Neuroscience of Depression | CEUs for Counseling & Social Work

Hey there, everybody, and welcome to this video on the neurobiology of depression continuing education for counselors and social workers. I'm your host, Dr. Donnelly Snipes. In this video, you're going to develop a very basic understanding of how neurotransmitters and hormones impact mood. You'll identify at least 10 causes for neurotransmitter imbalance and identify effective and ineffective strategies for healing the nervous system and rebalancing those neurotransmitters. Let's start out by saying this is not a quick fix video. And rebalancing the hormones and neurotransmitters and helping heal the nervous system takes time. This is not something that somebody's going to start doing and feel better overnight. This video is designed to help you understand how to achieve lasting relief, not a quick fix. I strongly, bold, underlined, italicized, encourage all people with mental health or addiction issues to get a physical with a full blood panel, including their vitamin D, iron, thyroid and gonadal hormones and blood sugar levels. This is important because all of these things impact the availability of neurotransmitters. And we know things like gonadal hormones go down as we age. We know that during the fall, winter and spring, many people struggle with vitamin D deficiency and seasonal affective disorder. So it's important to understand that there are a lot of biological components going into this. It's also important to screen and address sleep apnea, but we'll talk about that more later. Basically, I guess I'll get ahead of myself. People with sleep apnea, when they stop breathing, their body registers that as a threat. That's a problem, which is why they often wake up gasping. Or maybe they don't wake up, but they gasp and they catch their breath and they start breathing again. That's very stressful on the body. It's very stressful on the nervous system, which leads to neurotransmitter imbalance. A caution about nootropics. Everybody seems to want a quick fix. They want a pill for this or a pill for that. It just doesn't work that way. Most everything in the body operates on what we call the Goldilocks principle. Too little is bad and too much is bad. It's kind of like making marinara or spaghetti sauce. Everything needs to be in balance. Too much of one thing can overpower other things. And I've done this before because I'm one of those dash of this and a pinch of that kind of cooks. And if you add too much oregano, for example, you'll have to proportionally increase the other spices to get it to taste right, because the oregano is overpowering. Likewise, when you're baking, my grandmother always taught me that you want to add half as much lemon extract as you do vanilla because it helps bring out the flavor of the vanilla. So if you don't have that lemon extract in there or don't have enough, it doesn't enhance the vanilla as much. And your neurotransmitters are very much the same. They work in in tandem. And when one starts getting wonky, all of them start getting wonky. So let's go through Neuroscience 101, because for a lot of people, it's been a while since you had basic neurobiology. The neurons are the building blocks of the nervous system. Your presynaptic neuron is over here, and it's awakened by an electrical impulse. Okay? When it's awakened, it releases neurotransmitters into the space between itself and the receptor. And this is called the synaptic cleft. So it wakes up and it squirts some stuff into the synaptic cleft. And the receptors on the postsynaptic neuron are awakened. They're like, oh, hey, somebody's knocking on the door. And they produce electrical impulses that then carry the message down the line and the process repeats itself. Okay, so it's pretty simple. Electrical stimulation causes the release of neurotransmitters into the synaptic space. The receptors are awakened by the neurotransmitters kind of knocking on the door. And. And they take those in and move the message down. This continues, this knocking on the door of the receptors continues as long as the neurotransmitter stays in the synaptic cleft. So as long as the serotonin, we'll say, stays in that space between the presynaptic and postsynaptic neuron, the serotonin is going to be agitating or knocking on the door of the receptors. Enzymes are released into the cleft to assist with the breakdown and reuptake. So in a functioning system, the neurotransmitters are secreted into the synaptic cleft in the right amount, and they do their job. And the receptors are receptive, and they open the door, take the message, move it on down. And the enzymes are released, breaks down the neurotransmitter and the synaptic cleft. It's reabsorbed and ready for the next time. It works. Well, I will note that excitatory chemicals, your Glutamate, your norepinephrine, your dopamine. In some ways, these are all energy producing neurochemicals and they've been found to be released. I know this probably isn't a surprise. They're released both in response to distress as well as happiness. Anytime you need energy, if you want to get really excited or if you want to get really ticked off, it's going to cause the release of excitatory neurochemicals. So you have energy release in the body. So you can either enjoy whatever you're excited about or fight or flee. I want to go over briefly some of the functions of hormones and neurotransmitters. Now there's a lot of other functions of the neurotransmitters and hormones, and there's a lot of other hormones and