- [Narrator] If you or someone you know is in crisis, help is available.

Call or text 988 to be connected to trained counselors from the National Suicide Prevention Lifeline.

Free and confidential support is available 24 hours a day, seven days a week in the United States.

If it is an emergency, please call 911.

For more information, visit: suicidepreventionlifeline.org (soft music) - [Narrator] More people around the globe Googled how to maintain mental health in 2021 than ever before.

Between the pandemic, politics, and personal matters, we're stressed out.

The whole planet is stressed out.

We asked local and national experts for their advice, and the research behind it.

Breathing intentionally, being mindful, exercise, connection, creativity.

Those aren't just buzzwords.

They're science-based strategies to help us build resilience.

Sometimes the little things can make a big impact.

Let's start with a little thing.

(soft music) - There is no medication on the market that is more effective for emotional regulation than a 20-minute walk.

A 20-minute walk helps you balance.

Anything that we can do with rhythm is helpful.

Rhythm is helpful.

Dancing, crank on some tunes that you like, dance.

If you've only got three minutes, find a favorite song, dance.

Move your body and get your blood flowing.

It just helps with emotional regulation.

There's nothing on the market that's better than that.

- It doesn't have to be get on the treadmill, and walk a mile.

Do whatever you like.

Movement, it's just movement.

If you love hula-hooping, if you wanna do yoga, if you wanna go roller skating, just moving your body is great.

- I've often equated, especially depression, to existing in, like, a pitch-black room.

You don't know where the doors are.

You don't where the windows are.

I think you're just constantly searching for, like, an edge, and you're in this velvet blackness.

And I think, I've often found, like, trying to seek help can be really hard.

It's hard for people to understand that you are seeking help because they can't see the movements you're trying to make.

And I think it makes it a really lonely space 'cause you know you're in there searching desperately for any corner.

Just an edge, just something to understand where you are relative to anything.

- You know, there are commercials that say if you feel really sad.

I didn't feel really sad.

I felt nothing, nothing.

You know, people could be crying all around me, and I would be like, maybe I should be crying, but I wasn't, or people could be really joyously happy, and I wasn't.

That was one of the alarming things about it was the nothingness, the blackness.

- Bipolar depression, I'm telling you, one minute I can be like high and really, and then it can just automatically drop to a low.

I'm just depressed for nothing.

It's, like, back and forth.

My sleep pattern started to change.

I couldn't really go to sleep as I used to.

Working, I was fine, I'm kind of a workaholic, but this was a little different.

It hit me hard, and I just felt so different.

I was like, okay, I need to get help, like, really need to get help.

- To me, it's a feeling of sadness, but it's also a physical feeling.

Like, I feel it through this area on my head, and it just feels heavy.

You don't feel any joy, not even with things that you normally would enjoy.

- You might even not want to be around your family that you love and you know you do, but you just don't want to be around anybody.

You just want to stay in bed.

- My body physically feels like lead, like, cannot get up.

And it doesn't matter, like, how much I think I can think my way out of it, like, I can't.

And, obviously, you know, most of the time I'm able to muscle my way through, kind of white-knuckle my way through the day, and, you know, do my work and do my tasks.

And I might look like I'm okay, but inside, I mean, it's taken every, every inch to just get through.

- Depression is, it's tricky and sneaky.

And, again, we're learning more about depression.

We're really starting to understand more about it, but I like to think about depression in terms of changes from baseline.

When you're feeling good, you know how many hours a night you need to sleep to feel well.

You know where your appetite normally is, kind of your set weight.

And when we're depressed, things start to move from baseline, but it could move either direction.

So classically in melancholic depression, we see that you sleep less.

You're maybe having those early morning awakenings where you wake up at, like, three or four, and you just can't go back to sleep, but in some other types or variants of depression, maybe you're sleeping way more.

So sleep definitely is one of those big things that we look on in depression.

Any change in appetite, either increased or decreased, and then changes in weight related to that.

