Expert Tips for Treating Different Types of Depression | Counselor CE

You. I'd like to welcome everybody to today's presentation on the many forms of depression and 25 tips for recovery. Yeah, we're going to get through all of that in an hour. Today we'll identify multiple types of. Whoops, sorry, depression, and why holistic preventative approaches are important. We'll explore the effects of depression and identify strategies for addressing it. Now you see where my Freudian slip came in. I want you to first think about the flu. And you're asking yourself, what does the flu have with depression have to do with depression? Well, I'll get to that, but think about the flu. Fever or feeling feverish, Cough, chest discomfort, sore throat, runny nose, sinus congestion, muscle body aches, headaches, exhaustion, vomiting and diarrhea. Okay? Do you wait until you have all those symptoms before you go to the doctor? Probably not. Do you wait until you have all those symptoms before you start trying to do something to address them? Again, probably not. If you go to the doctor early to address the symptoms, if you even think that you might be getting the flu and you go to the doctor early, you can get medications like Tamiflu that will greatly reduce the intensity and hopefully the duration of the flu for you. My point, early intervention is vital. We are so much more aware and attuned and responsive to when we start having physical health issues that, you know, we're able to mitigate a lot of those a lot easier. But. But we don't do the same for behavioral health, and that really is frustrating. There are. There's a lot of discussion out there about different types of depression. And, you know, ultimately depression is an imbalance in neurotransmitters. It can be not enough dopamine, not enough serotonin, too much serotonin, not enough norepinephrine. There's. There's a lot of different neurotransmitters that are implicated in energy and appetite and mood. So we can't say for certain that it's necessarily serotonin. But we do know that there are a lot of different things that cause it. And, you know, if you're going into the dsm, you know, you're probably going to go straight for depression. But there are different types. You have major depressive disorder, which is what we, you know, all think of as our standard clinical depression. Sometimes it can include psychotic features. And I've seen a lot of videos online lately referring to psychotic depression. And it's really important to recognize that major depressive disorder can have psychotic features. But what we're focusing on is depression. And those psychotic features can mean, you know, hallucinations, delusions, a little bit of loss of touch with reality, but those are pretty rare. Persistent depressive disorder, what we used to call dysthymia or what some people call high functioning depression. A lot of people have PDD and don't even recognize it. They've felt this way for so long, it's not abnormal for them. They, they, it's, they think that's just the way it is. And it's important to help people recognize if they're experiencing, experiencing persistent depressive disorder that there are options to start feeling better and there are reasons probably that they're feeling that way. So let's start looking at those reasons and seeing if we can help their body factory function more effectively and efficiently and rebalance those neurotransmitters. Postpartum depression and premenstrual dysphoric disorder are also both depression related conditions. And you know, postpartum depression not only affects women, but it also affects men. I know every time it comes up I say that, but it's so important to recognize that postpartum depression can affect both caregivers. And interestingly enough, in that they've done studies and they found that in males in the, during the postpartum period, there actually is a alteration of testosterone levels. So just like females have alterations of, you know, estrogen and progesterone and oxytocin, males also have alterations in their levels of gonadal hormones during the postpartum period, which is really interesting. One of the things, and I know I'm going off on a total tangent, but one of the things that they speculate is that the levels of testosterone are altered because the male, if you want to think back to more primitive times, the male is not time to reproduce again. It's time to protect the young that is currently there, the helpless, you know, infant. So I thought that was kind of interesting from a evolutionary perspective. Premenstrual dysphoric disorder can impact people, you know, as their hormones fluctuate. This is more something that impacts mainly women because it has to do with alterations of estrogen. But we need to remember that when estrogen, testosterone, progesterone, when those levels change, it affects the availability of dopamine and serotonin and norepinephrine, which, which can contribute to depression. It's not just a hormone thing. It actually does alter the levels of neurotransmitters in our brain. And it's important to recognize that fact and normalize that fact for People so they understand that, okay, there is a physiological component to what's going on. Oops, there's depression in early recovery from addiction. When people are recovering from addiction, if they're recovering from stimulants, generally