>> THE GOLDEN YEARS MAY NOT BE SO SHINY.
REDUCING DEPRESSION IN THE ELDERLY, TONIGHT, "ON CALL WITH THE PRAIRIE DOC."
>> GOOD EVENING, AND WELCOME TO "ON CALL WITH THE PRAIRIE DOC."
DEPRESSION CAN BE A LIFE-CONTROLLING AND DEBILITATING EXPERIENCE.
WE'RE NOT TALKING ABOUT THE PASSING FEELINGS WHERE WE ARE
UPSET OR FEEL BADLY ABOUT SOMETHING IN OUR LIFE BUT,
RATHER, THE ONGOING CONSTANT FEELING OF AN EMPTY OR WASTED
EXISTENCE, OR THE BELIEF THAT SOMETHING BAD IS GOING TO HAPPEN EVERYDAY.
THAT IS OUR TOPIC TONIGHT.
FIRST, LET'S TAKE A LOOK AT THIS WEEK'S PRAIRIE DOC QUIZ QUESTION.
ARE ELDERLY DEPRESSED PATIENTS AT A LOWER RISK FOR SUICIDE
THAN YOUNGER VICTIMS?
ARE THEY LOWER IF YOU'RE ELDERLY?
YES OR NO.
WE'LL HAVE THE ANSWER AT THE END OF TONIGHT'S PROGRAM.
JOINING US IN THE STUDIO TONIGHT IS DR. MATTHEW STANLEY,
WITH AVERA MEDICAL GROUP UNIVERSITY PSYCHIATRY ASSOCIATES, SIOUX FALLS.
THANK YOU VERY MUCH FOR JOINING US, MATT.
ONE MORE TIME.
YOU MUST HAVE THE LONGEST LIST --
>> I HAVE TOO LONG A LIST AFTER MY NAME BUT I ALWAYS APPRECIATE
BEING HERE, RICK, SO THANKS FOR INVITING ME.
>> IT'S GREAT.
SO YOU'RE THE HEAD OF THE AVERA BEHAVIORAL --
>> YES, SO WE'RE A -- WE'RE ORGANIZED INTO SERVICE LINES SO
FOR AVERA, BEHAVIORAL HEALTH IS A SERVICE LINE SO THAT WOULD BE
ACROSS THE AVERA FOOTPRINTS, THE FIVE-STATE AREA, THE
SEVERAL HUNDRED CLINICS --
>> SO IT ISN'T JUST A HOSPITAL, IT'S A WHOLE LINE HAVE THE
>> YES, ONE OF MY RESPONSIBILITIES IS TO TRY TO
IMPROVE OUR ABILITY TO IDENTIFY AND TREAT DEPRESSION THROUGHOUT
ALL OF OUR OUTLETS.
>> SO THAT'S A BIG ADMINISTRATIVE BURDEN.
DO YOU PRACTICE AMONG ALL OF THAT ADMINISTRATIVE WORK?
>> SO IT'S A GREAT QUESTION.
THE AS THE COMMENCE STRAIGHTTIVE ASPECT OF MY WORK
HAS GROWN, MY CLINICAL PRACTICE HAS SHRUNK.
SO I'M ABOUT 75% ADMINISTRATION, 25% TREATMENT,
BUT THE AREAS THAT I'M STILL HIGHLY ENGAGED IN ARE
THERAPIES, ELECTRO CONVULSIVE THERAPY WHICH PEOPLE MIGHT KNOW
AS SHOCK THERAPY AND OTHER TREATMENTS, LIKE TRANSCRANIAL MAGNETIC STIMULATION.
>> THAT'S SORT OF LIKE A CAT SCAN, RIGHT, AND YOU DO IT IN PARTS OF THE BRAIN?
>> YES.
>> ARE OTHER PLACES DOING MAGNETIC STIMULATION?
>> THERE IS A FEW.
IT'S NOT A VERY WIDESPREAD PROCEDURE RIGHT NOW.
WE'VE BEEN AT IT A LITTLE OVER FOUR YEARS AND THE TECHNOLOGY
PROBABLY LENDS ITSELF MORE CLOSELY TO AN M.R.I., WE HAVE
AN ELECTROMAGNET THAT GENERATES AN ELECTROMAGNETIC FIELD AND,
WHEN PLACED IN PROXIMITY TO THE BRAIN, WILL STIMULATE THE CORTEX.
>> I WANT TO TALK ABOUT THAT MORE AND E.C.T., THE ELECTRIC
CONVULSIVE THERAPY BUT LET'S TALK A LITTLE BIT MORE AT FIRST
ABOUT WHAT IT IS THAT CAUSES DEPRESSION.
DO WE REALLY HAVE THAT NAILED DOWN?
>> THAT'S A GREAT QUESTION AND THE ANSWER IS, I WOULD SAY YES AND NO.
LIKE MANY DISEASES THAT WE DEAL WITH IN MEDICINE, WE SEE PEOPLE
THAT, THROUGH THEIR GENETICS, ARE GOING TO BE AT HIGHER RISK,
HIGHER PROPENSITY TO DEVELOP AN ILLNESS, BUT THERE'S THE
EPIGENETICS, THERE'S WHAT HAPPENS IN THE ENVIRONMENT THAT
EITHER TURNS ON AN ILLNESS FOR SOMEONE OR DOESN'T.
THOSE ARE THE QUESTIONS THAT ARE HARDEST TO ANSWER.
>> NOW, THE EPIGENETICS IS REALLY HARD TO APPEARS.
EXPLAIN THAT TO ME.
AN ENVIRONMENTAL CHANGE OF YOUR GENETIC --
>> IT'S OPERATING ON TOP OF THE GENETICS THAT --
>> MAY TURN IT ON OR OFF.
>> TRIGGER IT.
THROUGH MY FAMILY HISTORY, I'M AT RISK FOR DEPRESSION.
KNOCK ON WOOD, I REALLY HAVEN'T SUFFERED FROM IT TO THIS POINT IN MY LIFE.
BUT LET'S SAY IN MY 20s, I'M AWAY AT COLLEGE, ONE OF MY
PARENTS DIES, I MAYBE HAVE SOME VIRAL ILLNESS, WHICH ONE OF
THOSE THINGS MIGHT HAVE TRIGGERED ME TO HAVE A FIRST
SEVERE DEPRESSIVE EPISODE, AND THEN, YOU KNOW, ONCE IT'S
TURNED ON, WE SEE THAT DEPRESSION -- YOU KNOW, ONCE
YOU'VE HAD ONE EPISODES OF MAJOR DEPRESSION, YOU HAVE
ABOUT A 50% CHANCE OF HAVING ANOTHER.
