- Welcome to "Healthy Minds."

I'm Dr. Jeff Borenstein.

Everyone is touched by psychiatric conditions, either themselves or a loved one.

Do not suffer in silence.

With help there is hope.

Today on "Healthy Minds," I speak with Dr. Dan Hale.

Dr. Hale is a clinical psychologist, who treats people experiencing depression.

- The book is dedicated to my daughter, Libby, who died in 2013 by suicide.

And when I prepared for her memorial service, her brother and sister counseled me.

They said, "Dad, please speak openly about why she died."

If she had died of cancer, we would've talked openly about it.

Most people probably don't know that she was ill, and don't know that the illness was depression.

- That's today on "Healthy Minds."

This program is brought to you in part by; The American Psychiatric Association Foundation, The Bank of America Charitable Gift Fund, and The John & Polly Sparks Foundation.

Dan, thank you for joining us today.

- Glad to be here.

- I wanna jump into you speaking about what it was like to write your book, "Depression - Out of the Darkness and Into the Light."

As a person who is a clinical psychologist and has helped many people with depression.

As a person who has experienced depression and had treatment for it.

And as a father of a child who had depression and who tragically lost her life as a result of suicide.

Tell us what was it like for you to write a book about all of this?

- Well, the book is dedicated to my daughter, Libby, who died in 2013, as you said, by suicide.

And when I cared for her memorial service, her brother and sister counseled me.

They said, "Dad, please speak openly about why she died."

You know, if she had died of cancer, we would've talked openly about it.

Most people probably don't know that she was ill, and don't know that the illness was depression.

So please go ahead and say that.

So that Friday evening, when I spoke at the church where we had worshiped for years.

And there were about 400 people in attendance that night.

I did speak openly about it.

And I didn't know what the reaction would be.

But the reaction was afterwards, so many people said to me, we are so glad you openly about depression.

We need to talk about it more.

We need to talk about it in our homes, in our schools, in our workplace, and even in our churches, and other faith communities.

And so I took that on as a mission.

And I did a lot more talking.

I'd done some over the years, but I really felt I needed to spend even more time doing that.

And as I did that, so many people said to me, it's helpful to hear the three perspectives you can present.

You're a professional, like you just mentioned.

I'm clinical psychologist for years.

I treated people with depression, helped them recover, found it very gratifying.

But I also experienced two major depressive episodes myself.

So I know what it's like to be in that very dark place.

And then I had struggled trying to take care of my daughter and then deal with the aftermath of that.

And so, as I did that, people said, "Why don't you write more about it?"

Which is not something I was eager to do, but I decided to take it on.

And it was difficult, but it was good.

It was a good exercise for me.

- I wanna ask you for your daughter's illness and tragically, her passing away.

What was that like for you as a father, for her siblings, for the family, friends?

Tell us a little bit more about what that was like.

- Well, it was awful.

I can't say anything else than that.

It was very painful.

We knew that she was struggling with depression.

She had struggled with it as a teenager, but had been in treatment, had recovered and did very well.

Got married, graduated from college, started a family.

But then in her 30s, it came back, and really came back with a vengeance.

And one of the things we all struggled with was that it's hard to provide all the care and support for an adult child.

She had moved on, formed her own family.

We were spread in different parts of the country.

I was in Maryland.

Her mother was in Florida.

Sister was in North Carolina, brother in Tennessee.

And so we all tried to put together care for her.

And frankly, it wasn't enough.

And so there was a sense of failure.

We wish we had done more.

I'm not certain what more we could have done.

One thing we did say, looking back, we wish we had stayed in touch better.

But with her passing, we so certainly came closer together, found a way to support each other.

And all of us have taken on a mission of trying to bring depression out of the darkness and into the light.

It's not discussed enough.

So whatever we can do to talk about it more and to share, not only the bad story but the good story, which is it's a treatable condition.

And if we can only help more people get treatment.

- The sad statistic is the majority of people who have depression don't even seek treatment.

And many people who do seek treatment, don't receive appropriate treatment, a full course of treatment.

So there are people flowing through the cracks.

And then sometimes people who, even with treatment, they may not respond to the treatment.

So when you are speaking to people about this, what's your message?

What are you telling people?

- Well, I tell people that it is sort of a bad news, good news story.

Depression is a terrible illness.

I've been there, I know what it's like.

It is a painful, painful illness.

But the good news is that there are treatments.

There are medical treatments, there are psychological treatments, and often combining the two is best.