the withdrawal symptoms are the opposite. So they're going to feel depressed because they have been inundating their body with stimulants, with adrenaline type substances. So their body is responded by pumping up the calming type substances to try to balance that out a little bit. Because remember, our brain is kind of stupid when it comes down to it. It just, it responds by trying to keep the system in balance for survival. It doesn't have a whole lot of, you know, independent higher order thinking. So it's important to recognize that depression can be caused by withdrawal symptoms. But depression and early recovery can also be caused when somebody sobers up and looks around at all of the destruction that has happened in their life as a result of their addiction, and they feel very hopeless and helpless and grief stricken. Depression in early recovery can also happen because the person had underlying depression that they may have been self medicating with addiction. When they're not using anymore, those depressive symptoms really flare. So there are a lot of different reasons why we might see depression and early recovery. Bipolar depression is a little bit different than major depressive disorder. But what we really want to focus on is the fact that unlike, you know, most people think people cycle from manic to depressive and manic to depressive, and they alternate back and forth. And after a manic is always a depressive episode, that's not the way it is. It's important to help people recognize that in the course of their condition, they may have multiple manic episodes or hypomanic episodes. They also may have multiple depressive episodes or persistent depressive disorder. Keep wanting to call it dysthymia, but that's not what it is anymore in a row. So it, it doesn't necessarily alternate. Sometimes they'll only have one manic episode and the rest of them are depressive episodes. With bipolar, you can also have mixed episodes though, and it's important to recognize what a mixed episode episode looks like. You have a lot of the impulsivity and the drivenness and the, you know, not being able to settle down, the agitation. But you also have the low mood and the eating changes. So mixed symptoms can be very confusing for people. Seasonal affective disorder is another form of depression. When people's circadian rhythms get out of whack when they are vitamin D deficient, those are the two main reasons for seasonal affective disorder, people can start feeling very depressed, very irritable, agitated. So it's important to recognize that something as simple as light levels can actually trigger depression. Grief. And I put this in here because depression is a part of grief. Remember, we go through denial, anger, bargaining, depression, and acceptance. If somebody is grieving, they are going to go through a depressive period. Most people, you know, know that and take it for granted. It's important to recognize in the DSM 5, people can be experiencing bereavement and major depressive disorder at the same time. You can code them concurrently if they're both present situational depression, not including grief. So we have things that we grieve, but then there are other things that may just trigger feelings of hopelessness and helplessness. And, you know, sometimes you can trace it back to sort of esoteric grief, but sometimes things just happen and people feel frustrated and overwhelmed, and it can contribute to a sense of apathy and depression. And then depression due to a general medical condition, autoimmune issues. As inflammation, systemic inflammation goes up, depression symptoms tend to go up. And there is an extraordinarily strong correlation with that. So we do see a lot of depressive symptoms or mild depressive to major depressive symptoms in people with autoimmune issues. Depression makes the autoimmune issues worse, and the autoimmune issues make the depression worse. So we've got to figure out where we're going to break this cycle. Stroke and heart disease can both contribute to depression. And you're thinking, well, if I had a stroke, I'd be depressed too. Well, that's possible. And sometimes the, the depression can be due to getting the diagnosis and grieving the loss of a perfectly healthy body. But other times, the depression due to cardiovascular incidents like stroke or heart disease can be due to a reduction in oxygenation in the brain. You know, the heart's not pumping oxygenated blood as well, which is making people feel tired and apathetic and lethargic and, you know, slowing them down. In stroke, it depends on which areas of the brain are impacted. We have certain areas of our brain that are really filled with receptors that are associated with mood. And if that part of the brain is destroyed or part of that part of the brain is destroyed, it can contribute to, to depression caused by that brain injury. And in dementia, we also do see depression, especially in the early stages of dementia, when the person is cognizant that they are losing their ability to function independently. So that kind of goes along with Grief, but in dementia, because of the way it affects the brain, just like with stroke, those plaques and things can build up in areas of the brain responsible for emotion, and the person may just start feeling depressed. So we do need to recognize that there are a lot of different