Depression Signs Symptoms and Causes Part 2 of 4 Physical

You welcome to Integrative Behavioral Health. I AM your host, Dr. Donnelly Snipes. And today we are continuing our discussion about the common and some not so common symptoms of depression. Today we're going to be focusing mainly on physical symptoms. So when you look at the dsm, the Diagnostic and Statistical Manual of Mental Disorders, fatigue and slowing are characteristics physical symptoms of depression. But what the DSM doesn't mention are a lot of these other things. So let's take a look at some of the characteristics that physical symptoms that you may be experiencing if you're depressed. Now, it's important to remember that a lot of things can cause any of these symptoms. So for example, when we talk about cognitive tomorrow, which is your thinking, there are a lot of things that can contribute to feelings of confusion and foggy headedness and difficulty sustaining attention. It's not necessarily just depression. So we really do want to look at the whole person and figure out is this person symptom or are this person's symptoms of depression being caused by exclusively by their thoughts or their feelings, so to speak, or is there an greater underlying issue, and I'll give you a hint, 99.9999 times out of 100, there is something else going on. There's more going on than meets the eye. Now, when we are stressed for a long period of time, our body's threat response system, and we talked about this yesterday, our body's threat response system causes physical changes in our body. It causes our body to go into what you might consider conservation mode, which can trigger things like high hypothyroid that we're going to talk about. It can trigger low blood pressure because as our excitatory neurochemicals become depleted or less effective, then our body tends to be in more of a rest or hibernation state, if you will. So when we feel depressed, it could be because we've been experiencing something that was challenging and we feel hopeless and helpless. We lost something that was important. It also could be caused or contributed to by a variety of other things. So fatigue and slowing, for example, and we talked about this some yesterday, but dopamine, serotonin and norepinephrine, three of our main neurochemicals, as well as estrogen and testosterone and thyroid hormones. All of these are impacted by stress, all of these are impacted by a variety of things. And all of these impact our energy levels. So it is so important to make sure that you get an assessment to make to address or to identify if you have any problems with your thyroid levels with Your gonadal hormones, your estrogen, testosterone, progesterone and your vitamin D levels. All of those are easily measured with a blood test. When we are depressed or when we experience depression, we also may have reduced libido. You just don't feel like procreating, you don't feel like having sex at all. And that is the result of alterations in our gonadal hormones, our testosterone and our estrogen, possibly due to stress, possibly due to aging, possibly due to medication side effects. There are a lot of things that can cause our gonadal hormones to get wonky, for lack of a better term. And when that happens, we may experience feelings of depression. We may experience symptoms of depression. So, you know, if you make sure those are in alignment with where they should be, then that is one less thing. That's one thing you can cross off your list for potentially contributing to your depressive symptoms. Blood sugar challenges are another symptom or can be another symptom of depression as well as anxiety. When we are stressed, when we have a stress response, our body secretes cortisol, secretes norepinephrine, secretes adrenaline, which and causes our body to release blood sugar. So we have, you know, fuel to power on through that fight or flee response. Totally normative survival reaction. When it happens occasionally. But as we talked about yesterday, if it happens consistently, then your blood sugar, you're constantly going to be fighting with your blood sugar spiking or when you get to the point of feeling depressed. We talked about the Flat and the Furious yesterday, where most of the time you're just, you don't have much energy at all. But then when something does happen that triggers you to actually, you know, get motivated to get angry or upset about something, you have an extreme response. So you're either flat or it's an extreme response. The same thing is true about your blood sugar. It may be, you know, flat to relatively stable, but it could spike, you know, and have an extreme spike in the presence of, of stressors. So it is important to recognize that your mood and your stress response system will impact your blood sugar, your ability to regulate your blood sugar and your A1C levels. And, you know, obviously. So pay attention. If your blood sugar is becoming more difficult to modulate, then you may want to take a look at what's causing that. And part of it could be stress, you know, using that term broadly, which is ongoing, which is chronic, which is actually contributing to your depression, low blood pressure and dizziness. We'll talk about kind of all at once blood. Well let's start with blood. Blood carries oxygen to our brain, throughout our body. It nourishes all of the, you know, parts of our body and keeps everything going. When we are depressed, we tend to have a lower heart rate. We tend to move around even less, which