So please, if you think you might be depressed, or if you see somebody else, a loved one that you think might be depressed, get treatment.

Make the initiative yourself or encourage your loved one to take that step.

- Don't suffer in silence, don't allow someone else to suffer in silence, get help.

Often people are afraid if they're concerned about a loved one.

And if they're concerned that they may be at risk of suicide.

They're afraid to ask about it because they think maybe that could encourage it.

And we know that's not true.

In fact, asking about it can save a life.

I'd like you to speak a little bit about that.

- Sure, absolutely.

I'm so glad you bring that up.

Because I think if in any conversation you're having with someone, you hear statements that say, maybe this person is thinking about suicide.

I don't feel like I can go on any longer.

I wish I could go to sleep and never wake up.

Or people would be better off without me.

Ask them, speak to them.

And like you said, you're not going to put the thought into their head.

So ask if they are thinking about it.

And if they are then take some steps along with them.

Don't walk away from that, but make sure you connect them.

Connect them to the National Suicide Prevention Lifeline.

Take them to the local hospital, to the ED.

Your community might have a psychiatric crisis center.

Or in some cases you may need to call 911.

And if you do, please let them know this is a mental health crisis.

And if they can send out a crisis intervention team with some expertise in this area, that would be great.

- Similar, if you see somebody limping, you're gonna say, it looks like your leg hurts.

Or somebody clutching their chest, you're gonna say, are you having chest pain?

If you hear somebody speak about dying in this way, take action.

Ask them about it.

- Yes, please.

- I wanna ask you about your own experience with depression.

Tell us about how your episodes came on, what it was like.

And then what did you do for help?

- Well, I've had two episodes.

One that came about the first one was during the period of great turmoil and strife in my life.

So in one sense, I wasn't totally surprised, but it did take me to down to a level I'd never been before.

So I experienced a deep, profound sense of sadness, unlike anything I'd ever experienced.

And it was with me all the time.

There was no escaping it, no relief.

I found that I couldn't enjoy anything in life anymore.

All the activities that I had so enjoyed with my family, with my friends, with my colleagues, they weren't enjoyable anymore.

I didn't look forward to them.

- I just wanna interrupt, because you're referring to, we professionals call this symptom anhedonia, inability to enjoy oneself.

And a very important symptom in terms of making a diagnosis of depression.

But keep going.

- And noticing in someone else.

- Exactly.

- Someone who's no longer participating in certain activities or doesn't have the enthusiasm.

And that was me.

I wasn't there.

Or if I was there, there was no enthusiasm, no joy.

I couldn't appreciate humor.

I could remember hearing something that my mind would say that was funny, but I couldn't feel it.

I think I probably went for months without laughing.

My sleep was disturbed.

I had trouble both ends.

I had trouble getting to sleep.

And then even worse was waking up about two hours before I normally would.

Not able to go back to sleep.

Not rested, but not able to go back to sleep.

And that was just terrible.

Be lying there in the dark for a couple of hours.

I lost my appetite.

Food had lost its appeal.

And I didn't feel like fixing good meals or going out for meals.

So I lost 10 or 12 pounds, which is, again, something you might notice in somebody else.

But not think about.

- Weight loss.

Yeah.

- I was tired all the time.

I was exhausted, but it wasn't simply a lack of energy.

There was a sort of a weakness that overcame me, so much so that I sometimes doubted that I could even get outta bed and walk 10 steps.

I feared that I would collapse.

My mind was sluggish.

I'm a psychologist, I'm a professor.

And here I was, I could not think quickly or clearly.

I had trouble concentrating, even reading down a page or listening to someone attentively.

I had trouble with that.

And then I felt worthless.

I really felt like a fraud or an imposter.

And I feared that I would be discovered as such sometime, even though I had pretty good credentials and experience as a professor.

There was the fear that someday I would walk into that classroom, maybe a freshman class, and some student would ask me the most simple, basic question, and I wouldn't be able to answer it.

- And you make a number of very important points.

One is, sometimes people can develop a depression and there's real life events that you could point to and say, this is what brought it on.

But sometimes things could be going extraordinarily well, and it happens anyway, which in some ways could be even more upsetting, because everything is going well, why am I depressed?

So that's two important points.

The other thing you described so eloquently, what it was like for you.

And I think for somebody looking from the outside in, especially a family member who cares about their loved one.

They don't fully understand what they're going through, how overwhelming this could be.

And sort of stop it, get out of it.

Come back to yourself.

