[Music] good evening and welcome to this special mental health edition of doctors on call i'm dina claiba a psychotherapist and founder of insight counseling of duluth and virginia and i will be your host for the program tonight on anxiety and depression this is the first of four special mental health episodes that will be airing throughout this season of doctors on call our program is here to answer your questions about mental health issues that may affect you your family or friends please call or email your questions and we will do our best to address them the telephone numbers and email address can be found at the bottom of your screen our expert guests this evening are dr douglas heck a licensed psychologist with the duluth psychological clinic and dr debra viner is a licensed psychologist with insight counseling in duluth our phone and email questions are being received this evening by members of the wdse staff who will bring them to me here in the studio now let's begin with a discussion of anxiety and depression good evening good evening hello it is such a treat to to be sharing the space with the two of you you both have a wealth of experience uh and knowledge and expertise and it is just a treat so thank you great to be here yeah thank you for having me yeah how about if you both just take a moment to introduce yourself share a little bit about your practice yeah go ahead go ahead well i have worked as a licensed psychologist since 1984. i have done many kinds of work i've worked in an inpatient psychiatric unit i've worked as an adolescent partial hospitalization psychologist i've done outpatient therapy and i've worked primarily with families and children until later in my career when i started working more with just individuals and especially the age group that i'm in the growing older age group and so um i've done all kinds of different work um but i mostly see you know what everybody sees the depression anxiety and trauma issues so i'm with the duluth psychological clinic and i've been a psychologist for a little over 30 years and most of my career has been centered around working with people with medical conditions and so a lot of what i've learned about and and worked with over the years has been how psychology can be helpful to people who have had a medical crisis and how what psychology has to offer in terms of helping them heal helping them grow afterward helping their families adjust to the changes that they go through some of those things so i have i enjoy my practice because it's varied i work in the hospital part of the time so i'm working with people that are acutely recovering from some type of condition it might be a stroke or brain injury could be a heart attack or somebody with cancer and then i have an outpatient practice where i see those individuals it used to be in clinic and now it's through telehealth but so so that's what i do and obviously a lot of part of that is about helping people through depression okay wonderful i'm glad you mentioned telehealth i mean thank goodness we've had that option the last couple years which is a nice segue into one of the questions i had for you both because you have such such so many beautiful years of experience i'm curious how how you would describe what you've observed over the years maybe some big themes major themes i know personally even since the pandemic i've noticed some changes and some shifts in the way that we practice so i'm curious what what you've noticed as well yeah do you want um i guess my thoughts since the since the since covet is that prior to that i had maybe done it a little bit with telehealth but not very much and uh at the very beginning maybe for the first six months or so i kind of bristled at it a little bit because i wasn't able to read people as well and get all of the nuances and the non-verbal cues that i would get otherwise a meeting with somebody also a large part of therapy and a large part of helping somebody it starts with a relationship and so if you are able to establish a good relationship then you're more than likely able to help somebody move along their path and telehealth you can still maintain a relationship but it's not the same so i see telehealth is very important it's here to stay there's some people who have conditions that make it very difficult for them to leave home and come into the clinic so for those individuals i think it will stay and that's a really good thing um but i also think that getting back to seeing people in person at least for the kind of work that i do i don't know about for you deb but i i'm looking forward to the day of being able to see people in person again wonderful how are you done i see people in person and on telehealth i i initially came back from retirement to insight and i uh really missed seeing people in person when we couldn't when we did telehealth and i agree with you think thankfully we had telehealth to offer to people who couldn't get help and i see a lot of people with children young children who can't leave their home i see a lot of people with conditions various conditions that make it very difficult for them to to get in so i've enjoyed the telehealth experience a lot but really love the being in person as well and i will only do trauma therapy i know you do art therapy over telehealth i don't anymore i did not find that to be helpful i i feel like certain therapies really need to be done in in the office that's that's how i experienced it many trends have happened since i started working many things and the thing i love about um our newer uh look at things are the the welcoming the lgbtq [Music] community and this whole area which i'm not well trained in but i you know there's just many new areas that we're looking at and just uh you know any number of things that are so not what we used to do and and i i also agree with the whole new medication types of interventions that have really helped people and so i i'm just loving the changes wonderful and speaking of medications devil i'll have you um respond to our first question can you discuss weight gain after taking an antidepressant what types of medications cause weight gain and if you have to take them what do you do about it well doug well i think that weight gain is is sometimes associated with medication it's not something that i'm familiar with that occurs across everyone that takes a particular medicine i know that the ssris which is a class of medication that's used for treatment of anxiety and depression in some people can cause some weight gain and i've certainly talked to some clients about that there are some anti-seizure medications that are used to help stabilize mood that can sometimes cause an increase in in weight as well and so the first step is to be aware that that's a possibility and if there's a weight gain it may be due to the medicine it may not sometimes people gain weight because they're getting depressed and they're not as active and so even though they've started their medicine it may be that they're just not as active and that's why they're gaining the weight for people that are gaining weight and they feel like it's their medicine and they really want their medicine they don't want to get rid of the medicine then it's really about having a plan in place for watching