keeps our heart rate even lower because we're at that really low rest place. When our heart rate is lower, we also tend. They have found that people who are depressed tend to have lower blood pressure. Now, if you have anxiety and depression, that's probably not going to be the case. But if you have, you know, extreme depression, you may have low blood pressure or blood pressure that's low for you. That can contribute to foggy headedness, difficulty concentrating. It can contribute to fatigue. When you don't have enough oxygen, you're getting to your brain and everywhere else you're going to feel fatigued. When you have low blood pressure and you stand up from a sitting position, it often causes you to get dizzy for a minute. So these can be signs that are perfectly normal for you. Or if this is something that has started happening, it could be a sign of depression. So that's, you know, good information to talk about with your doctor. You know, if your blood pressure is, you know, low for you. I know my blood pressure tends to run pretty low anyway, but when it gets low for me, then I start having symptoms of dizziness and even we'll get to it in a minute. Difficulty with vision. Sleep changes are also another common problem and part of the diagnostic criteria for depression. Some people want to sleep all the time. They have no energy. So going back, you know, not enough norepinephrine, not enough cortisol at the right times, not enough dopamine. So they may be exhausted all the time. They also may be sleeping but not getting quality sleep. And when we don't get quality sleep, we wake up and we feel groggy because our brain hasn't been able to clear out the adenosine, which is a byproduct of, you know, being awake and thinking. So we feel foggy headed, which makes us often want to go back to sleep. People who are depressed also often aren't getting out into the bright sunlight. They want to stay inside. They, you know, want to pull the covers up over their head, keep the windows shut. All of that contributes to circadian rhythms getting out of balance. Out of balance. Circadian rhythms will impair your ability to get good quality sleep. So what's my take home here? Sleep hygiene is very, very important for maintaining neurotransmitter Balance and maintaining mood and maintaining a whole bunch of other things. So paying attention to sleep now. Some people, when they're depressed, can't sleep at all. They have insomnia, and the same sort of stuff is true. They're going to have a buildup of adenosine. They're going to have more difficulty maintaining focus. They may feel a little bit more scattered throughout the day. We need serotonin in order to make melatonin in order to get drift off to sleep. We need to have that sleep time in order to rest and repair and rejuvenate the body. Remember we talked about the body factory yesterday? We need time for the maintenance crew to go through and clear everything out and tune up all the machinery before the next day. So sleep is really important. And if you're not getting good quality sleep, that's something to talk about with your doctor. It's something to learn about because there's a lot of sleep hygiene things that you can do yourself. If you have difficulty sleeping because of past trauma, because you have difficulty relaxing enough, feeling safe enough to go to sleep, then that's something else that you need to address. And you may need to do it with the help of a counselor in order to process any of those traumatic memories, in order to get to a place where you can hopefully focus on feeling safe, getting a, creating a situation which is safe. One of the things, and I know I've kind of gone off on a tangent here, I used to run a treatment program for veterans. And a lot of the veterans in my program had ptsd, had night terrors. Some of them had emotional support animals that stayed with them and that helped them relax. Some because they knew that the dog was on alert so they could drift off and feel more comfortable going to sleep. They addressed their cognitions, their, their thoughts that would tell them, you know, you're not safe here. You know, they had a checklist of things that they would go through to re reassure themselves they were safe. Some needed to keep a night light on, but night lights are really bad for promoting good quality deep sleep. However they did, we did have the, the tap lights. I don't even know if they make them anymore. And by each one of their beds so when they woke up, they didn't have to fumble around trying to find a little tiny switch. They could wake up and hit that tap light and all of a sudden be illumina and be reoriented into where they were. Obviously they were working with counselors, EMDR for some of them in order to address their ptsd. But my point being, identifying things that you think, at least in the short term, might help you feel a little safer can go a long way to helping you get at least some deep, restful sleep. Eating and weight changes are also common in depression. When we crave carbohydrates, especially refined carbohydrates, or high fat foods, both of those things cause a dump of serotonin, dopamine and endorphins. So if you're craving those things, it may be your body saying, we don't have enough of these neurochemicals in the, in the inventory. We need some more. And that may be your body's way of trying to get you to self medicate. Unfortunately, that doesn't solve the underlying issue of why was your inventory low to begin with. The other