Whereas for the person, they're just overwhelmed by the feelings and experiences that you just describe to us.

What it's like to experience depression, how overwhelming it is.

And I think it's important for family members who see their loved one as depressed and know that they're suffering.

But they may not really understand the extent to which it is.

And they may wanna shake them and say, stop it, feel better, when they're overwhelmed by these symptoms.

- I think you're exactly right.

As a family member, you may see that they're hurting, but you're also not sure what to do.

And you're also likely to be experiencing some frustration yourself.

Because usually the depressed person has changed in some fundamental ways.

And they've lost some of the attributes that you've come to associate with them and with your relationship.

And so you, like you said, you wanna wanna shake them, sort of say, snap out of it, come back.

But that's not the right thing to do.

And it takes time to try to understand them better.

And to find out what you can do to help them, which definitely includes getting them to treatment.

I think that's often the most important thing you can do, is to encourage them, say to them, this is why I'm worried about you.

This is why I'm concerned.

Please schedule an appointment with your doctor or let's find a mental health professional that you can talk to.

- I wanna ask you about your treatment.

What helped you?

- So I think there were really three parts to the treatment.

One was I knew I needed to talk to my physician.

I needed help with some of the physical symptoms.

The problems with sleeping, with appetite, with energy.

He agreed.

So I was prescribed an antidepressant medication, which did its job.

It helped me, but I also needed psychological assistance.

Because much of the depression was tied up with these terribly negative thoughts that were rolling through my head constantly, that I was having trouble controlling.

So I needed a psychologist to help me get those under control and replace them with more realistic, accurate, positive thoughts.

And also I needed help, reestablishing some of the healthy routines that had been part of my everyday life, until they were disrupted by the depression.

So those were the two major treatments.

But I definitely think in my case, and probably many cases, there was a role for family and friends.

A few key people who knew me, who loved me, who cared about me, and who made a point of staying in touch with me.

So every week I was told by somebody that I was still loved, I was still valued.

And I think, my hour a week with the therapist was great, but there are 167 other hours in the week.

And to have those family and friends that were there, again regularly expressing love, concern, that was a part of my healing process too.

- Dan, I know that faith is very important to you.

And I'd like to ask you about the role of your faith in your recovery from depression.

- Thank you.

Yes, I've long been interested actually in the intersection of faith and health.

Something I've studied, partly because of my personal experience.

For me, the role of faith was really the faith community.

And I had a faith community that was responsive to me, and a faith community that was supportive of me.

But I have to say that that's not always the case with faith communities.

So I think there are ways that faith communities can do even more than many of them do right now.

And I think one of the things that faith communities can do is provide the support, which they often do with other illnesses.

- Right, if somebody has cancer or some other medical problem, they're gonna jump right in.

- That's right.

Can we take you to your appointments, to your treatments?

Can we pick up your prescriptions?

Can we bring in some meals for you?

As well as just regular expressions of love and support.

Unfortunately, when the illness is depression, I don't always see that.

And I think that's partly, because depression is a less visible illness.

No one's limping or they're out in a wheelchair, so you don't necessarily see it.

And I think that part of that reason, we have to blame stigma.

Unfortunately, I think stigma still is out there.

It's in our faith communities.

And so people are reluctant sometimes to explain what they're going through.

- I think your point about stigma and in many ways, I think stigma is too soft of a term it's prejudice, where people have prejudice against those who may be experiencing depression or other psychiatric conditions.

And unfortunately it exists throughout society and often gets in the way of people seeking help and getting the treatment that they need.

- I agree wholeheartedly.

It's a serious problem.

- What have you done to reach out to faith communities to start to address this problem?

- Well, we have found that actually, they're usually are receptive if you explain that.

So one of the things we have done is we've trained volunteers to be educators within their congregation.

To take back information, how to recognize depression.

What are some of the symptoms that you might see?

And I think, one of the things I find is that, often people in faith communities and everywhere, don't realize they're depressed.

That may sound funny.

They know they're hurting.

They know that something is different, something is wrong, but they don't know what it is.

They don't think of it as an illness.

So I think when faith communities, and this is what we train our volunteers do, can provide some of that information.

It can be done through announcements in congregational gatherings.

It can be done in bulletin, inserts, congregational newsletters.

Particularly I like, and we've been doing this a lot, of bringing in speakers.

We sometimes tie it to national campaigns.

So May is mental health awareness month.

October is depression awareness month.

