Hello everyone, welcome to the Said in Therapy Podcast. Have you ever considered going to therapy and you ended up not going? My question is why? In my humble opinion, I believe everyone can benefit from therapy. In fact, I believe everybody should go at least once in their life. My name is Iman Tohami and I'm a psychologist. This podcast tells you all about everyday cases with everyday people who have everyday problems and difficulties, and sometimes they carry around really deep wounds. These are their stories. Initially, I was planning to move on to another subject this week. However, I've gotten so many questions and so much input. Thank you so much, by the way, that I want to address a few of the question marks. I totally understand that many of you might have thoughts on depression, whether you suffer from it, have ever wondered if you suffered from it, or if you know someone who does. And it is really difficult to place or define depression if you are not a professional working in the field. And for that, I would like to approach the topic from a different angle. This episode, I won't be interviewing anyone, but tell you a bit about my practice experience in general and answer the questions that I have received. So today I'm going to talk about major depressive disorder. Number one, what is it? And number two, what are the treatment options? Because really, there are so many of them. First of all, I would like to introduce to you the DSM-5. So the DSM-5 is the Diagnostic and Statistical Manual of Mental Disorders. And the five stands for 5th edition, which was updated. Let me see, because I have it in front of me. 2013, actually. So not that long ago. Why is the DSM-5 so important? Um, professionals like me use it worldwide. It is the handbook in the United States. But healthcare professionals outside the US also use the ICD extensively, which is from the WHO and stands for International Classification of Diseases. To be honest, I use both, but to keep it simple, I will focus on the DSM today. I have it here, so let me see what it says. Major depressive disorder. If you're having trouble functioning in your daily life and you have had at least five of these symptoms for more than two weeks, which is, by the way, a very short period of time for the DSM, which tends um compared to the ICD to have shorter time frames. So the definition depressed mood and loss of interest or pleasure. Loss of pleasure is a key word here, and the scientific term for that is anhedonia, which I will cover a bit more in future episodes. So the five symptoms. Here we go. First, depressed mood most of the day. Second, diminished interest. So here we go again, the anhedonia. Third, appetite disturbance, either you're not eating enough or you're eating too much. Fourth, hypersomnia / insomnia, either you're sleeping too much or not enough. Um, and it's important to know that these things should differ from what you're used to. So if you're a normal eater and then you suddenly find yourself not eating enough or too much, this is a disturbance. If you're a normal sleeper and you get your six to eight hours of sleep, and then suddenly you find that you sleep too much, you have a hard time getting out of bed, or you don't sleep at all, this is a disturbance. Fifth, psychomotor agitation and retardation. So let me explain this a little bit. For one, if you're feeling anxious all the time to do a lot of things and you cannot sit still because there is a voice in the back of your head always telling you, you have to do something, you have to go out, you have to get this done, you have to, you have, you have, you have, you have. And again, it should be different from what you usually experience in your daily routine. This is also a disturbance. On the other side of the spectrum is you don't feel like doing anything. So basically, the most you can do is you get out of bed and go to the couch. Sixth, fatigue or loss of energy, which I believe is the most common symptom. I think many people go see a doctor first for that, which is good. It's important to rule out any physical difficulties that you might have before they actually go to a psychologist. Seventh, feeling of worthlessness and inappropriate guilt. I think that explains itself. Eighth, diminished concentration, which is the most overlooked symptom in my experience. But for instance, if you read and reread and then you figure out, oh my god, I don't know what I have just read, it's very difficult to recall it. That could be a sign. Or you watch TV and then you suddenly ask yourself, oh my god, I can't remember the last scene, and it happens all the time. Because I think it happens to all of us, but if you feel it happens too much too often, this could be a sign as well. Ninth, reoccurring thoughts of death. And I want to highlight if there is no other symptom that resonates with you, but this one does, go reach out for help, regardless. Please call a suicide hotline. I will soon add a worldwide list on my website, and I will leave it in the podcast description. No matter where you live, there is help available. You just have to make use of it. It's not all hopeless. Please, please, please believe that. It's not all hopeless. So, what to do when you have depression or when you think you have depression? There are two things that you can do. You either take medication or there are therapy options. For me, the combination of both is crucial. But I think even more important than medication is talk therapy because it helps you understand why you feel, how you feel, and what you can do to get out of it. Before you go to a psychologist, what really, really helps is if you could start a scale from one to ten and define for yourself where you stood the last week. So if you were feeling really, really low, you can say last week was a one. I want to use the second part