reasons a person can start to experience depressive symptoms. Do we want them to wait until they have a, an official diagnosis, until we're assured they've got major depression? No. As soon as they start feeling less than happy, it's time to start looking at what's going on and what those vulnerabilities are. And Carolyn points out that she's got a client with some spinal fluid issues that might be going on and what is hypothesizing whether it's related to oxygenation and brain function. I am not familiar at all with spinal fluid and, and that sort of thing. But, you know, it's always worth asking. Sometimes doctors are so set on thinking, you know, abc, they're thinking that the most common thing that they see, that they don't think outside the box. So sometimes it's worth asking the question and the doctor may say, no, you're way off base. Or they may say, oh, you know, let's. That's an interesting thing to consider. So, you know, I'm all, I always err on the side of being wrong, but at least bringing it up and, you know, learning something, if the doctor says no, that's absolutely. Can't be a, an issue. Then, you know, I may have them explain it to me or I may do research on my own. But, yeah, it's a good point. You know, I encourage you to really think about physiological causes of neurotransmitter imbalances. So what does depression do? No matter what type of depression the person has, if they're experiencing depressive symptoms, it can alter their sleep, which causes changes in circadian rhythms that further alter the balance and timing of neurotransmitter release. So we know that exhaustion and altered circadian rhythms are associated with alterations in cortisol, norepinephrine, as well as hunger and satiation, hormones and neurotransmitters. Sleep is so important. People, when they are clinically depressed, often have trouble either getting to sleep or staying asleep. So one of the targets for almost every person that I work with that is recovering from depression, that is dealing with depression, is to really look at their sleep. Because I want them to be able to not dread going to bed thinking they're going to toss and turn for six hours. I want them to Be able to start getting to sleep and sleeping for at least a solid six hours, you know, preferably eight. But I will, you know, take small chunks. We find that people are at much greater risk of things like suicidality if they wake up in the middle of the night and they can't get back to sleep and they're sort of alone with their thoughts. So sleep is really important. Altered appetite. Sometimes when people get depressed, they don't want to eat. Sometimes they want to eat comfort foods which are really low in nutrition. Either way, they may end up with poor nutrition. They may not be getting all of the amino acids, the proteins they need to make the neurotransmitters that will help them feel better. It can increase in consumption of stimulants to cope with food. Fatigue and lethargy and difficulty concentrating. We know that when we consume caffeine, it jumps into those receptors that the adenosine usually takes up if we don't. Let me back up. For, for those of you who haven't heard my diatribe on adenosine, when you don't get enough sleep, your body can't clear out something called adenosine. Adenosine is what makes us feel sleepy and keeps us from concentrating. It's the byproduct of thinking, if you want to think about it that way. The byproduct of energy use in our brain. When we sleep, our body clears out that adenosine. If we don't sleep well, if we don't get that deep sleep, our body doesn't clear out the adenosine. So it's hard for us to concentrate, which is why people self medicate with caffeine, because caffeine kind of kicks the adenosine out of place and takes over those receptors. Not a healthy way to respond to it. Ideally, sleep is what we want. And depression can also just cause fatigue and lethargy. If dopamine levels are low, if serotonin levels are low, norepinephrine levels are low. People may feel just blah. They may feel like they're carrying a 50 pound rucksack on their back and even getting out of the bed. And you know, it almost, it hurts. They, they feel so exhausted, which interferes with their ability to work and it interferes with their activities of daily living. So we want to drive this home to people that depression is not just a cognitive thing, it's not just an emotional thing. And it's really important to pay attention to our physical health in order to help ourselves start to feel better mentally. Depression can Impact Affect. Well, go figure. If you're depressed, it's, you're not going to feel happy. As often it can increase feelings of guilt and worthlessness. Compounding the depression. If somebody has, you know, no energy to get up and do things, if they're having a hard time taking care of their infant, if they're having a hard time even wanting to bond with their infant, that can cause all kinds of compounding complex, negative, unpleasant thoughts and feelings and it can cause a lack of interest in things that you used to enjoy. So those things you used to do that would cause a squirt of happy neurochemicals, so to speak, you're just not even interested in trying to do them anymore. So you're not getting that infusion of happy chemicals. We've talked before about how I I use the metaphor that our