Again, focus and concentration, really paying attention to are you able to do the things that you need to do?

Are you able to stay on task?

Can you make decisions, especially as compared to that baseline?

One of the other things that changes a lot in depression is the way that we move.

We call it psychomotor retardation where all your motor movements are slowed down.

You lose some of the expressiveness in your face.

You're just not as reactive.

And so maybe you're not moving as much.

Your arms don't swing as much when you walk.

Maybe your eye contact isn't great.

And so those can all be hallmarks as well.

With someone who has a more anxious type of depression, they might have more agitation, and feel more fidgety and restless.

So, again, there are all of these other signs and symptoms besides I just feel sad.

Depression is so much more than just that down feeling.

It impacts your whole person.

- [Narrator] Feelings of sadness, tearfulness, emptiness, or hopelessness are among the symptoms of depression.

(soft music) Depression, especially in midlife, or older adults, can co-occur with other serious medical illnesses, such as diabetes, cancer, heart disease, and Parkinson's disease.

These conditions are often worse when depression is present.

- We moved here four years ago, and I had to have my blood pressure medicine refilled.

So I picked a doctor and I went in, and he refilled my meds.

He said, "Is there anything else?"

And I said, "You know, I'm real tired."

And he brought me back into the office, and he gave me this questionnaire, and he said, "Fill this questionnaire out."

Well, 18 positives out of 20.

And he said, "You're having a major depressive episode."

And I just busted out crying 'cause, you know, I have a stigma now.

(soft music) I'm that age where, you know, "You don't pray enough.

You don't have enough faith.

Well, you must have done something wrong."

And all of that hit me in my head at the same time.

And I was like, what have I done wrong?

You know, I thought I prayed enough.

And medication and somebody to talk to later, and I realized that that's, you know, well, I've had depression since I was 8.

Thought it was normal.

- I would argue that I experienced it really young.

It was hard for me to get out of bed.

I skipped a lot of class.

My grades started failing.

It got really bad when I was in college.

And that's typically what we see based on my own knowledge, what I know now, that's generally when it starts to get really bad.

I could not find the motivation to do anything.

I was tired all the time and it wasn't just that I was sad.

It was that I felt like there was nothing available to me, that nothing would ever change.

I just became completely hopeless.

And one day I just was fed up, and I said I cannot do this anymore.

So I went into my counselor's office, and I told her everything.

And she said, "Have you ever thought about medication?"

And I was like, "No, why would I do that?"

She said, "You know, there's nothing wrong with it.

People who are diabetic they need insulin.

People with depression, their brain is not producing enough of the hormones that make us feel good.

And that's all the medication does."

- We've made a lot of progress as far as medications go.

And, again, this tracks with our understanding of mental illness.

And so we have medications that are able to target some of the ways we know that the brain changes with depression.

Some of the, the neurotransmitters, or the chemicals that are involved.

The classic ones that we think about are serotonin, and norepinephrine, but there are a lot more that are involved.

- [Narrator] Serotonin, norepinephrine, and dopamine are neurotransmitters.

The human nervous system has more than 40 of these chemical messengers.

Serotonin contributes to feelings of happiness.

Norepinephrine plays a role in your body's fight, or flight response.

And dopamine is a factor in pleasure, motivation and learning.

- Dopamine, histamine, acetylcholine, all of these have roles in how we function day to day.

And especially in terms of our mental wellness or illness.

- And I started taking medication, and, honestly, my life turned around.

I had no idea that I could feel that good.

And so that's kind of when my career path changed.

I had wanted to be a marriage and family therapist.

And, actually, that same summer, somebody in my family had attempted suicide.

And that's kind of when things changed for me.

And I think that's why I'm so drawn to crisis work, and trying to help pull people out from the places that they've let themselves get to, or that they've just unpacked there, because I was there once and I saw no hope, and all it took was somebody stepping in, and saying did you know this is available to you?

Did you know that you don't have to live like this?