calories burning up calories and adjusting that from what where they were before they took the medicine sometimes it changes metabolism so people need to drop down what they take in in order to maintain their weight so thank you another question about antidepressants is there any risk of dementia or alzheimer's when you take antidepressants for a long time i've never heard of anything like that now i don't know all of the literature but i have i've not heard i i would assume some some people might be more susceptible to that but i know that many many many people who are older with memory problems have been put on medications that's been my experience without any uh terrible effect but do you have any experience with that it's not something that i am aware is a large risk factor it's not something that i hear physicians talking to their patients about when they place them on an anti-depressant medication the thing is that sometimes occurs though as if somebody has had a brain injury or develops epilepsy for example those individuals may be at greater risk for developing dementia down the road may not develop it but they they may have a higher risk because of their condition not necessarily their medication so so to answer the question it's not it's not something that i'm familiar with okay yeah deb how are anxiety and depression different well they're similar in many ways but the major difference is with anxiety the part of the brain that's very acutely impacted and activated is the amygdala that's where our fight-or-flight response comes from and so anxiety has that going on much more usually than depression depression tends to be a much lowered state where you'll see people have you know um that anaedonia the very low motivation the the the body just seems to want to just not do anything strength is down physical activity is down so the whole brain seems very impacted um so we we worry a lot about um with depression the suicidal thinking which is is quite common and so of course that's a a primary targeted area you can have depression with mixed anxiety and then you've got the both you've got the the high activation and then the low the dipping and that's not necessarily to be confused with any bipolar type of disorder it just can happen that people have both but there is somewhat of a difference would you agree doug i do i i like what you're saying about anxiety tends to activate people and have people be on guard there's usually fear strong fears that exist which changes people's behavior people's behavior and causes them to avoid things or stay away from things that might be good for them and depression is much more about a lack of that energy and a real slowness and slowing down and withdrawal so there's some other differences obviously but those are the big ones thank you and doug what are some strategies that you think are helpful when someone is experiencing anxiety or depression well that's a good question there's uh textbooks written on those things there's quite a few i really my my preference is that i really think that good intervention starts with good assessment so i really think that any clinician out there who is looking to treat and any uh client or patient who is looking to get help really needs to invest some time to begin with about getting to know their clinician and vice versa because one person's depression isn't another and so i might interact with or intervene with one person and primarily focus in on the fact that they are highly self-critical and that they never feel like they can do anything well but there might be somebody else who is depressed that has a good confidence level and they believe in themselves but they just can't motivate themselves to do anything or that they tend to not eat well or not sleep well so everyone's depression can present a little bit differently so it begins with getting to know the person and having them get to know their treating clinician well and what their strengths are and what they offer and coming up with a good plan and anxiety and depression are treated somewhat differently but the what what i have learned over the years to go back to your question a long time ago is that i think that we've realized that um treatment for most mental health conditions especially these two really does begin with getting people physically active there is some good evidence that by just moving our bodies that it changes the chemistry in our body so that it helps to ward off or reduce depression and anxiety and so even before getting into other kinds of therapy it's about how much are you moving when are you moving let's get you going a little bit more because that's going to help whatever we do i love that you say that just this morning i listened to dr kelly mcgonagall and she has a new book out the joy of movement she has a popular ted talk and uws here actually just had her um come in and do an event for the community it was virtual of course it was beautiful and uh and the research i mean behind it is just i've always felt passionate about movement and supporting my clients around movement but as little as two minutes a day if you could just get you know you can get a little bit so i love that you said that yeah and as far as working with a clinician when deb when would you say that someone should reach out for help like how do i know that i need the help of a therapist or someone else on this journey well people vary in their reasons for coming in oftentimes somebody they love or you know like and within the case with young people their parents often you know urge them um sometimes people are you know told at work they need some help and um you know are really urged to go but the vast majority i think they kind of know they've had it and they really need help and they want help and they feel very motivated to get that help and um it's not easy to do uh so it takes courage and they uh you know and they and they you know get courageous and they come in so um a person usually kind of knows that things aren't right for them and that they really need to do something to help themselves and they know usually that they can't really depend on their families and or their friends to help them sometimes they feel they burden them and other times they just you know don't want to reveal some of the things that that are troubling them and absolutely when a person is feeling suicidal that they absolutely need to to come in and get some help that's a really big and important one yeah glad that you mentioned that too um what if you know someone in your life who has expressed suicidal thoughts what what are some steps how can you support that person well i think again i'm i hate to say that everything depends but it kind of does and to some extent if we're talking about an eight-year-old you would enter interact differently than you would with somebody who's 38 or 68 so i think again it depends on the relationship if if it's a friend or a family member and you already have a nice uh trusting relationship it takes courage for somebody to pull the person aside and say i don't know if i'm off face here but it just seems like you're not quite yourself lately and i'm just kind of concerned is there anything that you'd like to talk about and to see if they would be willing to open up