neurotransmitters are often like running a bath. Our stress neurotransmitters and our energy neurotransmitters are the hot water and our depression and our calming neurotransmitters are the cold water. Well, if you're running too hot, if you've got too much anxiety going on, too much irritation going on, then you know, sometimes you need to add in a little bit of happy to balance it out. Cognition when we're depressed, we have difficulty concentrating. We may have an altered self esteem due to internal and external criticism. When people are depressed, they often tell themselves, oh my gosh, I am so worthless or you know, I should be able to get over this and, and they beat themselves up for how they feel in the moment. And if they don't have a supportive environment, then other people may also who don't understand may also inadvertently be overly critical, which makes them feel even worse. When we are depressed or angry or anxious, when we're in a negative affective state, we notice the negative stimuli and thoughts in our environment more and our brain adds more weight to those than the positive stimuli and thoughts. They they estimate that it's about a five to one ratio. So when you are depressed, you're noticing five times more basically negative stuff than you are going to notice to the positive. And obviously they can. People can have self harm or suicidal thoughts during a major depressive episode or during a significant depression episode because it's just overwhelming to not feel happy in the environment. People who are depressed often stay inside, often in the dark or in bed, which is no good for circadian rhythms or oxygenation. And a lot of times it can get disorganized. Now not everybody Is super neat. But it's interesting to note, you know, kind of look at your environment, your environment, your outside often reflects your inside. And if I look at my desk right now, I can tell you that it's a pretty good reflection. It's disorganized, and I have felt kind of disorganized this week. So it's important to recognize that our, our environment can have an impact on how we feel. And finally, depression, we know, impacts relationships. It can contribute to misunderstandings. It can contribute to difficulty with empathy from significant others. It can contribute to attachment difficulties. And remember, attachment is not just that primary attachment. In the early childhood phases, we go through and we have attachment with our adult relationships. In attachment, I use the acronym craves. When people are depressed, they have difficulty being consistent in their relationships because they're withdrawing from other people. They have difficulty, they don't know when they're going to have the energy to deal with other people. So they a lot of times withdraw and don't reach out and aren't consistent in responding or being physically or emotionally available in their relationships. When they're depressed, they have difficulty being responsive Even if they're interacting with people. Sometimes they are just so overwhelmed, it's hard to care. It's hard to be emotionally available to other people because they are so weighted down with their own stuff. It's hard to pay attention and give attention to. To relationships when you're depressed, when you're having difficulty thinking about even getting out of bed or taking a shower, the idea of spending energy attending to relationships and nurturing them, well, that goes out the window. It's difficult to validate other people's feelings when you're depressed a lot of times because it's hard to feel anything but what you're feeling. And sometimes it's hard for them to validate your feelings because they just have difficulty understanding why you can't quote, shake it off. People who are depressed often have difficulty with empathy because they're overwhelmed. They're having difficulty dealing with their own stuff. So trying to understand someone else's perspective and really difficult. So it may come out more as irritability. If a child, for example, is being whiny and being needy, you know, children do that. But instead of empathizing with the child, sometimes a person who's depressed may respond with irritability because they just can't take that much input right now. And people who are depressed have difficulty providing support for others again because they're barely making it on their own and may have difficulty getting Support from others because they are not the most pleasant person to be around at that moment. And it's important to recognize that, you know, when we're overwhelmed, we go into protective mode and our brain is trying to help protect us and conserve our energy to help us survive. So it's a matter of starting to look at what are you willing to do to start feeling better. Hydration is one of the first things. Our synapses, our neurotransmitters operate in a fluid environment. If we are dehydrated, then the transmission of nerve signals starts to go way down really fast. As much as, or as little as 1%. Dehydration can start to make a difference in your ability to concentrate and your energy levels. Good nutrition is so important in order to make sure that your body has the building blocks it needs to make the neurotransmitters necessary to help you feel happy. Now, hydration and nutrition are places that most people are not totally opposed to