SO NOW YOUR LIFE COURSE HAS CHANGED.
THE GENETICS HASN'T CHANGED BUT SOMETHING TRIGGERED IT AND NOW
YOU'RE DEALING WITH KIND OF A DIFFERENT INTERNAL ENVIRONMENT,
A PHYSIOLOGY ENVIRONMENT.
>> THAT'S JUST AMAZING TO ME BECAUSE THEY SAY THAT'S THE
SAME THING WITH SCHIZOPHRENIA, THAT SOMETHING TRIGGERS IT AND
ONCE IT'S ON, IT'S THERE, AND THEN IF YOU LET IT BURN HOT FOR
LONG, IT MAKES IT HARDER AND SEVERER AND WORSE.
>> RIGHT.
SO WHAT'S INTERESTING IS PEOPLE DON'T TALK ABOUT BEHAVIORAL
HEALTH ISSUES LIKE WE TALK ABOUT OTHER IMMEDIATE ISSUES
BUT THAT MIRRORS WHAT WE WOULD SAY ABOUT ANY MEDICAL DISEASE
AND THAT'S IF WE GET NOTHING ELSE ACCOMPLISHED TONIGHT,
RICK, WE NEED TO MAKE IT CLEAR TO OUR AUDIENCE THAT DEPRESSION
AND SCHIZOPHRENIA AND OTHER FORMS OF BEHAVIORAL HEALTH
ISSUES ARE MEDICAL DISEASES AND WE NEED TO GET OVER OUR
STIGMA AND OUR BIASES --
>> IT'S ALL IN YOUR HEAD.
>> YEAH, AND PEOPLE NEEDS TO GET OVER THEIR SHAME AND GUILT
AND SEEK TREATMENT.
>> BUT I FEEL GUILTY ABOUT MY DIABETES.
I FEEL GUILTY ABOUT MY PANCREATIC CANCER.
SO THE QUESTION S SHOULD I?
DID I HAVE ANYTHING TO DO WITH THAT?
I MEAN, IS THERE --
>> I WOULD SAY ABSOLUTELY NOT, ABSOLUTELY NOT.
YOU KNOW THAT BETTER THAN I AND YOU'RE WORKING YOUR WAY THROUGH IT.
BUT IT IS HUMAN NATURE TO LOOK INSIDE US AND SAY, WHAT DID I DO WRONG?
HOW COULD I HAVE AVOIDED --
>> HOW CAN I BLAME.
>> IT'S THE WOULDA, SHOULDA, COULDA, AND AT THIS POINT TAKE
A SIDE BAR ON THE SCHIZOPHRENIA BECAUSE WE'RE IN THE MIDST OF
DISCUSSING LEGALIZING MARIJUANA, ACROSS THE COUNTRY,
A DECISION THAT WILL CONTINUE TO BE BROUGHT FORWARD HERE IN SOUTH DAKOTA.
SCHIZOPHRENIA AND MARIJUANA, THERE IS A CLEAR CORRELATION
THAT IF YOU'RE AT RISK GENETICALLY --
>> FOR SCHIZOPHRENIA --
>> FOR SCHIZOPHRENIA AND YOU SMOKE MARIJUANA --
>> IT MIGHT FLIP YOU INTO IT.
>> UNQUESTIONABLY, IT INCREASES YOUR RISK SEVENFOLD.
YOU'LL BE YOUNGER, HAVE A HARDER EPISODE OF SCHIZOPHRENIA
AND THERE IS A DEBATE ABOUT WHETHER OR NOT MARIJUANA CAN CAUSE SCHIZOPHRENIA.
IT IS NOT AN ENTIRELY HARMLESS DRUG, PARTICULARLY NOT ON THE DEVELOPING BRAIN.
>> THERE ARE YOUNG PEOPLE IN PARTICULAR, TERRIBLE IDEA.
>> I THINK WHAT HAPPENS -- YES, IT IS A TERRIBLE IDEA,
PARTICULARLY UNDER THE AGE OF 20.
I MEAN, 18, CERTAINLY, BUT NOW WE TALK ABOUT THE DEVELOPING
BRAIN INTO THE EARLY 20s.
THERE'S OTHER EVIDENCE, TOO, THAT IT DECREASES I.Q. AND
OTHER ISSUES ABOUT THE I THINK THE HARDEST PART FOR YOUNG
PEOPLE IS, THEY SEE US LEGALIZING IT, THEY SEE US
SAYING IT'S MEDICINAL AND IT'S OKAY, IT MIGHT BE OKAY IN FULLY
DEVELOPED ADULTS, NOT IN DEVELOPING ADOLESCENTS AND
THAT'S WHERE WE'RE SEEING SOME OF THE GREATEST INCREASE IN USE.
>> THE ONLY COUNTER I WOULD HAVE, HOWEVER, IS THAT RIGHT
NOW WE KNOW THAT WITH OPIOIDS, NARCOTICS, OPIOIDS SUDDENLY,
THIS LAST YEAR, THERE WAS 65,000 DEATHS FROM OPIOIDS,
WHICH IS ALMOST TWICE AS MUCH AS FROM AUTOMOBILE CRASHES.
I MEAN, THAT'S FROM OPIOIDS AND WE'RE PROVIDING THEM FOR PAIN
RELIEF, AND THAT, FOR AN ADULT, THERE'S STRONG DATA THAT MANY
PEOPLE CAN HAVE RELIEF OF PAIN WITH CANNABIS AND MARIJUANA.
>> SO I'M SAYING THE DEVELOPING BRAIN, I AGREE WITH YOU.
IT'S INTERESTING -- SO I AM NOT ADVOCATING THAT ADULTS COULDN'T
USE IT AND -- RESPONSIBLY.
I'M WORRIED ABOUT OUR ADOLESCENTS AND DEVELOPING
YOUTH, JUST LIKE WE WOULD SAY THE SAME ABOUT ALCOHOL.
>> RIGHT, RIGHT.
>> IT'S INTERESTING IN THE OPIOIDS, AND I KNOW WE'RE GETTING OFF OUR...
[Overlapping Conversation]
>> GREAT, LET'S GO THERE.
>> BUT IT IS THE HEROIN NOW AND IT'S OTHER DRUGS -- NOW THAT WE
ARE CLAMPING DOWN ON PRESCRIPTION OPIOIDS --
>> THEY'RE TURNING TO THE --
>> YEAH, TO THE ILLICIT DRUGS AND, YEAH, BUT TO YOUR POINT,
WE HAVE AN INCREDIBLE PROBLEM.