issue we see is weight change, and that may not be related to eating. Some people will gain weight when they're depressed, even if they're not eating that much more, because the stress, the chronic stress that contributed to the development of their depressive symptoms, also contributed to the development of hypothyroid. So that contributes to weight changes, which again is why it's so important to make sure you get assessed anything that can easily be assessed. When we are stressed, when we are depressed, when we are dysphoric, as they say, our immune system also goes down during the stress response. The, the HPA axis secretes cortisol. That's one of the things that it secretes to help you get ready to fight or flee. Well, cortisol is a steroid, and in the short term, cortisol's job is to suppress your immune system so you don't have inflammation, so you don't have as much pain, so you can fight or flee more effectively. When there's persistent cortisol, it can persistently keep your immune system suppressed. And most of us can think back to a time when we were stressed out and how we tended to get sick a little, a little bit easier. So if you find you're getting sick more easily or you're having flare ups of, you know, anything that causes itching, swelling, rashes, obviously get that checked out because there's a lot of things that could cause it. But depression causes physiological changes that can make autoimmune conditions worse. And that's because of the changes in the neurochemicals and the hormones in your body in response to stress. When we are stressed, when we are depressed, people have a decreased pain tolerance as well as muscle aches and headaches. Sometimes let's think about. Let's put all those three of those together and think about why. Well, serotonin is one of our main chemicals that are neurochemicals that helps with our pain tolerance. When we're depressed, typically our serotonin levels are low. Endorphins are another chemical we have in our brain. That's our natural painkiller, kind of our natural opioids. And when we're depressed, we typically don't have a whole lot of endorphins circling around because endorphins are associated with pleasure and pain relief. And when you're depressed, neither one of those is really easy to come by. When we are depressed, we often don't move around as much, partly because we feel exhausted, but partly because we just don't have the motivation. And when we're. When we don't move around a lot, we tend to get stiff. We tend to have more muscle aches. When you. When people are depressed, and I can tell you I've done it myself, and I've just been in this funk and I've been on the couch for, you know, three movies in a row. I can feel, you know, I typically don't have good posture, so that contributes to muscle aches. Not only am I not moving around, but I'm also sitting in all these weird, contorted positions that are probably not ergonomic. And that adds to muscle aches. Muscle aches cause pain. Pain prevents good sleep. Good sleep contributes to maintenance of depression. Another interesting thing that I learned, actually doing this presentation, I love learning. So I thought it was fabulous that I found something else that I could share with you guys. But people who are depressed often have changes in the way that in their vision, they have more difficulty with what they call contrast vision, seeing the difference between black and white. And the authors hypothesized one reason the world may seem gray when people are depressed is because of their impaired contrast perception. Now, for those of you out there who have crappy vision like I do, you may be able to really understand this, because when I take my glasses off, things don't look as crisp. They don't look as dark. They look like a sort of a medium gray instead of a. A sharp black color when I'm looking at text, for examp example. And that actually happens when people are depressed. It's not a permanent vision change, but when their neurotransmitters are altered and they're not exactly sure why or which neurotransmitters, but they have shown repeatedly, and there was this study that was published in the Health Harvard Edu, it's called the Quirky Brain How Depression May Alter Visual Perception. Anyhow, so if you find that you get more eye strain and more headaches when you're depressed, guess what? That's not, forgive the pun, all in your head. Your vision actually is changing and you are actually having more difficulty focusing. So be comforted, I guess, a little bit in the fact that, you know, once the depression starts to remit, you know, once you start finding a good treatment plan for you, that the, your vision may return to a baseline level. You know, mine's never going to return to what it was when I was 20. But it helps me understand, number one, why where my headaches might be coming from and also that, you know, I will see things more crisply when my mood improves. GI changes are the last symptom that we're going to talk about that is common during depression. And remember, a lot of these are not your normal screening symptoms from the dsm. So it's important to recognize that these may be either a symptom of depression and, or a cause of depressive symptoms. Either way, these are not things that we want, these are not characteristics that we want to live with on a day to day basis. So you want to figure out what is causing my GH GI changes or my fatigue or my low blood pressure so you can address it and live a happier, healthier