neurotransmitters we're not going to talk about. My point is to help you recognize that things like dopamine and serotonin and endorphins and your gonadal hormones like testosterone and estrogen and your thyroid hormones are involved in pretty much everything. They're involved in arousal, they're involved in mood, they're involved in motivation, they're involved in helping you regulate your sleep. Remember, tryptophan is converted to serotonin, which then is converted to melatonin when it's time to go to sleep. If you don't have the ingredients for your body to complete the process, then you may not have enough serotonin to make melatonin or you may not have enough of what it the vitamins and minerals that are needed and enzymes that are needed to make serotonin into melatonin. So it's important to recognize all these things go together. These hormones and neurotransmitters are also involved in energy and insulin regulation. Yes, testosterone, estrogen, serotonin, glutamate, dopamine, all of these are impact your energy levels as well as your blood sugar and your insulin levels inflam. Inflammation and immunity are also impacted by these hormones and neurotransmitters. And when the system becomes dysregulated and there are not, there's not enough of some of these hormones and neurotransmitters or they lose their effectiveness. Then people start experiencing more pain. And we know from research that there is a really strong correlation. We can't say it's exactly one for one, but it's pretty darn close to one for one correlation between inflammation and depression. Now you can argue that people who are have inflammation and are in pain all the time, can get depressed. But there are also a lot of people who have inflammation and they're not really experiencing pain per se. The inflammation may be more systemic in nature and they just don't even really realize it because they've lived with it all their lives. Like people with autoimmune issues before they have a major flare. It is important to recognize that these hormones and neurotransmitters are also involved in immunity. And immunity and inflammation kind of go hand in hand, hand. But when you're sick, it's certainly much harder to have energy and feel good and eat well and all that stuff. And pain tolerance is impacted by the levels of your hormones and neurotransmitters. This is why we see when people come off opioids, for example, in the early weeks, sometimes months, they have a much lower pain tolerance because their body hasn't gotten the message that, hey, you need to start producing your own again. So let's talk about depression and neurotransmitters. Serotonin is the one we hear about most of the time. But serotonin is not your only anti. Anti depressant, mood related chemical. You can have inadequate serotonin system action because of many things. Okay? And I want you to recognize it's not just because you don't have enough. You may have enough, but there's problems down the line. So you can have serotonin system dysfunction where there's problems in the activation of the presynaptic neuron. It gets the electrical impulse and it goes, nah, don't feel like responding. All right, that's a problem. And SSRIs aren't really going to help with that. There could be a problem in the reuptake where it's the serotonin is broken down too soon or not enough is secreted into the synaptic space. So then not enough receptors get activated. There could be problems with the receptors on the, the, the postsynaptic neuron where the receptors aren't active. They've become tolerant or resistant to activation. So the message it doesn't get pushed through. You can have dysfunction in other systems even if your serotonin system is working. Peachy, eat and keen. If you have dysfunction, for example, in your dopamine system, and we see this a lot in people with addictions and early recovery from addiction, when dopamine levels are inadequate, then a lot of times you see depression and low levels of serotonin as well as other hormones and neurotransmitters. Remember, I said earlier, when you reduce one, it impacts the availability or amount of all the rest of them. It works in a system, and it's this finely tuned symphony, if you will. You also may have dysfunction in the HPA axis, your stress response system. When you're too stressed for too long, the brain adapts, and we'll talk about that in a minute. You could have dysfunction in your HPT system. That's your hypothalamic, pituitary, thyroid system. And we know that chronic stress is a strong risk factor for development of hypothyroid because the receptors become less receptive to the thyroid chemicals when they're released because the brain has adapted to protect itself. Or you could have dysfunction in the hypothalamic pituitary gonadal system, where your estrogen levels or your testosterone levels or progesterone levels are inadequate or excessive. But generally, when we're talking about depression, we're talking about inadequate. There could be inadequate supply of the serotonin. Your body may be working fine. The system, the serotonin system and the dopamine system, they may be working great, but you don't have any serotonin or enough serotonin to release into the synaptic cleft. Now, how does this happen? This happens when you're eating crap. And to be brutally honest, what you eat, it forms the building blocks that your body needs in order to build serotonin and norepinephrine. And you know, all of the hormones and neurotransmitters in your body. So if nutrition is lacking, then you may