WHO WOULD HAVE EVER BELIEVED THAT OPIOID OVERDOSES WOULD
PASS MOTOR VEHICLE ACCIDENTS AS CAUSE OF DEATH IN THE UNITED STATES?
>> FOUR OUT OF FIVE HEROIN USERS GOT STARTED ON PAIN
RELIEF FOR THEIR BACK OR THEIR POST-SURGICAL PROCEDURES,
THAT'S JUST REMARKABLE.
WELL, LET'S TALK ABOUT CAUSES OF DEPRESSION.
I MEAN, NOW WE'VE SAID IT ISN'T YOUR FAULT BECAUSE THERE IS
SOMETHING GOING ON IN YOUR BRAIN, THERE'S SOMETHING
THAT'S -- IT'S A MEDICAL PROBLEM.
THERE'S A VARIETY OF REASONS, THOUGH, THAT -- SEASONAL
AFFECTIVE DISORDER, LET'S TALK ABOUT THAT, FOR EXAMPLE, IT'S A
CAUSE FOR DEPRESSION.
>> THAT'S A GREAT EXAMPLE BECAUSE THERE ARE ASPECTS OF
YOUR GENETICS -- FOR INSTANCE, WHERE YOU CAME FROM.
NORTHERN EUROPEANS ARE AT HIGHER RISK FOR SEASONAL AFFECTIVE DISORDER.
WHERE YOU LIVE, THE HIGHER YOUR LATITUDE, THE FARTHER YOU ARE
FROM THE EQUATOR, THE HIGHER THE RISK FOR HAVING SEASONAL AFFECTIVE DISORDER.
SO WE HAVE KIND OF A CLASSIC INTERFACE THERE BETWEEN A
GENETIC AND EPIGENETIC THAT ELEVATES THE RISK OF SEASONAL AFFECTIVE DISORDER.
>> IT'S INTERESTING THAT PEOPLE WHO LIVE FARTHER NORTH ARE THE
ONES WHO DON'T GET ENOUGH SUN AND --
>> THAT'S EXACTLY WHY, AND IT IS HORMONAL, IT'S MELATONIN,
IT'S CONTROLLED IN THE PITUITARY GLAND AND THAT IS THE
ASPECT AND IT ACTUALLY CAN BE EFFECTIVELY TREATED WITH BRIGHT
LIGHT THERAPY, PARTICULARLY EARLY IN THE MORNING.
I'VE SET UP A BRIGHT LIGHT RIGHT BY MY ROWING MACHINE AND
I DON'T NECESSARILY HAVE THE DISORDER, BUT --
>> YOU'RE BATHED IN BRIGHT LIGHT WHILE ROWING.
>> YEAH, FOR THOSE FIVE MINUTES.
[Laughter]
>> I DO THINK EXERCISE HAS A LOT TO DO WITH IT, WE ARE A
POPULATION THAT NO LONGER HAS TO GO DRAG WATER UP FROM THE
RIVER OR THE CREEK, WE DON'T HAVE TO, YOU KNOW, SWATH THE
GRASS OR EVEN PUSH ONE OF THOSE --
>> THE REAL MOWER, WE DON'T HAVE TO WORK VERY HARD IN THIS
SOCIETY OF OURS, AND I DON'T THINK WITH -- MY PERSONAL BIAS
IS, I THINK, BECAUSE OF THE LACK OF EXERCISE, MANY OF US
ARE INVOLVED -- HAVE DEPRESSION BECAUSE OF IT.
>> THINK ABOUT THIS, SO WE'RE TALKING ABOUT -- MY EXAMPLE, SO
I GET UP IN THE MORNING, EXERCISE, USE THE BRIGHT LIGHT.
HOW MANY OF US ACTUALLY PRACTICE SOME FORM OF
PROPHYLACTIC TREATMENT FOR DEPRESSION?
>> PREVENTIVE.
>> YEA, PREVENTIVE.
WE ASSUME OUR MOODS ARE OUT OF OUR CONTROL, RANDOM.
BUT WE TELL PEOPLE, CUT DOWN ON YOUR CARBOHYDRATES, YOUR RISK
FOR DIABETES, YOU CAN EXERCISE MORE.
WE RARELY TALK ABOUT PROACTIVE APPROACHES TO MENTAL -- GOOD MENTAL HEALTH.
>> I HAVE SELF-TREATED MY DEPRESSION, WHICH I THINK I
HAVE AN INTRINSIC KIND OF A LOW-GRADE DEPRESSION THAT WOULD
BE THERE HAD I NOT BEEN AN EXERCISER.
IT HAS KEPT MY BUOYANT ALL MY LIFE AND I'M BACK TO IT.
I RAN 5.5 MILES YESTERDAY, I'LL HAVE YOU KNOW.
THAT'S THE BEST I'VE RUN SINCE I CAME DOWN WITH THE DIAGNOSIS
OF CANCER AND IT MAKES ME JOYOUS TO BE ABLE TO DO THAT.
>> THAT IS AMAZING.
>> SO, FOR SOME -- MOVING TO A NURSING HOME IS A DEATH SENTENCE.
WE'LL TALK ABOUT DEPRESSION IN THE ELDERLY.
>> FOR SOME, MOVING TO A NURSING HOME IS A DEATH
SENTENCE, WHILE OTHERS THRIVE IN THE CARING AND SOCIAL ENVIRONMENT.
THE HEALTH CARE PROVIDERS AT NURSING HOMES ARE ACUTELY AWARE
OF EACH INDIVIDUAL'S SITUATION.
>> THAT'S SOMETHING THAT WE MONITOR PRETTY CLOSE HERE AT
THE NURSING HOME IS DEPRESSION AND WHAT TO DO TO HELP EVERYBODY WITH THAT.
AND WHEN YOU COME INTO A NURSING HOME, YOU ARE LOSING A LOT.
MAYBE THEY'RE LOSING THEIR CAR, THEIR HOME, THEIR FAMILIAR
SETTING, ROUTINE.
THEY'RE INDEPENDENCE.
AND SO YOU NEED TO LOOK AT THAT WITH THAT PERSON AND TRY TO HELP THEM OUT.
MAYBE THEY NEED SOME COUNSELING TO HELP GO THROUGH THAT
GRIEVING PROCESS FOR SOME OF THOSE LOSSES AND THAT'S ALL THEY NEED.
YOU NEED TO LOOK AT THAT PERSON AS A WHOLE, NOT JUST KIND OF
LUMP EVERYBODY IN THE SAME CATEGORY.
YOU MIGHT WANT TO LOOK AT THEIR HISTORY, HAVE THEY BEEN ON
MEDICATION THEIR ENTIRE LIFE?