- Medications don't work for everyone though.

Unfortunately, we don't have a great remission response, or people who get all the way better with medications.

That's at about 30%.

But that means that 30% of people do get all the way better with medications, which is great.

So I think when I talk to patients, specifically about depression, I say medications can work, therapy can work.

What the evidence shows us is that they work better together.

- Well, if you notice somebody in your family, or your friends is acting a little off, talk to them, talk to their parents, talk to them, and find a doctor.

Find a doctor that will listen to you, and communicate with you.

And if your doctor is not listening to you, and communicating with you, get another one, find one.

Go until you can find one because my doctor she has changed my life.

Honestly, she has really, she's changed my life.

I'm a different person.

I'm a person.

I'm not a lump.

I can laugh and mean it.

Somebody tells a joke, somebody's happy, I can be happy with them.

I don't have to fake those emotions.

- We know that suicide is I think, the 10th leading cause of death in the United States, or it was the last time that they did the data.

I've seen some research recently that it's in like the top five causes of death for adolescent girls.

Suicide is not going away anytime soon.

We use the Columbia Suicide Severity Screening tool.

And I kind of base my questions off of that.

I want to know if that person has had thoughts of dying, or if it's kind of passive, wanting to go to sleep and not wake up.

You know, if the good Lord took them right now, it wouldn't phase them.

And I want to know if they've actually had thoughts of taking their own life, and how far they've gone.

Do they have a plan?

Do they want to overdose?

Do they have medication stockpiled somewhere?

Do they know exactly when and where they would do it?

And I also want to know if they have a history of suicide attempts, because we know that just one attempt increases your chance for completing suicide.

- We have situations where people who are visibly depressed, or visibly going through a very difficult time, it's okay to ask if that person is thinking about taking their own life.

That's something that we teach in Mental Health First Aid.

(soft music) It's not going to make anyone more likely to do anything, but it will show that you're taking note, you're paying attention.

And maybe the person at that point will reach out.

It's not an easy thing, but it is important.

Mental Health First Aid is a training.

It's an eight-hour training, and it's based on the premise that it's okay to ask someone if they're having suicidal thoughts, thoughts of harming themself, and there are strategies and things to look out for that are taught in the class.

There's a training for adults.

And there's also one for youth Mental Health First Aid.

And we're doing a lot of that in the schools now.

- If you see someone having a difficult time, and crying or upset, all you have to do is go up and say, are you okay?

Mental Health First Aid teaches you what you say, what you do.

It's just like physical health first aid.

If somebody's having a heart attack, or a stroke, or an accident in a car you don't leave them until help comes.

You take care of them because you, hopefully, know CPR, or you know enough to know what to move, and what not to move.

Mental Health First Aid does the same thing.

You don't have to get involved forever.

You don't have to be part of the family.

You don't have to think, well, I don't know anything about this.

I shouldn't even approach.

You know what to say, and you know what to do to get help for that person at that time.

That's where the prevention comes in.

Everybody needs to take it.

I don't care who you are: a mother, a father, an uncle, a grandmother, a teacher, someone who doesn't have children, someone who doesn't have anyone in their life who has mental health challenges.

We all need to be prepared, just like we need to be prepared to take care of a heart attack, or stroke, or an accident, and make sure you get some help for that person.

- [Narrator] Regular exercise is one prescription for depression.

It has also been shown to reduce symptoms of stress, anxiety, attention-deficit/hyperactivity disorder, and insomnia.

Plus, exercise can improve memory and self-esteem.

(soft music) - One thing that I always push is exercise.

I live by that.

I exercise several times a week, and it seems like the more vigorous I exercise, the better I feel afterwards.

- Exercise has just an unlimited amount of benefits.

One thing it does is it increases the good neurotransmitters that we need to make our brains feel better.

Have you ever heard of runner's high?

Runners, if they don't get to run, they're depressed.

They're down about it because they get those neurotransmitters after they work out.