a little bit to you and to help them feel safe in doing that i think getting the person to be able to talk and about what's going on is probably the most important thing i don't think that somebody should be rushed into an emergency room or going to see their doctor or even seeing a counselor if they're not ready to say i i would like some help because sometimes i think family members inadvertently rush people in and nothing happens because they're not ready to talk but i think it's important to not ignore and to not just act like it's not going on but to show your care and be there when that person decides to open up and say yeah you're right i'm uh i got some real heavy stuff that i'm dealing with right and i agree with that and i'd like to add another thing sometimes people get caught in in in supporting someone who has suicidal thinking being responsible for helping them and um i try to urge people not to feel responsible but to have them get help and and not be the person who is trying to get them past their suicidal thinking because that can be a very heavy burden but i agree with what you said if if they can talk to you about it they probably will yeah and i think again younger people may tend to not want to talk to their parents or family members so there may be an online resource that could be helpful in some cases clergy can be really helpful as they tend to be trusted quite a bit by a number of people and so if there's somebody there who they may trust then that might be the relationship that they can uh open up in and begin to talk a little bit so right and and one important thing is to to not try to tell people to stop feeling suicidal and you know trying to convince them not to be that tends to not help trying to talk them out of it right trying to talk them out of it but just kind of recognizing that that's a place they've gotten to and that that you know that there is help available and really validating they're very validating to the experience right i love to offer you know how can i support you right now sometimes even just hearing your friend or family member exp you know express that can be helpful in itself and speaking of getting help i think it's important that we that we mention um and i think all of us know that there are a lot of wait lists right now in order so if i have made the decision to seek help i may not be able to do so you know def within a couple weeks in the community so what are some resources or strategies or skills or things that we could offer folks at home that's available to them whoever wants well nami is a wonderful resource and it is it is the acronym for national association for mental illness i believe thank you i think so yeah and there's an office in duluth and there's an office in douglas county um i oh i think we have we have the resources up too resources up they offer free services um they i have some familiarity with the uh with the organization it's really a great organization and um i know that they have helped lots and lots of people with resources and they even have family a family group for family members of people who have loved ones who you know and friends uh and um there's also uh birch birch street center birch tree center here in duluth again the resources up and um these are our ways in which people can connect with other people and find resources yeah so the only thing i would add to that because i agree with with all of that would be that in today's age when we are using telehealth we don't need to necessarily look for somebody local anymore i mean there could be someone in red wing or someone out state that has an opening and so i've been encouraging a lot of people i talk to is to not stay local because if it's telehealth they can still see you as long as it's within state the state line so there's some help available that way yeah excellent idea thank you we have a question from the iron range excuse me how does having ptsd affect the treatment of depression doug well trauma is a life-changing event and it changes people in so many ways mentally physically spiritually and so the the best thing in my mind is for the clinician to know about the trauma and the ptsd and so that when that initial plan is made with the client about this is how we're going to work together that it takes into account where they are with respect to their ptsd some people some people who have ptsd have had it for a while and they kind of know how to manage the symptoms if the symptoms aren't managed then in many cases that's where treatment needs to start before going on to work on the depression so it's really about individualizing the care but it's a very very important part of the picture to know about anything you'd want to add well they can both be work done and there might be some different strategies that are used one with you know one for ptsd it might be quite different than one for depression for example the newer therapies the trauma-informed therapies such as emdr or um art accelerated reprocessing therapy well those are targeted toward uh trauma although they can be used for other things for like other life dilemmas or or even depression or anxiety other therapies that are used for depression and anxiety um are you know they're all really good and will work but they can be treated separately so you know it what what you're saying doug about you need to know that client's um style you know just how it is that they resp what kind of depression they're having one with anadonia the the kind where they can hardly move as compared to an agitated depression you might want to change up some of those treatments or interventions some people will not tolerate the emdr types of interventions so you've got to get creative and perhaps use metaphor there are many powerful powerful strategies and but they certainly both can be worked with and together thank you i think we have time for about one more question uh doug this is a question out of superior wisconsin i have been on antidepressants for 20 years well i have to take them well i have to take them for the rest of my life going off meds has failed it's a good question one that many people ask it's really a question that needs to be worked on with the physician who's treating you and it's very important to let the physician know that you wish to see whether you still need the medicine or not and if you're really wanting to come off of it then there are strategies medical strategies that can be followed to help address some of the withdrawal symptoms that might occur so i wouldn't say that it's a given that you have to stay on it for that person but it really needs to be coordinated with a physician i i know once you're started you start feeling well same with psychotherapy it's like oh i don't need it anymore so there may be a 10 so i think consulting is really important yeah too so thank you well i want to thank our panelists dr doug heck and dr debra viner for their time and expertise tonight and for those of you who called or email questions please join dr peter nalen on december 2nd for a program on lower extremity knee hip and foot problems when his guests will be dr joshua rother and dr william uffman i'm dina claiba for the guests and crew here at wdse thank you for watching good night [Music] [Music] you