HAVE THEY BEEN DEPRESSED THEIR WHOLE LIFE?
IS THE REGIMEN THAT THEY'RE TAKING RIGHT NOW SOMETHING THAT
HAS WORKED FOR THEM AND YOU DON'T WANT TO ALTER THAT.
DO THEY NEED A LITTLE TWEAKING TO THAT REGIMEN TO GIVE THEM A LITTLE LIFTING?
THAT MIGHT BE THE CASE, TOO.
OTHER SYMPTOMS, CONDITIONS THAT THEY'RE EXPERIENCING THAT ARE
MIMICKING THE DEPRESSION SYMPTOMS THAT WE'RE SEEING --
PAIN CAN CAUSE SOMEBODY TO BE VERY SAD AND THAT WOULD BE
SOMETHING THAT WE WOULD NEED TO ADDRESS WHETHER THEY NEED SOME MORE MEDICATIONS.
ARE THEY BORED IN THEIR ROOM, DO THEY NEED SOME MORE
ACTIVITIES OR ARE WE MISSING SOMETHING THAT THEY ROUTINELY DID AT HOME?
SOME OF THE ELDERLY ARE FROM STOIC AND SO THEY DON'T PRESENT
IN THE SAME WAYS AS MAYBE THE YOUNGER POPULATION WOULD.
YOU HAVE TO KIND OF LOOK SOMETIMES FOR SOME SUBTLE
CLUES, WHETHER OR NOT IT'S THE OUTRIGHT EXPRESSION OF I'M SAD,
I'M LONELY, I'M DEPRESSED OR WHETHER IT'S POSSIBLY COMING
OUT THROUGH BEHAVIORS, WHETHER THEY ARE HITTING OR SWEARING OR
REFUSING TO EAT OR DRINK, YOU KNOW, MAYBE THAT COULD BE
SOMETHING THAT THEY'RE TELLING YOU IN THAT WAY VERSUS, YOU
KNOW, A YOUNGER POPULATION THING, I'M SAD AND I'M DEPRESSED.
EVERYONE'S DIFFERENT.
WATCHING THE TRANSITION FROM THE OLDER BROOKVIEW MANOR INTO
THE NEIGHBORHOOD IN BROOKVIEW, YOU WATCH THE CHANGE IN THE
RESIDENTS AND EVEN THE STAFF.
THIS IS THEIR HOME AND THAT'S WHAT WE'RE TRYING TO STRESS THAT UPON EVERYBODY.
THIS IS THEIR HOME, THIS IS NOT JUST AN INSTITUTION THAT PEOPLE
COME TO LIVE OR TO REHAB HOME, THIS IS THEIR HOME AND WE NEED
TO TREAT IT LIKE ONE, AND GIVING THEM THOSE OPTIONS AND
THAT PRIVACY OF A LOT OF THE PRIVATE ROOMS I THINK HAS
HELPED ENHANCE THEIR QUALITY OF LIFE AS WELL AS THE OPTIONS FOR
ACTIVITIES AND JUST GIVING THEM A SAY IN THEIR DAILY ROUTINE AS
MUCH AS WE CAN AND, YOU KNOW, NOT BEING SO RIGOROUS IN THE
ROUTINE OF AN INSTITUTION, YOU'RE UP AT 7:00, YOU'RE TO
BREAKFAST, YOU'RE LAYING DOWN FOR A REST, YOU'RE UP AT 11:00 FOR LUNCH.
GIVING THEM A SAY I THINK REALLY HELPS ALLOW THEM SOME OF
THAT OWNERSHIP OF THEIR LIFE AND NOT TAKING IT ALL AWAY FROM THEM.
>> SO THE INTERESTING THING IS THAT PEOPLE WHO LIVE IN A
NURSING HOME HAVE PEOPLE WATCHING THEM TO SEE THAT THERE'S DEPRESSION OCCURRING.
WHAT'S YOUR COMMENT ABOUT DEPRESSION IN A NURSING HOME?
>> YOU KNOW, A NURSING HOME -- OBVIOUSLY IT'S AN INCREDIBLY
VALUED INSTITUTION BUT MOST PEOPLE GO IN RELUCTANTLY AND
TRANSITIONS IN LIFE ARE JUST DIFFICULT, WHETHER IT'S YOUR
CHILD GOING AWAY TO COLLEGE FOR THE FIRST TIME, WHETHER IT'S
YOUR PARENT GOING INTO A NURSING HOME FOR THE FIRST
TIME, YOU KNOW, WE ALL -- PARTICULARLY AS YOU GETS OLDER,
YOU JUST DON'T LIKE ENVIRONMENT TO CHANGE.
YOU'VE KIND OF GOTTEN INTO YOUR HABITS, YOU'RE IN YOUR COMFORT
ZONE, I THINK IT'S MOST DIFFICULT FOR THOSE FOLKS.
THE OTHER THING THAT OFTEN GOES ALONG WITH A NURSING HOME OR
PRECEDED BY BY NOT TOO MUCH, YOU GOT YOUR LICENSE TAKEN
AWAY, THE OTHER KIND OF GREAT AMERICAN FREEDOM.
>> DRIVING, YEAH.
>> IT'S A TOUGH -- I DON'T WANT TO CALL IT A PHASE IN LIFE
BECAUSE THAT MAKES IT -- THAT SEEMS TO KIND OF MINIMIZE IT
OR -- IT'S TOUGH BUT, YET, IT'S EXACTLY WHAT YOU SAID, YOU
KNOW, VERY FEW OF US, IF ANY OF US, ARE REALLY GOING TO THRIVE
WITHOUT SOCIAL INTERACTION.
WITHOUT OTHERS AROUND US TO CARE AND THAT WE, -- THAT WILL
ENGAGE US, SO THAT IS CRITICAL.
>> I SEE PEOPLE GO TO THE NURSING HOME AND THEY SAY,
DON'T GO THERE, I WON'T GO THERE, IT MEANS THAT I'M LOSING GROUND.
IT'S -- THE END IS NEAR AND THEY GET IN THERE AND THEY HAVE
BREAKFAST WITH THEIR FRIENDS AND THEN THERE IS A COFFEE HOUR
AND THEN THERE'S THESE ACTIVITIES AND THEN THEY GET
INTO THE ROUTINE AND THEY GO, YOU KNOW, I'M ENJOYING THIS.
THIS IS NOT THE END OF MY LIFE, THIS IS A LIFE THAT IS ACTUALLY
WAY MORE FUN THAN IT WAS ALL ALONE AT HOME.
>> RIGHT.