of the episode to answer the questions I talked about before and to keep it confidential. I won't mention the handles or names of the people who submitted them. By the way, I'm thinking to add a form to my website where you can send questions anonymously. Tell me if this is something you would like. So that way we could publish a Q&A after every episode. It's just an idea. Okay, let's move on to the questions. First one I grew up in a country where everybody seems depressed all the time. And the last years I found it became even worse. Do culture and whereabouts make us depressed? I think this is a very good question, but there are nuances that you need to understand first. Many of the risk factors for depression are similar across cultures. These include gender, unemployment, traumatic experience. The themes of depression tend to revolve around loss. But what people make of their losses and how they interpret their distress differs tremendously. In the West, for instance, people increasingly believe that depression is about biomedical factors. So they tend to believe if you distance people from their distress, that this can be a functional way to help them. However, I think this can backfire. It encourages the people to ignore the circumstances that can lead to depression. I've been to a few regions in the world and I found that yes, culture plays a huge role in depression. But even more important than culture is in general the sense of family that you have. So how was your upbringing? Was it okay to talk about emotions? Was it okay to be flawed? These things I found are huge drivers into depression, especially in the Middle East, for instance. The general rule is the more insecure you feel to talk about your emotions and to address them, the more difficult it becomes to deal with them. And that can always lead to depression because you end up feeling powerless. The second question, I will not read all of it. I will give you the essence of the message. I was diagnosed with depression six weeks ago. My family pushes me to ignore it and move on. Unfortunately, I hear that very often. And it's very difficult to heal in such an environment. But please remember, frustrations are created because there is a lot of love. Loved ones can easily feel powerless and helpless. And when frustration turns into anger, it can often be directed to the patient. So you. Could be anything, really. So if you like listening to music, do that. If you like reading, do that. If you want to watch a good movie, do that. Create a happy place for you. And it doesn't need to cost money. So I hear often that when you are depressed, you should go buy something nice for yourself or eat something nice. That shouldn't be the answer all the time. You should find something that is healthy for you and doesn't break the bank or make you feel awful after you. But for example, if you like reading a book, read books. Don't stop doing the things you love. And if you can't remember what you love or you haven't found out yet, experiment. Sometimes it differs. Because we change and the things we love can change too. I want to highlight that these things don't need to cost money. I have mentioned this before. See, going for a walk doesn't cost anything, but it can be freeing. Also, when you locate negativity, fight it by doing the exact opposite of what it tells you. If you don't feel like going out and you haven't felt like going out in a while, go out. You might enjoy it. I know this is easier said than done, but when you locate negativity and you learn how to talk back to it, do the opposite to what it tells you, it is almost guaranteed that you feel better after a while. Or if you tend to tell yourself how awful you are, find one thing that you love about yourself. I am sure you will find something and focus on that. Break the thought pattern. It is no guarantee that you will always be able to avoid depression, but it is a wonderful start and it can help you fight depression. Next, is there a difference between depression and burnout? Yes. However, the difference between the two is not always easy to spot. For example, the DSM that I mentioned before, it doesn't recognize burnout as a separate disease and it falls onto depression. But the rule of thumb between psychologists is we separate burnout from depression. Burnout is generally defined as an extreme exhaustion after the body and mind have been pushed too far. Depression and burnout are very similar to each other. By the way, there will be an episode about burnout coming very soon. Next, do children get depression? Yes, children are subject to the same factors that cause depression in adults. However, when you look at the behavior of children, they are a little different to what you see when you deal with a depressed adult. Last question, no, two more questions. Can lack of sleep cause depression? No. The lack of sleep alone does not cause depression, but it plays a huge role. How can you determine if an illness is causing depression or depression is causing an illness? Illnesses that lead to depression are usually major, chronic or terminal. When an illness is causing depression, there is often long-term pain linked to it or a sudden change in your lifestyle, such as like after an accident. Here we go again. This is the end of the episode. I want to thank everybody for listening. Please let me know what you think. And also reach out on social media, follow me on Facebook, Twitter, and Instagram. The handle is always @saidintherapy. Thank you so much for tuning in. I want to thank everyone for listening. Please let me know what you think about the episode so far. But also if you have any topics you want me to cover, let me know. Please reach out on social media and leave a comment there or DM me. Follow me on Facebook, Twitter, Instagram. The Handle is always @saidintherapy.