not actually be making enough. You need things like iron and folate and calcium in order to break down tryptophan to make serotonin. If you don't have those in your diet, guess what? Your body's not going to be very effective at making serotonin. This is why I said at the beginning, a blood test is super important because it can help identify some of those nutritional factors and other hormonal factors that might be impacting the availability of your neurotransmitters. And I don't want to say just serotonin, because serotonin, dopamine, and norepinephrine are all intimately involved in your mood tolerance. Can also happen, and this is rare with serotonin, where the serotonin receptors are bombarded too often and they just quit responding. That doesn't happen often. Could it happen? Sure. We do see that a lot more when we start talking about norepinephrine, dopamine, or cortisol. Systems, dysfunction in the system, the brain. For some reason, somewhere along, the activation reuptake transmission process isn't working. Well, it can happen. It can happen because of brain damage. It can happen because of genetics. There's a lot of reasons it could happen. So that's possible that it may be the wiring is just not working. There could be inadequate supply, just like serotonin. All of these things are made from things that you eat. And yes, your body can produce some of them, but eventually you've got to restock the warehouse and then frequent exposure leading to tolerance and norepinephrine, dopamine and cortisol. These are all involved in the stress process. And when somebody is chronically stressed, the brain responds by developing tolerance, or sometimes it's called resistance. The postsynaptic neuron quits responding. It starts saying, you know what? No. So let's take a look at that. Our senses receive input that are assessed by the amygdala, your fear areas, what we usually think of it as, and the hypothalamus. So your senses get in information based on sights, smells, sounds, you know, all that. And it interprets the information based on prior experiences, based on your schema. It's not saying in this context at this time what's going on. It's saying based on prior experience. This is what I can expect. So, for example, I had, oh, gosh, I can think of it, well, we'll go with Brussels sprouts, because I can't think of what I'm wanting. Artichokes. I remember having artichokes when I was very young, and I found them quite distasteful. And I'm sorry for those of you who love them, maybe it wasn't cooked right or whatever, but I found them most distasteful. And so now when I smell artichokes cooking, my brain goes, oh, I know what that smell is. You don't want to go there. And I. My response is one of distaste. The brain is not saying, well, I wonder if this one was cooked differently or what the facts are in this context, or maybe you'll like them now that you're grown up. The brain's not saying that. All it's saying is sensory input. Let me reach into my memory banks. This is what I expect to happen. The hypothalamus decides whether to ignore or respond to the stimulus. So it checks those memory banks and it goes, yeah, this is worth responding to, or, nah, you know, not something that is. Is really worth the effort. Stressful stimuli Trigger the HPA axis. That's your stress response system. Now, your HPA axis does not act all alone. Everything's interconnected. HPA axis also calls up his buddies, the HPT and HPG axis, the thyroid and the gonadal in order, or the gonads in order to get all the hormones and neurochemicals that are necessary for the fight or flight response or for the production of energy. So when the HPA axis, the stress response system is activated, we cortisol is released, which initiates a cascade of reactions to release the excitatory neurotransmitters and help the person fight, flee, or respond. Now, it's important to recognize that cortisol is a steroid. And when cortisol, when the HPA axis is operating well, correctly, and cortisol is released, it suppresses inflammation in the system and, and suppresses recruits, other buddies, and they work to suppress pain. So guess what? You can focus on fighting or fleeing, not being in pain. Then when the threat has passed, cortisol gets reabsorbed and inflammation increases. And all of the little worker bees, or whatever you want to call them, from the immune system are released to go out your inflammatory cytokines, they're released to go out and see where there is any damage, bring blood flow to that area and fix it. It's a really fascinating system that works quite well where things go wrong in the initial message. If the person's interpretation of the stimuli is based on trauma from the past or feeling hopeless and helpless from the past, that's been their experience. Then even if they are completely safe and empowered in this context at this time, their brain expects disempowerment. And it's going to be really important to address cognitive distortions and consider reprocessing schema, acknowledging, yeah, back then you were sick, you were unsafe. That was traumatic. Recognizing that. All right, in this situation, I need to look at the facts in context. When people feel unsafe, when their HPA axis kicks off, the body says, guess what? We're going to pay attention to the vipers, not the bunny rabbits. And people tend to see, notice stimuli in the environment and interpret stimuli in the environment based on their current mood. And if they're feeling depressed, they're going to notice the depressing things, not the