And to bring in a mental health professional, who can speak to the issue and educate the congregation.

And often what goes along with that, is if you can bring in somebody who will talk about their own personal experience with depression and their recovery.

I think actually the studies show that that personal contact is often the most effective.

Education is great, we need to be doing more education to overcome stigma or prejudice, but also to have people come in, so they can see a real life person who has gone through this and recovered.

It's a hopeful message there.

- What message do you give to somebody who's watching right now, who may be experiencing depression themselves?

what should they do?

- Please get help.

Do not hesitate about that.

That could start with your primary care provider or a mental health professional.

Make that appointment.

I typically advise before that appointment though, go and prepare.

So prepare a list of symptoms.

What have you been experiencing?

What's changed in terms of your mood, your activities, your thoughts.

It's also often helpful to consult with a family member or friend who has seen the changes.

They might have something to add.

When you go to the appointment, please be open.

This is a confidential relationship.

It's the time to say whatever you're experiencing, whatever you're feeling, whatever you're thinking.

Let your provider know.

And then follow whatever treatment recommendations, follow from that.

So that could be antidepressant medication, could be psychotherapy.

- Could be both.

- Could be both.

- And I think that especially, if antidepressant medication is part of it, make sure you understand before you leave, what to expect from the medication.

'Cause as you and I know, medications don't work immediately, they take time.

And people need to stay with the treatment even when they're not getting that initial effect that they were hoping for.

And also stay in touch, because you might have some unpleasant side effects.

Or you might not get the desired effect.

So you need to stay in touch with your physician.

I would also advise, reach out to a couple of friends, let them know what you're going through.

Let them know what would be helpful to you.

Maybe it's that visit once a week.

Maybe it's that daily call.

This would be helpful.

And finally, don't give up.

Please, don't give up.

With time and treatment, people do recover from depression.

- I think it's an important point not to give up, because one of the symptoms of depression is feeling hopeless.

So you don't have hope, you're gonna give up.

But that's one of the symptoms, just as appetite disturbing, sleep disturbance and other symptoms, hopelessness is a symptom.

- Right.

Sometimes you have to sort of live on borrowed optimism.

Your provider is still optimistic.

Your family and friends are optimistic.

You just have to believe that someday you'll feel that.

But you're right.

Hopelessness, pessimism is right at the heart of depression.

- One of the challenges for family members of a person who's depressed is that person may minimize the depression or not wanna speak about it and not seek treatment.

What do you tell family members to do, when their loved one really says, no, no, no.

I don't want any help?

- Well, it's a frustrating place to be.

I know that, I've seen that, I've felt that.

But I think you have to continue to encourage them to listen.

And I think listening is a very important part of this.

Because if you push too soon, they may be thinking, you don't understand what I'm going through.

And so if you can say, I want you to tell me more what you're going through.

Tell me why you don't think you need to go see somebody right now.

But tell me what you're going through.

Listen patiently, attentively, empathetically.

And then still, try and give them hope that they could feel better, if they could go get that treatment.

And sometimes have to just say, I know you don't think it's necessary, but for me, please it'll make me feel better.

I'll feel much better if you'll just go.

- I think very good guidance.

And I think the perspective of listening and even picking up on what the person does point out.

So they may not point out depression, but they may say, well, my sleep isn't so good.

Or I'm feeling very stressed.

Focus on what the person is verbalizing and let them seek help for that, which could then lead to them, really getting the treatment that they need.

- Right, you don't have to get an argument over whether or not they are clinically depressed.

If they're having some of those symptoms, there are ways you can get relief for those symptoms.

Let's go talk to your doctor.

- Dan, I wanna thank you for joining us today, for sharing your experience and for all of the people, I'm thanking you on behalf of all of the people that you've helped by doing this.

- Thank you for having me.

- If you, or a loved one is experiencing depression with symptoms, such as sleep disturbance, appetite disturbance, difficulty concentrating, inability to enjoy activities that you usually would enjoy.

If you are experiencing this, don't suffer in silence, seek help.

And if you believe that a loved one is experiencing this, encourage them to receive help as well.

With treatment, which can include medication, talk therapy, getting back into one's regular routines with support of family and friends.

With treatment, people get better.

With help, there is hope.

(gentle music) Do not suffer in silence.

With help, there is hope.

This program is brought to you in part by; The American Psychiatric Association Foundation, The Bank of America Charitable Gift Fund, and The John & Polly Sparks Foundation.

Remember, with help, there is hope.

(gentle music)