starting. You know, they, they can probably look at what they're doing right now as far as eating and drinking and go, yeah, you know, it could use a little tune up. So this is a good early intervention that you can start off with, you know, first session after, at the assessment session, encourage them to take a look at improving their hydration and nutrition. Breathing. Yeah, I know we take that for granted, but in our culture, we tend to breathe shallowly and maybe not quite enough, which is why we yawn a lot. Encourage people to take deep breaths, Breathe in for four, hold for four, breathe out for four. Do it a couple of times through periodically throughout the day. When we increase oxygen in our body, it increases our energy levels. When we are oxygen deprived, we are sleepy. Have if you've flown recently, I know this is one of the reasons I hate flying in any plane, but especially in, you know, little Cessnas and stuff, because when you're flying in the Cessnas, you're up there where the oxygen levels are lower, you know, even at 3,5000ft. And it contributes to significant exhaustion in some people. I'm one of those people. I know that when my oxygen levels get low that it makes me really fatigued. If you've ever visited someplace like Colorado, you know, the mile High city, and I think Denver's the mile high city in Colorado, but don't quote me on that. Anyway, way up there, oxygen is much less in ratio. So people often, when they visit places like that, feel more fatigued for the first couple of days until their body adjusts. So breathing is important. Force your body to get that oxygen move. Moving not only helps, encourages you to breathe more, but it also gets your blood circulating more. So your heart is pumping that oxygenated blood throughout your body, throughout your brain, and helping energize the whole system. When I'm talking about moving, what I'm talking about is literally that walking around the house at a slow pace. I'm not talking about necessarily even going to the gym. People who are clinically depressed often can't even fathom going on a long run or even a, you know, couple mile hike or something. What I want them to do is what they can any, if they're sitting on the couch all the time, any movement is better than no movement and they can build up from there. Take the dog on the walk if they don't want to leave the house, if it's too overwhelming to take the dog on the walk. Okay, well play with the dog. Get a balloon or a ball and throw it for the dog in the house. You know, at least you're moving your arm and moving around with Fido a little bit. Hopefully they have a dog. Rebalance circadian rhythms encourage people to maintain a schedule where they're going to bed about the same time each night, getting up about the same time each day, so their body knows, you know, when it's time for the, for the cortisol to peak, which is first thing in the morning, and when it's time for the cortisol to beat its lowest levels and the melatonin to kick in, which is obviously right before bed. There's a lot you can do with sleep hygiene and I have other videos on sleep hygiene. So important to addressing some of those issues like fatigue, fatigue, apathy and difficulty concentrating. Light therapy can be really helpful, especially in the non summer months when the days are shorter. Light therapy can help rebalance those circadian rhythms. But we're talking about super bright light therapy with daylight spectrum bulbs, not your average software white, you know, overhead fluorescence or whatever, rule out or address thyroid or go nadal hormone, hormone imbalances. So that would be your estrogen, your testosterone, your progesterone, vitamin deficiencies, autoimmune and cardiovascular issues. Imbalances in any of these can cause depressive symptoms. They can keep your body from being able to make the, the neurotransmitters that it needs being able to or, or it can contribute like the autoimmune issues because of the increased inflammation, it contributes to depression and the cardiovascular issues relate back to, you know, lack, lack of oxygenation, a Lot of times. And finally, pace yourself. People who are depressed, if they're mildly depressed, can probably do a little bit more. But it's important for people not to go out full bore the first day and then be sore or exhausted, too exhausted this the second day to do it. Encourage them, if they're doing nothing right now, encourage them to do five minutes tomorrow. And if the next day they get up and they feel good, maybe do 10 minutes and keep building on that until they get up to, you know, 30 minutes twice a day would be great. But, you know, whatever they're willing to do affectively, we want to add in the happy for 10 minutes two times a day. That's not that hard to do. We have 10 minutes while we are eating our breakfast in the morning. We have 10 minutes while we are getting ready for bed at night. Figure out ways to add in the happy. Whether that's listening to comedians, listening to your favorite songs, watching the birds, whatever it is that makes people happy, they should keep a list so they don't have to think, well, what could I do to make myself happy today? I'm big on playlists. I have playlists on my Amazon account for my, for my music. I have playlists on my YouTube account for my happy things. I have some that are comedians and