bunny rabbits. If they're feeling scared, they're going to notice the threatening things, not the bunny rabbits. And that leads the person to start believing that everything is miserable all the time, because that's what they're seeing. That's what they're noticing their brain says in order to stay safe, you need to be aware of all these things and it forgets the bunny rabbits. Perceptual disturbances can also cause things to go wrong in the initial message. Sometimes people see or hear things incorrectly. I remember one time I was driving down the road with my dad and we passed this thing on the, on the highway and I said my prayer for it really quick because I feel really bad for animals that get killed by cars or whatever. And we passed it and it turns out it was. Somebody had dumped a piece of rug and something else into the road. It wasn't an animal at all, it was road trash. So I got upset for a minute because I thought it was an animal, when in reality it was road trash. No harm, no foul. The initial message can also get messed up or the person can feel unsafe in the current context if it triggers prior trauma or grief situations. In veterans, for example, fireworks can be extremely triggering even though they know in this context at this time, I'm safe. Those sounds trigger those threat memories and it causes them to feel unsafe and it causes them to again start paying attention to the things that are potentially threatening. Or maybe you're in the mall and somebody sounds like your mother who recently passed away and that could trigger the depression response. Now I say where things go wrong. I should, maybe I should have said things that might trigger depression. But this is your brain responding the best way it knows how to help you stay safe. So then we need to look at these and process them in the current context based on the current facts. Insufficient amounts of the neurotransmitters or hormones to secrete can also cause things to go wrong. It can make it difficult for people to feel happy, to feel energized if they've got nutritional jet nutritional deficits. If they have a genetic predisposition, their wiring from birth was not the same as other people. As I mentioned before, age. As we age, our balance of hormones and neurotransmitters changes considerably. And for some people, that can make it harder for them to feel happy when they're primarily their gonadal hormones are getting progressively low and then substances. People who use or abuse substances may be causing the neurotransmitters to get used up too quickly. And that's again grossly over simplified. But it's important to recognize that stress on the system is going to have an effect. Another thing that can cause people to feel depressed. As I mentioned earlier, the initial electrical signal is not strong enough to trigger the secretion of neurotransmitters into the cleft. The presynaptic neuron says, nah, I don't feel like being bothered. The neurotransmitters can be broken down too quickly or reabsorbed too quickly. And this is what SSRIs do. ESS, selective serotonin reuptake inhibitors, and selective norepinephrine reuptake inhibitors work by preventing those enzymes from being released and keeping the neurotransmitters in that synaptic cleft longer. So they have a better chance of activating the postsynaptic neuron or the receptors. And the receptors could just be downright unresponsive or dead. I know. Dead. Really? Yes. Chronic stress, chronic trauma. Having that HPA axis activated too much for too long actually causes neuronal death. And the brain starts shutting down or getting rid of receptors because it says, you know, we don't need this many doors open. We don't need to be bombarded this much. When receptors are consistently bombarded and overwhelmed by the neurotransmitters, the brain recognizes the imbalance and takes corrective action by reducing the responsiveness of the receptors. So let's use a metaphor here. The receptors are like homeowners. The Amazon driver comes along. It's the holidays. The Amazon driver knocks on the door. Person opens it, responds appropriately, hey, great to see you. A while later, the mail carrier comes. Same thing happens, no problem. So they get two deliveries a day or less. No problem. Not a big deal. However, when people engage in addictive behavior or are regularly stressed that HPA acts as is going off, the brain responds to protect the receptors from being overloaded. So the homeowners, if you will, the receptors need to be protected. So now it's holiday season. Instead of one or two deliveries a day, the homeowner's getting 10 or 15. It's a big family, and it's exhausting. Every time they start to do something, somebody else is knocking at the door. The brain responds to protect the receptors from overload. So the homeowners, what do they do? The exhausted homeowner decides that they're not going to answer the door unless it's an emergency or a signature is required. And generally, if a signature is required, the person knocking on the door is going to knock louder, more urgently. They're not just going to knock once and leave. Many drivers won't stick around and continue knocking, especially if they don't need a signature. So the homeowner doesn't get all of their packages they were going to send to Relatives, they don't get all the packages to pass down the line. So what happens? You have very sad relatives. After the holiday's over, the homeowner is still exhausted and unmotivated to answer the door. And this is what happens in early recovery for