THERE'S DIFFERENT PERSONALITIES, THERE'S
DIFFERENT SITUATIONS BUT TO HEAR, YOU KNOW, AMANDA TALK,
IT'S TRULY A CARING ENVIRONMENT WHICH IS I THINK THE MOST CRITICAL COMPONENT.
AND TO YOUR POINT, YOU TALKED ABOUT THE ABILITY FOR
WELL-TRAINED STAFF LIKE THAT TO IDENTIFY DEPRESSION AND IN THE
ELDERLY, IT OFTEN GOES UNIDENTIFIED, EVEN THE
INDIVIDUAL THEMSELF DOESN'T RECOGNIZE IT.
>> I HAVE HEARD THERE'S SUBCLINICAL DEPRESSION IN THE
ELDERLY THAT THEY EVEN CALL IT SUBCLINICAL OR SUB
SYNDROMIC, YOU SENT ME THAT ARTICLE --
>> YEAH.
BECAUSE IT DOESN'T PARALLEL WHAT WE CALL OUR CLASSIC
SYMPTOMS OF DEPRESSION SO OUR CLASSIC MAJOR DEPRESSION
TYPICALLY HAS TO INVOLVE THE PATIENT RECOGNIZING EITHER
DEPRESSED MOOD OR LOSS OF INTEREST IN ENJOYMENT.
IN GERIATRIC PATIENTS, YOU OFTEN GENERALLY DON'T SEE THOSE COMPONENTS.
IN OTHER WORDS, THEY -- IT'S NOT THAT THEY'RE UNAWARE OF THE
ENVIRONMENT THEMSELVES BUT THEY JUST DON'T IDENTIFY THAT BUT
THE OTHER SYMPTOMS ARE THERE AND AS YOU SAID EARLIER WHEN WE
WERE TALKING, SOME OF THE MOST COMMON SYMPTOMS YOU SEE IN THE
ELDERLY INCREASE IN PAIN, INCREASE IN ARTHRITIS
COMPLAINTS, INCREASE IN GASTROINTESTINAL COMPLAINTS,
THEY BECOME PHYSIOLOGIC AND --
>> I LEARNED THIS, IF YOU'VE GOT CHRONIC ABDOMINAL PAIN, IT
BUMS YOU OUT, IT BRINGS YOU DOWN.
SO IF YOU'RE LIVING WITH A CERTAIN AMOUNT OF PAIN IT MAKES
YOU DEPRESSED, BRINGS YOU INTO THAT DEPRESSION LEVEL.
AND I THINK IF YOU'RE NOT EXERCISING, YOU'RE NOT ABLE TO
MOVE, YOU'RE NOT GOING SOME KIND OF EXERCISE, I THINK THAT
WILL BRING YOU DOWN, TOO.
SO I THINK THAT WE NEED TO REALIZE IT'S A REAL THING AND WE HAVE GOOD TREATMENT.
I MEAN, WE CAN TREAT THESE PEOPLE WITH THE MEDICINES AND
NON-MEDICINAL THINGS, CAN'T WE?
>> OH, ABSOLUTELY, ABSOLUTELY.
SO GERIATRIC DEPRESSION STILL RESPONDS TO TREATMENT.
YEAH, IT CAN BE MORE COMPLICATED BECAUSE OFTEN AS WE
GET OLDER, WE'VE KIND OF ACCUMULATED OTHER ILLNESSES AND
WITH THAT LIST OFTEN GOES OTHER MEDICATIONS --
>> OH, YOU JUST RANG MY BELL ON THAT ONE, TOO MANY MEDICINES TIMES.
>> RIGHT.
OUR MEDICINES AS GOOD AS THEY'VE BECOME OVER THE YEARS,
ALL CARRY SOME FORM OF SIDE EFFECTS AND SOME OF THOSE SIDE
EFFECTS IN SOME OF OUR MOST COMMON MEDICATIONS ARE, YOU KNOW, DECREASED ENERGY.
>> BETA BLOCKERS.
>> I FEEL WEAKER, I DON'T FEEL AS SHARP, I'M ALWAYS TIRED.
YOU KNOW, THAT IS -- THAT'S SYNONYMOUS WITH DEPRESSION.
SO YOU MIX IN THE MEDICINES, THE ILLNESS AND YOU MIX IN AN
AMOUNT OF DEPRESSION, THAT'S REALLY HARD FOR BOTH THE
PATIENT AND THE CLINICIAN TO SORT THAT OUT AND EAT A GOOD
TREATMENT PLAN THAT'S EFFECTIVE AND ONE OF THE BEST
TREATMENTS -- I'LL TELL YOU THIS STORY, IT ACTUALLY HAD TO
DO WITH TAKING MY SON TO A BASKETBALL PRACTICE AT A
CHURCH, I'M WITH THE COACH AND HE'S INTRODUCING ME TO THE
PASTOR AND WE'RE SAYING, OH, THANKS FOR LETTING US USE YOUR CHURCH PRACTICE.
HE SAYS, O I KNOW YOU, Dr. STANLEY, I WANT TO THANK
YOU FOR TAKING CARE OF MY FATHER-IN-LAW.
THE BEST THING YOU DID WHEN HE CAME IN, YOU SAID HE WAS ON TOO
MANY MEDS AND YOU TOOK HIM OFF AND THAT WAS ALL THE TREATMENT HE NEEDED.
[Laughter]
>> ACCORDING TO THIS AND I KINDS OF REMEMBER THAT, THE
ONLY TREATMENT REALLY WAS REDUCING MEDICATIONS.
SO I WILL STEER CLEAR TO THE AUDIENCE, DON'T START GOING OFF
THE MEDICATIONS BUT SOMETIMES THE MEDICATIONS -- AND YOU
SLOWLY ADD A MEDICATION HERE AND THIS SO YOU CAN'T PINPOINT
WHEN YOU STARTED TO FEEL WORSE.
IT'S A TRICKY PROPOSITION.
>> I GAVE A PRESENT TAKING TO THE COLLEGE LAST NIGHT, AND WE
WERE GIVING AWAY A BOOK THAT WAS ABOUT ARAB MUSLIMS AND THE
DISCRIMINATION THAT OCCURS AND -- BUT WE WERE TALKING
ABOUT MEDICAL ASPECTS OF ALL OF THIS AND THE DISCUSSION WENT TO
MEDICATIONS AND I MADE A BIG FUSS ABOUT TOO MANY MEDICATIONS.
SOMEBODY CAME UP AND SAID, WELL, MY GRANDFATHER, I KNOW IS
ON WAY TOO MANY MEDICATIONS.
HOW CAN WE HELP HIM GET OFF MEDICATION?