some that are funny animals. So whatever I feel like is already ready for me. Encourage people to develop distress tolerance skills. And today we're going to use the acronym cats and you see the little Cheshire cat looking critter there. Comparisons. Encourage them to compare how they're doing right now to how they've done in the past. Encourage them to look back because hopefully they're doing a little bit better. Or they can compare themselves to other people who may not be doing as well. And that's kind of a morbid approach to it. But sometimes it does help to get perspective. Activities. Doing activities that make you happy or just distract you so you're not thinking about how depressed and how sad you are, or doing activities that get you moving. You know, activities can do a lot of different things. The goal of distress tolerance skills is to help you get out of your head and focus on something else that is positive in the moment. Thoughts. A lot of times with depression, people have a lot of negative, hopeless, helpless thoughts. So I encourage them to evaluate their thoughts and try to also force themselves to identify positive thoughts. They're, you know, there's always the potential for some negative somewhere. But it's important to not only not just focus on the negative, but also to Focus on the positive. 20 minutes a day, think about things you know, when you're driving to work, think about all the positive things that could happen that day or on the way home from work. Think about, just dedicate yourself to only thinking about the positive things that happen that day. And then sensations. We've talked about that before. That can be smells, that can be feelings. Doing things that help distract your mind. Whether, you know, if you're feeling particularly overwhelmed, sometimes holding ice cubes or doing 20 push ups can help you. Sometimes splashing water on your face. You know, you can look at some of the suggestions that Linehan put out for dialectical behavior therapy. Cognitively encourage people to identify and address their core beliefs that are contributing to to them feeling hopeless, helpless and unsafe. Depression is about feeling hopeless and helpless. So let's identify those beliefs that are maintaining that feeling and maintaining those thoughts. Right now, use reasoning that is focused on facts and probability. If you feel hopeless and helpless and unsafe, what are the facts that this situation is actually hopeless, help and helpless and that you are unsafe. What are the facts against that belief and against that feeling? So, you know, argue both sides of the coin and what is the probability that there is nothing you can do to change this situation? I, as I said earlier, focus on the positive for 20 minutes a day. Practice mindfulness to tame the monkey mind. Think about it when you're doing something. You know, when I'm crocheting or I'm cooking or you know, sometimes even when I'm doing work, I'll be doing work and my mind will wander. A lot of times when our mind wanders, it wanders to things that are stressing us out because our brain is going. By the way, did you forget this threat out here? You know, I want to make sure you're still aware of it. So our mind tends to wander to stressful things which can contribute to our feelings of hopelessness and helplessness. By taming the monkey mind, by being able to stay focused in the present, what's going on, what you need in the moment, and what you can and cannot control in the moment. We start helping people feel more empowered. Help people identify parts of situations that are within their control and focus on those. There are lots of things that are out of your control. I was talking to a woman in the locker room this morning who wants to go hiking this weekend and she was feeling kind of bummed out because it looked like it was going to rain and you know, we can't stop the rain. However, I pointed out to her that the Spaghetti model indicates that whatever this tropical depression is or hurricane at this point maybe that's coming through, looks like it's pretty much going to go smack dab through Nashville. So if she gets out east towards one of my favorite parks, which is called Edgar Evans, she's, she'll probably miss it. So, you know, to look at the, the forecast for that part of Tennessee instead of, you know, smack dab in Nashville. And she was like, oh, yeah, that's, that's a good idea. Looking at, you know, different a park that. Different than where I usually go. When you're having a bad moment, remember to accept it non judgmentally. Explore the reason you're having a bad moment and ask yourself, all right, this is what's going on. This is how I feel. What can I do to improve the next moment? That is one of those that people can carry with them all the time. They can ask themselves, what can I do to improve the next moment? When my kids were small and they would fall and skin their knee or they would get their feelings hurt or something, you know, I'd empathize with how they felt. And then, you know, we would talk for a minute and then I would say, okay, now what? What do you want to do now? Which is basically, you know, what can you do to improve the next moment? Environmentally, make sure it's bright during the day and dark as dark can be at night. Sleep. Sleep masks are really helpful for people who live in areas with