people. The brain needs time to restore and repair because it's plum exhausted from what happened prior to beginning recovery. It needs time. Eventually, the homeowner has recovered and starts answering the door again. But it takes a while. Even if they're only getting one or two deliveries a day, they initially, they're exhausted and they're just like, you know what? Leave it on the. Leave it on the front stoop. I ain't got it in me. Eventually they start getting back to that old routine. And our nervous system, through neurogenesis, will repair and rebuild itself to a large extent. But it takes time. So let's talk about how this all applies to withdrawal and depression. Once the receptors become less responsive, it means that all the necessary packages aren't getting through. So that's going to cause a problem downline. When that happens, we may start having cravings for junk food or addictive behaviors as the body tries to compensate. Your dopamine, your serotonin, your norepinephrine are low. What causes that to be released into in the synaptic space? Well, junk food does. So a lot of people will look at. Look toward junk food or alcohol or sex or gambling or some other addictive behavior in order to try to override the system and increase the flood of those neurochemicals coming in so they can feel something. When not enough packages of serotonin, dopamine, thyroid hormones, and all their buddies are available to activate the nervous system, the person starts to feel apathetic, depressed, and can become disregulated. So they feel flat until there's suddenly a surge of those neurochemicals, at which time they become frantic or furious. So we go from flat to furious. In many cases of depression, the person was first stressed either physically or psychologically. And I think it's important that we recognize this. When somebody is physically stressed for a long period of time, they are over exercising, they're not getting enough sleep, they are abusing substances. They are. They have a chronic health condition that causes them pain, which triggers the stress response. Any of those things left unchecked can cause the brain to start adjusting and becoming less responsive to the cortisol. This continuous or excessive exposure of the receptors to cortisol, glutamate, dopamine, all those stress hormones cause the brain to adapt and become resistant to activation by the cortisol to prevent that neuronal death due to what we call excitotoxicity. So the brain's really trying to protect itself, but it doesn't adapt as quickly as we might like. Common causes of neurotransmitter imbalance. I know I mentioned some of these earlier, but let's look at the practical side of this. Sleep deficits. When you are sleep deprived, your brain registers that as a vulnerability, triggers the HPA axis and releases excitatory hormones. So your brain's trying to give you its own internal caffeine jolt, if you will. Sleep deficits are also problematic because it prevents the body from cleaning out, if you will, all of the debris that builds up in your brain over the course of the day. One of those things is called adenosine. When adenosine's not fully cleared out, people start to develop brain fog. Circadian misalignment can also be stressful. Circadian rhythms affect the release of cortisol, which is supposed to be highest in the morning and fall throughout the day. If your body doesn't know when to secrete cortisol, you may wake up and be like, no, no, it's not happening. And then be up half the night. So that can be a problem. People who are on shift work or people who travel across time zones may experience circadian misalignment. But circadian rhythms are involved in your hunger, your biological clock, your secretion of your gonadal hormones, and your hunger and satiation hormones. They're involved in a lot of things. If you have nutritional deficits or irritants that can cause physical stress. Now, nutritional deficits, we've already covered. Balanced nutrition is important to break down the food into the component parts to make the neurotransmitters and the hormones. Irritants are things that you're eating that cause inflammation in the body. Like, if you are sensitive to gluten, then eating gluten, that will cause stress, that will cause inflammation, and inflammation is a stress response. Pain, we all know pain is stressful. It's hard to be in pain now. Not all pain can be eliminated, but helping people develop a. An attitude of acceptance, learn tools to minimize the pain and mitigate the pain when it happens can be important. Systemic inflammation, including autoimmune disorders, cause physical stress. Inflammation is a stressor. When we see it, it's a problem. And the core feature of autoimmune disorders is inflammation. Diabetes, especially type 1, which there's strong evidence that type 1 diabetes is a, has an autoimmune component. But there's increasing information that type 2 diabetes may also have an autoimmune component. But inflammation is stressful. Diabetes is stressful on the body. When your blood sugar is all over the place, it causes stress. So if a person has diabetes, they need to be really monitoring their A1C level. Research indicates that about 25% of Americans right now are pre diabetic and don't even realize it. Therefore, it's important to talk about diabetes, prediabetes and making sure they're getting screened by their doctor. Sensory differences can also be stressful. If you are someone who is easily overwhelmed by sights, sounds, smells, that is considered stressful. Overwhelmed