I SAID, THE ANSWER IS THAT YOU GO WITH HIM TO THE DOCTOR'S
VISIT AND EVERY TIME YOU SEE THE DOCTOR, YOU SAY, WHAT CAN WE STOP?
DO WE HAVE TO BE ON ALL THESE MEDICINES?
WHAT MEDICINES CAN WE STOP?
I THINK THAT'S PROBABLY SOMETHING WE SHOULD ALL BE
DOING EVERY TIME WE GO TO THE DOCTOR AND THE DOCTOR SHOULD CONSIDER IT.
BUT WE, AS PHYSICIANS, AUTOMATICALLY GO, YOU CAME IN
FOR HELP FOR SOMETHING AND YOU WANT SOMETHING AND WHAT DO I
HAVE BUT A PRESCRIPTION PEN?
>> RIGHT.
WE LOSE THE FOREST FOR THE TREES.
YOUR SYMPTOM TODAY THAT I NEED TO TREAT, I KNOW THIS DRUG WILL
TREAT THAT SYMPTOM BUT I'M NOT LOOKING AT THE WHOLE SPECTRUM.
I AM IN REALITY, I'M MAKING SURE I'M NOT INTERACTING WITH OTHER
DRUGS BUT TO SOME DEGREE, YOU HAVE TO SAY WHAT'S THE BIGGER
PICTURE AND IS THIS -- IF I'M GOING TO ADD THIS, SHOULD I TAKE SOMETHING AWAY?
IT IS -- IT'S A MINDSET AND WE DO HAVE TO WORK AT THAT, BOTH
AS A MEDICAL PROFESSION BUT ALSO A CULTURE OF CONSUMERS OF MEDICAL CARE.
>> IN GERIATRICS, ONE OF THE PRIMARY THINGS THAT THEY TEACH
GERIATRICIANS IS THAT EVERY -- POLY PHARMACY, WHAT DRUGS CAN
WE USE, WHAT CAN WE STOP?
>> GO SLOW AND GO LOW.
>> AND MAKE SURE IT'S UNDER SUPERVISION, DON'T STOP YOUR
MEDICINES RIGHT NOW ON YOUR OWN.
YOU SAID, THAT I'M SAYING IT AGAIN.
TALK TO YOUR DOCTOR.
WELL, LET'S TALK ABOUT -- YOU BROUGHT UP THE ISSUE WHEN WE
WERE DISCUSSING PRE-MED STUDENTS WITH THE PRE-MED
STUDENTS, THE TOPIC ABOUT SUICIDE.
LET'S TALK ABOUT THE ISSUE OF SUICIDE AND THE WHOLE RISK.
WHO'S AT HIGHER RISK FOR SUICIDE?
>> STATISTICALLY -- HERE'S SOME DATA THAT'S UNFORTUNATE.
UP UNTIL 1999, ACCORDING TO THE C.D.C., IT LOOKED LIKE WE WERE
IMPROVING IN SUICIDE, ACROSS THE U.S.
FROM 1999 TO 2015, UNFORTUNATELY THAT TREND
REVERSED AND SEEMS TO BE ACCELERATING.
SO OVERALL, OUR GENERAL POPULATION, WE'RE NOT IMPROVING.
VERY FEW PEOPLE RECOGNIZE THIS, THAT FROM ABOUT THE AGE OF 14
TO AROUND THE AGE OF 30, SUICIDE IS THE LEADING CAUSE OF DEATH.
IT'S FRIGHTENING, ALMOST AMAZING THERE ISN'T A GREATER CRY FOR ACTION.
YOU KNOW, ONE OF THE OTHER.
THAT JUST BLOWS ME AWAY.
>> DOESN'T IT?
IT'S PREVENTABLE, IT'S TREATABLE, WE'RE JUST NOT -- I
THINK WHAT'S HARD IS PEOPLE DON'T KNOW HOW TO INTERVENE,
THEY DON'T KNOW WHAT TO DO, AND IT IS A MULTI-FACETED PROBLEM
BUT THAT DOES BLOW YOU AWAY.
>> I THINK ONE OF THE THINGS THEY ALWAYS SAY, IT DOESN'T
BRING THEM TO SUICIDE IF YOU ASK THEM IF THEY'VE THOUGHT
ABOUT SUICIDE, AND IF YOU THINK THERE MIGHT BE SOMETHING, ASK
THEM AND IF THEY SAY, WELL, YEAH, I THOUGHT BIT, I'VE BEEN
THINKING ABOUT IT BUT I'M OKAY, WELL, IF THEY'VE BEEN THINKING
BIT, WE NEED TO TALK WITH SOMEBODY WHO CAN HELP.
>> YEAH, ABOVE ALL -- I THINK YOU NEED TO GET -- YOU NEED TO
ASK THE QUESTION AND WHEN YOU GET THAT ANSWER, YOU NEED TO
TRY TO GET THEM TO HELP.
THE OTHER THING IS, GET THE GUNS OUT OF THE HOUSE.
YOU KNOW, I MEAN, IT SOUNDS SIMPLE BUT IF YOU COULD DO ONE
ESSENTIALLY THING TO PREVENT A SUICIDE, WHEN YOU KNOW YOU HAVE
SOMEBODY THAT'S AT RISK, GET ANY FIREARM OUT OF THE HOUSE.
>> THEY'RE JUST NOT AVAILABLE, GONE.
BUT WE'RE TALKING ABOUT SUICIDE IN GERIATRICS, LET'S TALK ABOUT THAT.
>> YEAH.
SO ONE OF OUR HIGHEST RISK AGE GROUPS IS ELDERLY MEN.
IN FACT, PAST THE AGE OF 85, WHERE THE NORMAL SUICIDE RATE
RUNS ABOUT 11, 12% PER 100,000, IN MEN ABOVE 85 YEARS OF AGE,
IT RUNS ABOUT 65 PER 100,000, SO ABOUT A SIXFOLD INCREASE-
[Overlapping Conversation]
>> SO SIX TIMES HIGHER RISK AT 85.
>> YEAH.
>> AND A LOT OF THAT IS BECAUSE OF LOSS OF THEIR SPOUSE?
>> YEAH, ONE OF THE RISK FACTORS OR ONE OF THE SET OF
RISK FACTORS IS LIVING ALONE, ELDERLY MALE, AND, YOU KNOW, IN
THE MIDWEST, WE UNDERSTAND THEY ALSO, FOR THE MOST PART, HAVE
ACCESS TO THE MOST DANGEROUS FORM OF SUICIDE, WHICH IS FIREARMS.