light pollution. The darker it is, the your, your brain relies on it being dark to know that it's time to go to sleep. So even having the TV on or a really bright night light in the room can be enough to keep you from getting into that re really deep, restful sleep. So super dark at night and then bright as possible during the day. Open the windows, open the blinds, have bright lights in your office, preferably not fluorescent lights, but whatever you can get to keep it bright is helpful. My husband struggles with seasonal affective disorder and he does find that having a desk lamp that has a really bright full spectrum daylight bulb in it improves his mood significantly. On the days that it's, you know, kind of gross outside or, you know, during the winter when we've got really short days. Encourage people who are depressed to get out of the bedroom. Don't sit in bed all day and watch tv or heaven forbid, do work in the bedroom, get out of the bedroom and get out of your PJs and preferably encourage people to get out of the house. I would always Challenge my clients. You know, once they were to the point where, you know, I thought that they could handle it in the morning to get up, to eat breakfast, to get dressed, you know, get a shower. So put on their outside clothes, street clothes, whatever you call them, and then either go out for a walk or go shopping or do something to get out of the house, to tell their system, to tell their brain that, hey, it's daytime, it's time to get energized. It takes a while for the body to start registering this new rhythm, but once the circadian rhythms get rebalanced, people find that it's a lot easier to sleep and it's a lot easier to be awake during the day without living on stimulants. So those are all awesome things. Essential oils. Now, I am a big proponent of essential oils because smell is one of our greatest memory triggers. But they've also found that medical grade essential oils, not your just random aroma oils, but your, your therapeutic essential oils have compounds in them that trigger receptors in your nose that actually trigger chemical changes in the brain. Who knew? So there are three main terpenes that are associated with improving depression. Linalool, geranol, and limonene. Now, linalool is present in essential oils of lavender, cinnamon and basil. And now those are really different essential oils. I mean, we all know what lavender smells like and that's a sort of a sweet, soothing sort of smell. Cinnamon is much more warming, a much hotter smell. And then basil, I personally think is somewhere in between. Geranio is present in citronella, geranium, rose oil and rose geranium. Now, rose oil, essential oil of rose is really expensive, so most people won't want to afford that, especially if they're not 100% convinced it'll work. Rose geranium is an option and it's a lot less expensive. Doesn't have quite the intensity of rose oil, but it, it smells pretty good. Rose oil and bergamot, you see those too, are bolded. They are also associated with reductions in systemic inflammation. So if you're working with a client who is, has depression and also has some autoimmune issues or some inflammation issues, then rose oil, rose geranium or bergamot may be helpful for them, you know, as one of the places to first start. Now, limonene is interesting. It's mainly present, we think of it as being present in citrus fruits we use. At our house, I try to do as much organically as possible and I use a pure D limonene cleaner. So our House smells, depending on which bottle I choose, like oranges or lemons, like all the time. It's a great degreaser, it is a great antiseptic. And, you know, you can use it to clean most things. And it also helps with mood. So a lot of your citrus fruits, think of them, they're fruity, they're often uplifting, energizing. So clean with them. Bergamot also has a citrusy smell to it if you've never smelled it before. Others that are associated with improving depression include peppermint, rosemary, pine and clary sage. I encourage people to go to a health food store where they've got essential oils and just smell a few different ones. The ones that smell good to you are probably ones that would be beneficial. The ones that you smell and you're like, oh, no. Smells like dirty socks, probably not beneficial to you. There are times, for example, when patchouli smells amazing to me, and other times I smell it and I'm like, yeah, no, not working for me today. And I really believe that that has to do with, you know, my chemical balance at that particular point. But that's purely speculation. I'm not making any recommendations based on that. If your people are interested in the essential oils, though, have them sniff it out at a Whole Foods store or somewhere where they have the essential oils before they go through and try to buy it. To use the essential oils, you don't need to apply them at all. You just need to inhale them. The benefit comes from the way they trigger the receptors in the nose. So sniffing the bottle that does it, applying them can be toxic, it can cause skin irritation. You know, there's all kinds of issues with application that you would want to make sure to consult an aromatherapy expert on. But sniffing generally not going to be a problem. You can put it in little bottles like this that you can keep in your purse. That one