is stressful. Likewise, if you are somebody who is underwhelmed, who has difficulty getting enough stimulation, back to that Goldilocks principle. It is still perceived by the brain as a stressor. So it's going to release energy and say hey, you got to do something in order to get a little more stimulation going. And cardiovascular issues including sleep apnea. When the brain, when the cardiovascular system is not working effectively, the brain's not getting enough oxygen. When the brain doesn't get enough oxygen, guess what? It's a stressor. And all of these stressors can cause dysfunction in the HPA axis which can eventually cause mood issues. When the person's system rebalances to protect itself from the excitatory neurochemicals, they may start feeling flat, depressed, low energy, apathetic, emotional, cognitive and environmental stress stressors. I'm just putting them all together. Trauma related schema and triggers. When people are, have experienced trauma in the past and even if they've quote dealt with still occasionally may be triggered, maybe just for a minute, but it still may occasionally be triggered. So when those trauma schema are triggered, that is stressful and if it's, if they're regularly triggered, if the person's regularly feeling unsafe and powerless, then we're going to start to see that remodeling in the brain, that cortisol resistance and the person's going to start to feel depressed. Cognitive distortions already mentioned those. If somebody is perceiving the world as all bad, then they are going to feel more hopeless and helpless. If they are jumping to conclusions based on past experiences, and those conclusions are negative based on past experiences, they are going to feel more hopeless and helpless. When you go through each of the common cognitive distortions, you can see how they may contribute to feeling scared, feeling unsafe, feeling powerless, or feeling hopeless and helpless. So it's really important to address those cognitive distortions. Chronically being stressed or overwhelmed. And this is somebody who might be working two jobs or working one really stressful job. Like maybe you're a doctor or a nurse in the emergency room or something. If you are constantly feeling overwhelmed, too much to do, no time to do it, or stressed about everything, that HPA axis is going, it is going full bore. And eventually you'll start to see the remodeling. Eventually the person will get to the point where they're just too exhausted and they're like, you know what? I just, I don't have the energy to care. When we talk about the stress response, what do we talk about? Fight, flee, freeze, fawn, or forget about it. I just, I'm burned out, ain't got it in me. In order to heal the nervous system. I've said it twice already, I'll say it a third time. Blood work. Get the blood work done to make sure the person is balanced in their nutrients. I've had patients come in who have been anemic and that's contributed to their mood issues. They address the anemia. It didn't do everything because a lot of stuff had gone on while they were depressed, but it certainly helped them have more energy to tackle what we needed to tackle in treatment. And getting those gonadal and thyroid hormones checked is also important. Not everybody is going to want to be on hormone replacement therapy, but at least then they can make a informed decision about what they want or need to do. Sleep good quality sleep, seven to nine hours. Even people who are 50, 60, 70 still need seven to nine hours of quality sleep per night. So look at sleep hygiene. If they're getting up every three hours to pee, well, how can we address that if they are snoring, how can we address that if they're getting weight awakened every two hours because their partner is snoring, how can we address that? And I've got a lot of videos on the YouTube channel that talk about sleep hygiene. Set those circadian rhythms. That means keeping a similar routine every single day. Now, there are going to be those occasional days where it's, you want to stay up two hours later to celebrate something or you want to go out and have fun, no problem. But in general, you want to get up about the same time and go to bed about the same time. Your circadian rhythms are actually set. Yes. By the sunlight. So during the day, when it's daytime, exposure to bright light is helpful and lightbox therapy can be helpful for some people. But it's also important to know that circadian rhythms are regulated by temperature as well as social activity. So just like we do with kids when we're, when they're, when they're young, they come home from school, they play, they eat dinner, they take a bath, we read a story, they go to bed, the body starts picking up on those cues. And by the time they get to bath time, the body is secreting melatonin. So when it's time to actually go to sleep, they're ready. Nutrition improvement not going hog wild People who are depressed are often not real excited about having to suddenly switch to eating rabbit food, for example. That's not what we're talking about. We're talking about making minor improvements in, in the diet. As counselors and social workers, we are not dietitians or registered nutritionists. So it is vital that we stay in our own lane. We can educate people about nutrition, but a registered dietitian is the only one who can prescribe dietary changes for health or mood issues, help them understand about inflammatory foods like simple sugars and ideally start reducing them. They may or may not. They have the