- Exercise releases so many chemicals in your brain, endorphins that help combat anxiety and getting stuck.

And so when you exercise, even for 10 minutes, it can make a big difference in the way that you feel.

- We know that exercise helps in a couple different ways.

It increases norepinephrine, which we know is helpful in managing depression and anxiety, but it decreases other stress hormones like cortisol.

(soft music) So it helps us to mitigate stress in a couple different ways, makes us better able to do it with the norepinephrine, and less baseline stress levels by decreasing the cortisol.

It also increases certain areas, volume in certain areas of the brain, like our hippocampus, which is involved in memory and learning.

And so that's some of that neuroplasticity.

(soft music) - And I would recommend burst training.

Where you - you could even do this with walking where you maybe go for a 30-minute walk.

And then every few minutes you do, like, a burst of a really, really fast walk and you go all out, and then you slow it down, and do, like, four or five of those bursts within that 30 minutes.

That really affects the brain.

And so that does help with depression.

- We see the impacts in memory and learning, in managing stress and anxiety.

And the other area that exercise really helps with is the prefrontal cortex, which is kind of, we refer to it as executive functioning.

So making good decisions, planning out long processes, being able to think about complicated problems.

That's all executive functioning that's coordinated largely by our prefrontal cortex.

And exercise helps to get the blood flow going in there, increasing our ability to do all of those things.

So, exercise, some of the best possible medicine for your body, for your brain, all across the board.

(soft music) - Cultivate a practice.

I hate, I don't hate, but I dislike the word routine because routines can lead us back to the same spot.

So a practice is something that you keep working on each day, and you learn and grow from it.

During my morning practice, I get up at 6 a.m. every morning.

I drink a big glass of water.

And then I find my way to my yoga mat.

Usually I'll play some kind of relaxing tune, and I'll be honest, the first 10 minutes of my practice are generally me laying there in one pose either with legs up the wall, or I'll sit in Baddha Konasana, which is a Bound Angle Pose, and I just kind of wake myself up.

Sometimes I'll put my hands on my heart.

Then I'll grab my journal, and write one thing that I'm thankful for because when I start my day with gratitude, it seems like, no matter what happens in that day, it's a little bit easier to handle.

And usually my practice on the mat lasts about half an hour, sometimes an hour if I've got a little bit more time.

And then I'll just go from there and get ready for work, but those 30 minutes to an hour every morning are sacred to me, but we all start somewhere.

I didn't start with an hour of yoga every morning.

It was more like 10 minutes, 15 minutes.

And just starting with one thing at a time, and try to get that one thing into your daily routine.

If that looks like drinking more water, or eating more vegetables, then make it a point every single day to reach that goal.

Then once you accomplish that first goal, that's when you're able to add on other little things 'cause that's really all it is, is one step at a time, one small piece.

We can't all change our entire perception overnight.

It just takes a little bit of practice.

- [Narrator] Next time on "The Little Things."

- I meditate or try to meditate, try to just find, like, a quiet place, and just not let my brain consume everything, 'cause I think about things all the time, and everything, I don't know, it just feels like, like I said, my brain feels like it's going 150 miles an hour constantly.

(soft music) - In the integrated health program we try to help folks understand that above the shoulders and below the shoulders, they're not distinct things.

They hold hands 'cause they're friends, and they work together.

If you feel like s---, you feel like s---, you know.

And the body is gonna affect the mind, and vice versa.

- Self-care, huge.

Believing that you're worth taking care of that's more difficult than actually doing the things sometimes.

But self-care looks like going outside, and feeling the sun on your face.

Getting up out of bed when you really just want to stay there.

Eating a healthy way.

Staying hydrated.

I mean, those sound very basic things, but when people are in crisis, they forget those things.

- One of the things I always suggest to patients, and I try to do myself is thankfulness and gratitude.

So every day it may be something silly, like, okay, I got out of bed this morning, right?

But I'm so thankful I was able to because I got on my feet and some people can't.

(soft music)