>> MY SENSE IS THAT THAT SHOULD BE A CALL TO FAMILY MEMBERS WHO
KNOW THAT THEIR GRANDFATHER OR THEIR FATHER IS ALONE, THAT
SHOULD ALSO BE A CALL TO ALL THOSE CHURCH LADIES WHO WANT TO
HELP SOMEBODY, WHEN THERE IS A DEATH IN THE -- IN CHURCH AND
IT'S AN ELDERLY WOMAN AND THE MAN IS ALL ALONE, SMOTHER THAT
GUY WITH SUPPORT, GET HIM THROUGH THIS PHASE, GET HIM
ACTIVE, GO VISIT HIM, GO INTO -- SOCIALIZE BECAUSE WHAT
HE'LL DO IS HE'LL ISOLATE, HE'LL GET LONELIER, GET SADDER AND THEN HE'S GONE.
DIDN'T NEED TO DIE.
>> THINK BIT, WE'RE MORE ISOLATED, LESS ACTIVE.
SOME OF THESE FOLKS CAN'T -- THEY LOSE THEIR FREEDOMS, THEY
LOSE THE THINGS THAT USED TO MAKE THEM ACTIVE.
AND YOU SAID CHRONIC PAIN, ALL THESE OTHER ILLNESSES, THEY ALL ADD TO IT.
>> YEP.
LET'S TALK A LITTLE BIT, MATT, ABOUT COGNITIVE FUNCTION, OKAY,
SO WE KNOW THAT ONE-THIRD OF THE PEOPLE OVER 85 HAVE LOST
SOME MEMORY, BUT THAT MEANS TWO-THIRDS HAVE NOT, ARE FUNCTIONING FINE.
BUT ONE-THIRD ARE.
IT'S A HIGH NUMBER OF PEOPLE IN THAT AGE BRACKET WHO HAVE SOME
ALZHEIMER'S DISEASE OR SOME DEMENTIA OF SOME KIND, LITTLE STROKES.
WHAT DOES THAT HAVE TO DO WITH DEPRESSION?
>> WELL, I THINK AS YOU RECOGNIZE THAT YOU'RE LOSING
FUNCTIONING, YOU KNOW, THAT FORCES A LOT OF
SELF-REALIZATION, AND SOMETIMES IT'S WHERE AM I GOING TO BE IN FIVE YEARS?
AM I GOING TO BE A BURDEN TO MY FAMILY, MY WIFE, WILL I END UP IN A NURSING HOME?
THESE ARE FRIGHTENING QUESTIONS FOR ANYONE BUT I THINK WHEN YOU
FIRST RECOGNIZE THOSE SYMPTOMS, YOU'RE AT VERY HIGH RISK OF DEPRESSION.
IF NOT DEPRESSION, AT LEAST ADJUSTMENT DISORDER WHERE YOU REALLY GET DOWN.
BUT, YOU KNOW, AS THE DISEASE PROGRESSES, THAT --
>> IT GOES AWAY.
>> IT REDUCES SOMEWHAT, AT LEAST THAT PART THAT'S TRIGGERED BY AWARENESS.
NOW, WHAT'S ALWAYS DIFFICULT, I THINK, FROM A CLINICIAN'S
STANDPOINT IS IF YOU TRIGGERED THAT NEUROCHEMICAL ENVIRONMENT,
EVEN AFTER YOU'RE NOT QUITE AS AWARE, SOME OF YOUR BEHAVIORS
MIGHT ACTUALLY INDICATE THAT THERE IS AN UNDERLYING
DEPRESSION BUT IT GETS VERY DIFFICULT AT THAT POINT TO DIFFERENTIATE.
>> IN THE LITERATURE, BEFORE YOU WERE PRACTICING, IN THE EARLY '80s...
[Laughter]
>> BECAUSE I WAS AWARE OF THIS ONE, THEY USED TO LOOK AT
PEOPLE WHO PRESENTED WITH DEMENTIA AND THEY WOULD STUDY
THEM, LOOKING SPECIFICALLY FOR DEPRESSION, PSEUDO MENSHA OF DEPRESSION.
THEY DID STUDY THAT AND THEY FOUND THERE ARE MANY PEOPLE WHO
WEREN'T DEMENTED, THEY WERE JUST DEPRESSED.
SO I THINK WE KNOW THAT THAT THAT'S TREATABLE.
I MEAN, THE ALZHEIMER'S DISEASE MAY NOT, YOU KNOW, GET BETTER.
WE CAN GIVE DRUGS FOR ALZHEIMER'S BUT DEPRESSION CAN BE REVERSED.
>> RIGHT, ABSOLUTELY, DEPRESSION CAN, THAT'S A GREAT POINT.
MANY PEOPLE ASSUME THAT WHEN THEIR LOVED ONE, YOU KNOW,
MOTHER, FATHER, WHATEVER, ELDERLY, QUITS READING THE
PAPER, DOESN'T SEEM TO KEEP TRACK OF LOCAL OR LOCAL -- THEY
THINK, OH, THEY'RE LOSING THEIR MEMORY.
ACTUALLY, WHAT IT IS IS DEPRESSION, PARTICULARLY WHEN
IT COMES ON RELATIVELY QUICKLY AND SEEMS TO BE PROFOUND AND
YOU SEE THEM ISOLATING MORE AND GROOMING AND HYGIENE DECLINES.
THOSE ARE MORE SIGNS OF DEPRESSION.
THEY CAN BE DEMENTIA BUT A CLINICIAN NEEDS TO SORT THAT
OUT BECAUSE IT IS HIGHLY TREATABLE AND HIGHLY REWARDING
TO SEE SOMEBODY BOUNCE BACK FROM THAT.
>> REMAINING IN YOUR OWN HOME AS LONG AS YOU CAN SAFELY LIVE
THERE IS THE GOAL FOR MANY.
SOMETIMES, JUST A LITTLE HELP WITH EVERYDAY LIFE CAN MAKE THE
DIFFERENCE BETWEEN STAYING INDEPENDENT OR MOVING.
>> I HAVE ADVANCED MACULAR DEGENERATION AND I DO NOT SEE VERY WELL.
I HAVE VERY LOW VISION.
I HAD REACHED A POINT WHERE SHOPPING WAS DIFFICULT, DRIVING
WAS DIFFICULT, READING PRINT IS ABSOLUTELY IMPOSSIBLE.
I HAVE NO FAMILY LIVING HERE.
THEY ARE ALL SPREAD ALL OVER THE COUNTRY AND I STARTED OUT
BY ASKING THE SECRETARY IN THE CHURCH IF THERE WAS ANYBODY IN
THE CHURCH THAT COULD HELP ME.