information, they can make choices and help them learn how to pay attention, be more mindful and regulate their blood sugar. Relaxation is also important. That's physical relaxation triggering that vagus nerve. So GABA's released, so serotonin's released, so the person can actually physiologically relax. Strengthening vagal tone is another thing. Our vagus nerve is our, think about it if you will, as the relaxation nerve. And it helps regulate the stress and relaxation traffic in our brains. And a lot of people who are depressed, their vagus nerve has just gotten out of whack as well. The stress hormones keep coming, they have difficulty shutting them down. Eventually the whole system goes kaput. Vagal tone is your body's ability to respond to stressors and down regulate the ability to reduce the emotional response in a situation. And that can be done with distress tolerance skills, guided imagery, breathing. Some people when they do yoga for example, and they're in a stretch, breathing through the stretch. The stretch causes a little bit of discomfort that triggers the stress response. And by consciously breathing through it, it's triggering the vagus nerve to say hey, we're safe. We can actually let that muscle relax. Address addictive and unhelpful behaviors including gambling, drinking and doom scrolling. All of these things trigger the, the stress response, trigger the HPA axis which is going to further cause the nervous system to be out of balance. Interpersonally setting boundaries, helping people learn how to set and maintain boundaries is really important. When people are depressed, they often feel hopeless and helpless. When people are depressed, they may be less likely to prevent people from walking all over their boundaries and telling them how they should feel or should think. Likewise, sometimes people who are depressed invade other people's boundaries and expect other people to do things for them they can do for themselves. But learning how to identify and set healthy boundaries will help them feel safer and more empowered. Developing effective communication skills, being able to listen without defensiveness, being able to be mindful of what they need and, and communicate it to themselves as well as to another person instead of expecting mind reading, being able to handle conflict, all of those things can be very, very stressful if you're not able to communicate effectively. Relationship skills and this, there's kind of one of those garbage categories. But helping people learn how to create secure attachment with themselves as well as others and feel secure where they're not constant terrified of abandonment or splitting all or nothing and improving self esteem. All of these things can help a person feel safer, more loved, more empowered. Emotional and cognitive interventions develop mindfulness of their status, their needs, their triggers, and their vulnerabilities for planning and action. Yeah, that's a lot of stuff. Mindfulness is so important. Having people start the day by asking themselves, how am I doing? What do I need today? And how can I address it? What triggers do I have right now or might be coming up that I know? If I know that I'm going to be triggered, you know, I have to be in a meeting with somebody that just gets on my very last nerve, okay, it's gonna happen. How can I deal with it? So it helps people plan so they feel more empowered. And being aware of vulnerabilities. If I'm feeling tired, if I'm feeling sick, if I'm stressed out over something else. Knowing that, knowing that I am not on my A game is important because then I can plan for how to approach the day in ways that will prevent any unnecessary stress. Help the person understand what's happening in their nervous system and all of the interconnections. It's not just something they can will themselves out of. There are physiological things going on now. Those physiological things can be rebalanced and readjusted and healed and all that kind of stuff. They do have the power to do that in most cases. And it can be very liberating for people to finally understand. Oh my gosh, that makes so much sense. Why I developed depression three years after I developed an autoimmune Disorder. Okay, well, let's look at the connection and help you see. Now we can't get rid of the autoimmune issue. However, we can help you see the connection. We can help you feel safer, more empowered and figure out ways to reduce the systemic inflammation, reduce the flares so you're putting less stress on the HP axes and your body is more able to maintain the neurotransmitter balance and identify and explore those stressful schema and restructure them when possible. It's not for me to tell anybody what to think or believe about a situation. My job is to encourage people to look at the facts in context and then make a decision for themselves based on that knowledge. Is there a threat or is there not a threat in the situation? Doesn't mean invalidating the past. The past sucked. And similar situations in the past may have been threatening or painful. No doubt. Okay, I'm not invalidating that, but I'm encouraging people to explore those schema in the present and recognize what they do and don't have control over. Help people define their rich and meaningful life. It's a whole lot easier to answer the question, am I using my energy to move toward my goals or away from my goals? Once they know their goals, address those cognitive distortions to increase feelings of safety and empowerment. Teach them distress tolerance