actually happens to be peppermint. You can add it. I add it to my mop, my dry mop when I mop around the house. So it spreads it kind of throughout the house. You can put it on the air filters. You don't need much, so it's not like it's going to clog up the air filter. Obviously, you can just sniff the bottle. There are a lot of different ways you can make essential oils available to you. Relationally, it's important for people who are dealing with depression to have a support system, and depression often pushes away the support system. So it's important for people who are depressed to be able to help their loved ones understand what's going on and how they can help and encourage. You know, not everybody responds the same way or needs the same thing when they're depressed. So it's important that you tell people that this is what would be helpful at this moment. It's important that people who are depressed. Excuse me. It's important that people who are depressed don't assume that they know how others are thinking or feeling about them. For example, if somebody is super duper depressed and they just don't have the energy to get out of bed to make dinner, you know, assuming that the family is judging them or angry with them because they didn't do that is only going to compound their depression. Likely the family, if they understand what's going on, is fine making their own supper. It's important that we encourage people to look at the assumptions they're making about their relationships that may be keeping them depressed, that may not even be valid, and encourage them to, you know, check the facts on those beliefs. Encourage people who are depressed to get support. It's helpful to talk to somebody else who's been there, whether it's postpartum depression or, you know, any of those types of depression that we talked about. If somebody's depressed, encourage them to ask themselves, what would I do for someone else who's having this problem? And that might help them think about, you know, what they need to do or what they might want to do. Encourage them. You know, when we're. When we're depressed, sometimes we tend to be irritable. We don't have the energy to have that filter on. Um, so when we're depressed, it's important to remember to think before we speak. And the Rotary Club is where I learned this. I don't know if they're the ones that came up with this acronym, but think stands for is what I'm getting ready to say. Is it true? Is it helpful? Is it inspiring? Is it necessary, and is it kind? There can be some things that you want to say that are, you know, 100% true, but they are not helpful. You know, somebody just doesn't even need to know that. But is it. If it's true and it's helpful, okay, well, maybe we need to say this, but then we need to make sure that we're saying it in a way that's kind. So true. Helpful, inspiring, necessary and kind. And in relationships, even when we're depressed, sometimes it's helpful to contribute. Sometimes it helps us to get out of our own head if we can do something for somebody else. It may not be a lot, you know, because we don't have the energy because we're so depressed. But sometimes if we just do a little bit, we can feel a little better. Depression has many causes and consequences. You know, you saw that sometimes it's caused by physical problems, brain injury, grief, hormone changes. You know, there's a lot of different things that can cause depressive symptoms. What's important is for people to start recognizing these symptoms early. Like even before they start feeling, quote, depressed. If somebody notices that they're starting to have sleep difficulties, intervening then before they get to the point of being depressed, you know, it saves a lot of other stuff that you've got to fix. If you fix it early, if you address it early. Ultimately, it's necessary to address all the issues that could be contributing to a neurochemical imbalance, including physical things like hormone imbalances, pain, malnutrition and exhaustion, affective things like not enough happiness or emotional dysregulation, cognitive issues like unhelpful thinking styles, environmental issues that contribute to the, to stress or a lack of safety. You know, if you've got too much light when you're trying to sleep, or there's noise all the time, that can be overwhelming and it can contribute to over activation of that HPA axis, your stress response system. When it's over activated for too long, eventually the person starts to feel, feel helpless. And it's kind of that learned helplessness sort of scenario. A lack of safety in the environment can also keep the HPA axis overactive, which can contribute eventually to feelings of hopelessness, helplessness and depression. And relationships that are toxic, critical or unstable can also make people feel out of control. And you know, if you're always feeling, fearing abandonment or your relationships are communicating to you that you are not good enough, then that is, you know, I mean, just think about it. If, if that's going on, you're probably going to feel hopeless and helpless and, and somewhat depressed. So it's important to figure out, you know, what's contributing to these symptoms, what can we do differently to help the person be able to regulate that HPA axis, regulate their emotions and improve their cognitive outlook and their physical health.