” Maybe there are factors that have nothing to do with the action of psychedelics that would make them feel better for at least a little while.
Scientists like to do blind tests. They like to do these randomized, controlled trials where half of the people would be on a placebo and the other half would be on psychedelics. The problem is there is no placebo. There’s no way to have somebody not know that they took a psychedelic trip. There’s no way to truly test these remedies and see if they’re effective. Even un-blinded tests are looking positive. I’m glad that there are there doctors and scientists investigating this. It’s sounding like it’s very positive. I’m glad that the authorities are willing to let doctors and scientists test this.
I wouldn’t self-medicate with psychedelics. You’re getting into a lot of brain changes there. There are a few places in the US where doctors can go ahead and prescribe that. I don’t know for sure of any places, but I’ve heard rumors. There are a few places in the US where doctors can prescribe that. Go talk to one of those doctors and see if it’s something that helps. Don’t self-prescribe psychedelics, but if they’re under medical supervision, it’s looking positive.
That’s what I was fascinated with when I watched a few episodes of Michael Pollan’s documentary or series on Netflix on how he was working alongside those doctors. He was not just working. He was observing them and sharing all of the details of those clinical trials. I thought that was fascinating.
When I think of psychedelics, I do think of somebody that is taking them for leisure. They’re doing it with a group of friends perhaps and not something that happens in a medical office. I found that interesting. The series makes it look appealing. We’re also in a time where if you’re getting something off the street to not know where the source is. To your point, there are all sorts of things that could go wrong if you get it from a friend of a friend.
You don’t know for sure what you’re taking. Also, you don’t know if you are taking it in a medically effective manner. There’s a newly approved drug for depression called ketamine. If you’ve ever heard of ketamine, it’s an anesthetic. Special K is a street drug. In the year 2000, there was a test that found that ketamine, given to somebody at a very low dose or a microdose, has an immediate, rapid antidepressant effect that lasts for 7 to 10 days. This is amazing. Someone who is so depressed that they can’t get out of bed can take some of this low dose of ketamine and they’ll be fine and normal for 7 to 10 days. It only has that antidepressant effect at that low dose.
You can imagine someone getting, “I’m depressed. I’m going to get some Special K. I’m going to get some street ketamine and take it.” They’re endangering their lives. It is a street drug. They’re also not taking it in a way that has been shown to be effective against depression. Ketamine, I understand, does have a psychedelic effect. It might be the same with LSD or psilocybin in that there are ways and dosages that are effective for depression and ways of administrating it and dosages that are not effective for depression. If you want to take something like that for medical effect, you need to be connected to the medical community so you get the right stuff and you know what you’re doing.
I appreciate your approach to all of this because you have so much data. You come across as both down-to-earth and deeply informed. It’s like you’re making this feel like it is okay to talk about, that there are solutions here, and that there are so many pieces of information available to us. I feel so much hope and gratitude after this conversation.
I like data personally. I appreciate anecdotes and opinions, but when I can see studies done, I feel like it legitimatizes things. It makes me feel more at ease. I’m grateful for all the work that you’ve done around this subject matter. Do you feel like your work has created the ripple effect that you were intending for it? Going through the process of writing this book and putting it out, how has that impacted you on a personal level?
It has been important to me. The fact that I was trying to understand depression and trying to understand how people get better was because of a friend who had made several suicide attempts and tried to help her. When I realized, “She’s depressed. She’s attempting suicide. This is very bad,” I go out on the internet and say, “What’s depression? What can I do?” There’s an explosion of information. Some of it’s dubious. It’s all over the place.
If you look and scroll down through pages of search results about depression, you feel, “I can’t do anything,” so I started peeling it apart. I started trying to understand, “What is this? What do these treatments do that affects this thing we call depression?” I do feel like I was able to organize it and put it in a way that you have to be a little geeky or motivated to read the book. It’s got a lot of data, detail, and facts. There’s a lot there. Thank goodness that there is a lot that science knows. I’m able to report a lot of things that science knows.
One thing that I was able to do about it is to understand in myself what turns out to be my experience of SAD in 2021. Going into this winter in 2022, I am doing things differently. I’ve got myself a light device. I’m taking different precautions. I’m feeling positive that I’m not going to spend six months of every year being miserable. I’m going to do it better this 2022.
It helped me and it helped my friend. I do think that she’s doing fine. She did end up doing some of the ketamine treatments. That helped, too. Everything that she was able to do got her out of her suicidal depression into a normal balance state of sometimes happy and sometimes not happy. That was good.
I’ve heard from lots of different readers that it helped them. You write a book and put it out there. It’s like with your show. You spend a lot of work on it. You prepare for it, do it, edit it, make it good, and put it out there. You don’t know exactly what effect it’s going to have, but when you hear reports back of, “This helped me. This is worthwhile,” that’s very rewarding and motivating.
I’m so glad to hear that. The story of how this came about is beautiful in the ways that it’s impacted you not just on an emotional level, but on a practical level. You’re gearing up. You’ve got more tools and insight. It sounds like you’re empowered. You’re prepared for a different experience this 2022 with all of these mental and physical tools. I’d love to hear which of the lights you got. I’ve heard a lot about the different lighting that you can put in your house to help with Seasonal Affective Disorder. What did you choose for yourself?
I went to the professionals. One of the experts that I interviewed is named Anna Wirz-Justice. She is part of the Center for Environmental Therapeutics. I went to their website. They have lots of information for the public and for professionals. I went and looked at what light devices they recommend. There was one there that they recommend, and I bought that one.
I did this in June 2022 knowing that I would need to prepare, but I don’t need it quite yet. I’m thinking as soon as the clouds roll in, I’m going to start using that device. I went with the professionals. I also contacted them and said, “How do I use this?” I am trying to do it right. It’s Northern Lights Technologies, but it’s on the Center for Environmental Therapeutics or CET.org website.
Thank you so much for providing that. That’s another thing that somebody could do if they’re resonating with your story. They get to go to that website to check it out. Also to have something vetted is helpful. Certainly, you can go onto social media and see what all the people are recommending there. You can go onto Amazon, but how do you know which one is worth your money? Is it a gimmick or is it going to work? It might take some experimenting. A good place to start can be working with expert recommendations.
Thank you so much for that and everything else that you’ve shared with us. Your wonderful book, Fighting Chance, even that title is compelling. It shows us that we do have things available to us that can help. There is something else that you said so brilliantly, which I’m going to make the title of this episode. It was how to spiral upward. I thought that was so lovely because we often associate spiraling with going down. We can spiral upward. We can have a fighting chance for taking care of ourselves and others. That’s why your work is so important to this world. Thank you for being here. Thank you for writing that book. Thank you for all that you do.We often associate spiraling with going down, but we can spiral upward and we can have a fighting chance for taking care of ourselves and others. Click To Tweet
You’re welcome. Thanks again for tuning in. Thank you, Sarah, for being here with us.
About Sarah Zabel
Sarah Zabel retired from the U.S. Air Force in 2018 as a major general and embarked on a new career as a science writer. Motivated, frustrated, and inspired by a friend’s battle with depression, she made it her first goal to understand that deadly illness. She currently works from her home in Bayview, Idaho.