life. In terms of GI changes that can include everything from nausea to diarrhea to constipation, not everybody experiences changes in their system quite the same way. Why GI changes, you may be asking. Well, our friend serotonin, again, serotonin as well as norepinephrine are made in the gut for one, but they are also directly re involved in the motility and how quickly stuff goes through our gut. So when there are changes in the balance of some of those neurotransmitters that we normally associate with mood. Excuse me. When there are changes in those, we also may have changes in our GI functioning. Excuse me. The final thing I want to talk about on this slide today or on this presentation is the fact that not to frustrate you or depress you, but, but antidepressants only work for about a third of the people who have depression. Why is this? Well, partly because for a lot of people who have depressive symptoms, it may not be because their serotonin levels are out of whack. It could be because they've got hypothyroid or because they've Got low testosterone or a variety of other things, or they've got heart disease. There are a lot of things that can cause these types of symptoms. It's also important to recognize that your antidepressants, Even for the 30% who do respond well to antidepressants, each antidepressant works slightly differently on the brain system. Some are affect serotonin only pretty much. Some focus on norepinephrine primarily, others focus on dopamine primarily. And then there are yet others that focus on a combination. They are serotonin, norepinephrine, reuptake inhibitors. So there are a variety of different medications out there, which is why sometimes people have to try different meds before they find the one that works for them. So it is important to educate yourself about the different medications that are out there. And maybe if you have a family member who was on an antidepressant and it worked for them, you know, ask them what, which one worked. When you think about antidepressants, I want you to think about this analogy. And we're going to get away from the factory for a minute. Imagine being at home and you get into the bathtub and you turn on the water and you're getting ready to take a shower and there's like barely any water pressure. Okay, well you got to ask yourself what happened to the water pressure? The water pressure for, for us is like our neurochemical levels. You know, adequate water pressure means everything's imbalance in balance and doing what it's supposed to do. Inadequate water pressure means there's a breakdown in the system somewhere. So there's probably a leak. Now it could be because the, the city decided to reduce the water pressure, which, you know, then you have to turn it up at the road. Or it could be that there's a break in the line between the road and your shower somewhere. Well, you could turn up the water pressure, which is kind of akin to taking an antidepressant. But if there is a leak somewhere, that's only going to, you know, increase your water pressure for so long because that leak is still there and it's only going to get worse. So you really want to figure out, you really want to work backwards and ask yourself what is causing or what things might be contributing to my neurotransmitters, to my hormones being out of balance. What can I do to going back to the analogy of the factory, what can I do to make sure my factory, my body factory, is running as efficiently and effectively as possible? What can I do to ensure that all the workers in my factory are happy and that my management is using a good managerial style, which that's, you know, we'll talk about cognitions tomorrow in order to keep the factory running. Well. So I know that that analogy is kind of way out there, but, you know, if you think about hopefully will start making sense as we progress through the week. And, and you point out that salty foods can contribute to weight gain. Salty foods contribute to water retention. Water water retention is going to increase how much you weigh. So being aware that that salty foods can alter your, your weight temporarily is important to be aware of. Phil points out something very, very good, that there are other things besides hormone imbalances that also need to be ruled out. And that includes things like Lyme disease. So, you know, making sure that you're going to a doctor who is a good diagnostician is so important instead of just going to a doctor who says, okay, looks like a duck, quacks like a duck, must be a duck. You know, let's look. Maybe it's a platypus. But in all seriousness, there are things that can contribute to like Lyme disease that can contribute to feelings of depression that may not be immediately obvious and Lyme disease. Unfortunately, if you look at the maps, those ticks carrying Lyme disease are really penetrating down into the main part of the United States now, whereas they used to be primarily in the Northeast. Alrighty, everybody. I think that takes care of all the questions. I really appreciate you being here today. I really appreciate the interaction. Tomorrow we will talk be talking about how our thoughts can contribute to depression and also cognitive signs of depression, including things like difficulty concentrating, poor memory and. And other issues. So I look forward to seeing you tomorrow morning. Have a wonderful day and try to find one thing today that you can look forward to and that you can really embrace with happiness and joy.