skills. Radical acceptance and unhooking. We all are aware of distress tolerance skills. Thoughts that are stress tolerant. Activities like breathing that can or blowing bubbles that can help stimulate that vagus nerve. Guided imagery to help people feel safer and more empowered. There's a lot of distress tolerance and grounding skills out there, helping people find what works for them. Radical acceptance is saying it is what it is. I accept that this is what it is right now. What am I going to do about it now? You know, it's instead of struggling with it and saying it shouldn't be this way or it should be this way, it isn't. It is what it is. So radically accepting the present moment without judgment, radically accepting your reactions to the present moment without judgment and then saying, all right, what can I do? And then unhooking is helping the person learn to identify their reactions and say, I'm having the thought that or I'm having the feeling that this is scary. Let me figure out what to do with that thought or feeling. You're unhooking from it. I am not my feelings. I am not my thoughts. Those are things that I have. Now that I have it, do I want to put it back on A shelf. Do I want to throw it in the garbage? Do I want to remodel it? Or do I, do I want to keep it just as is? But that's what unhooking allows people to do, is start to see there are things that they have control over. Goal setting. And I didn't mistype this. Smart goals. Instead of specific, measurable, achievable, relative, relevant, and time limited, I add small. And I know that could go along with those things. But a lot of people set goals that are too big. And when people are depressed, they usually have very little motivation and very little energy, which both can be partially due to low levels of dopamine. With achievement of small goals, with small successes, the person is going to start feeling more empowered and it's going to increase naturally increase the levels of dopamine and endorphins and those other happy chemicals in their brain and body. Sometimes, depending on the person, I'll encourage charting and progress monitoring. So they rank, using a Likert Scale 1 to 4, they rank their mood or they rank their sleep each day and they're looking for gradual improvements if they see a long period of backsliding, not just one day. If they see a long period of backsliding, they look at it and try to figure out what's going on. A lot of times, you know, people may not sleep well every single night, and if they get too caught up every time they have a little bit of a half a step back, that'll cause additional stress. So I really encourage them to look at it from a big picture standpoint. Environmentally, add calming, empowering triggers to the environment. Sights, sounds, smells. So pictures, things in your environment, people in your environment. You see them, you feel calmer, you hear them, you feel calmer. So what can you add in your environment that helps you feel safer, calmer and more empowered? Eliminate unnecessary stressful triggers to again promote that comfort and safety. If one of the stress triggers is your dog that barks every time a leaf blows and it just sends you through the stratosphere, considering getting one of the collars that can help train him not to bark so much. Or even simpler, pull the blinds down so he can't see out and bark at the leaves, develop a plan to cope with inevitable triggers and stressors. It's going to happen. Strategies can include asking themselves, is this person or situation deserving of my energy? And what response in this situation helps me use my energy to move toward my rich and meaningful life? How empowering is that to be able to say, okay, I've got this energy. What response is the best way to use my energy to continue moving toward that life that I want? A little caution about CBD oil and CBD gummies and everything else. CBD has been touted to have a lot of amazing anti inflammatory pain management and even mood improving properties. Not arguing with that. However, CBD is broken down by enzymes in the cytochrome P450 pathway like most other medications. From antidepressants to anticoagulants to blood pressure medications. Even your non steroidal anti inflammatories are all broken down by enzymes in the cytochrome P450 pathway. Therefore, if you're taking CBD, it's using up some of those enzymes and there may not be enough enzymes left to break down medications or other things you're taking as efficiently. Depending on the pathway, it can alter the availability of the medication significantly. Either up or down doesn't mean not to take cbd, but it does mean if you are taking any medication. It's important to consult with your doctor about potential dose adjustments if you are determined to take cbd. Feelings or Reactions Caused by a Neurochemical Process the chemicals involved in the stress response are also involved in happiness and energy regulation. So if you've been too stressed for too long, you may have difficulty feeling happy or energetic. And guess what? You're starting to feel hopeless and helpless if that stress keeps going on. Makes sense how stress generally precedes depression. Excess anger, anxiety or stress can cause a variety of changes in the nervous system that impact hormone and neurotransmitter balances and consequently mood. A huge part of recovery is eliminating unnecessary physical, emotional and mental stress, developing tools to deal with inevitable stress, and helping the person establish a sense of safety, empowerment and hope.