SHE ADVISED ME TO GET A HOLD OF THE BROOKINGS COUNTY
VOLUNTEERS, WHO IN TURN REFERRED ME TO SOCIAL SERVICES,
WHO IN TURN REFERRED ME TO THE SENIOR COMPANION PROGRAM
THROUGH THE GOOD SAMARITANS.
HOME HEALTH CALLED ME AND TOLD ME THAT THE VOLUNTEER THAT THEY
HAD IN BROOKINGS HAD HAD A CANCELLATION AND THAT SHE WAS
WILLING TO TAKE ME ON AND THAT SHE WOULD LIKE TO VISIT WITH ME.
WITHIN AN HOUR OF THAT CALL, LORRAINE WAS HERE.
>> SENIOR COMPANION IS REALLY JUST A PERSON LIKE YOU AND I
AND ORDINARY PERSON WHO HAS KIND OF LIKE A JOY TO SHARE
WITH OTHERS AND HELP OTHERS.
I REALLY ENJOY HELPING OTHERS AND IF I CAN MAKE LIFE EASIER
AND STEP IN FOR A MOMENT FOR A SPOUSE, I TOOK TRAINING TO
BECOME A SENIOR COMPANION FROM CHRISTIAN FOX, THE MANAGER DOWN
IN SIOUX FALLS OF THE SENIOR COMPANIONS OF SOUTH DAKOTA.
I'M ALLOWED TWO HOURS WITH EACH PERSON, WITH EACH CLIENT.
FOR INSTANCE, WITH MONTE.
MOST OF THE TIME, WE DO ERRANDS LIKE GOING TO LOWE'S OR
WALMART, OR THE OTHER THING IS, PICKING UP GROCERIES AT HyVEE AND CARDS.
PEOPLE DON'T THINK ABOUT IT BUT IT'S KIND OF HARD TO GET AROUND
TO GET CARDS AND THE LITTLE THINGS YOU NEED.
>> TO ME, IT HAS BEEN A GODSEND.
SHE CAN TAKE ME -- SHE TAKES ME TO DO BASICALLY MY CHORES.
I SEE WELL ENOUGH THAT I'M WELL AND ABLE AND CAPABLE OF CARING
FOR MYSELF BUT SHOPPING IS A REAL PROBLEM.
>> WE HAVE ADS IN THE PAPER, SENIOR COMPANIONS, IT MAY SOUND
STRANGE BUT PEOPLE LOOK AT IT AND DON'T REALIZE THAT IT'S REFERRING TO THEM.
WE NEED BOTH PEOPLE WHO WOULD LIKE A SENIOR COMPANION AND WE
NEED SENIOR COMPANIONS.
THEY CAN CALL THE OFFICE IN SIOUX FALLS, 1-888-239-1210 IS
THE TOLL-FREE NUMBER AND TALK TO EITHER CONNIE OR KRISTEN AND
TELL 'EM WHAT YOU NEED.
>> FOR ME, THE SENIOR COMPANION FILLS ALL OF THOSE NEEDS FROM
ONE PERSON AND IT IS JUST FANTASTIC.
>> I LOVE THAT SENIOR COMPANION STORY, AND THEN OF COURSE SHE
WHIPS OUT THAT NUMBER AND, OF COURSE, I MEAN, YOU CAN SEE THE
TWO OF THEM HAVE GOT THEIR NOODLE.
THEY'RE JUST CLICKING ALONG.
THE PROBLEM IS, HIS VISION IS A PROBLEM.
WHAT DO YOU THINK ABOUT THE VALUE OF A COMPANION?
>> WELL, I THINK IT'S CRITICAL.
I DON'T KNOW ANYBODY THAT THRIVES -- I MEAN, YOU KNOW,
THERE IS A FEW PERSONALITIES THAT SEEK SOLITUDE BUT EACH
PEOPLE THAT PREFER SOLITUDE AT TIMES NEED COMPANIONSHIP.
>> YEAH, AND THAT'S SOMETHING THAT ALL OF US COULD DO.
I MEAN, YOU DON'T HAVE TO BE TRAINED IN PSYCHOTHERAPY AND
MAGNETIC SHOCK THERAPY OR WHATEVER IT MIGHT BE TO BE A COMPANION AND A FRIEND.
>> IT'S ONE OF THE CHANGES THAT'S KIND OF OCCURRED OVER
THE LAST COUPLE GENERATIONS HERE, YOU USED TO GROW UP IN A
FARM COMMUNITY, FOR INSTANCE, AND YOU HAD THREE GENERATIONS
OF YOUR OWN FAMILY LIVING RIGHT THERE SO YOU HAD CARE-GIVERS
BUILT INTO THAT SYSTEM.
NOW WE'RE SO MOBILE AND, YOU KNOW, WE LIVE --
>> NUCLEAR FAMILY
>> THE FAMILIES HAVE REALLY DISINTEGRATED IN A SENSE BUT
WHAT YOU LOVE TO SEE IS SOMETHING LIKE THIS WHICH IS
KIND OF A WAY TO RECREATE THAT, THAT COMMUNITY OF SUPPORT.
>> SO THERE IS THIS BIG DISCUSSION ABOUT HOW TO PREVENT
ALZHEIMER'S DISEASE AND SOME OF THEM TALK ABOUT, WELL, I'VE GOT TO DO PUZZLES.
YOU HAVE TO WORK YOUR MIND, YOU HAVE TO EXERCISE IT BECAUSE
THEN IT WILL BE BETTER.
AND I READ ONE DISCUSSION THAT WAS, I THOUGHT, VERY
EYE-OPENING TO ME, THE BEST BRAIN EXERCISE THAT THERE IS,
WHAT DO YOU THINK IT COULD POSSIBLY BE?
THE MOST CHALLENGING AND SUBTLE AND NUANCED AND HARD TO DO BUT
REWARDING IS A CONVERSATION.
>> YEAH, THERE YOU GO.
HIGH TECH.
>> HIGH TECH.
YOU KNOW, YOU DON'T NEED TO DO A PUZZLE ALL BY YOURSELF, YOU
CAN HAVE A CONVERSATION.
IT'S BETTER THAN JUST, OKAY, WHAT -- WHAT THE WEATHER IS BUT
IF YOU CAN REALLY LISTEN TO WHAT THE OTHER PERSON IS
SAYING, COME BACK AND FORTH, THAT'S A WONDERFUL THING.
>> WELL, YOU THINK OF ALL THE FUNCTIONS YOU HAVE TO BE ON TOP
OF, YOU HAVE TO READ YOUR AFFECT, YOU HAVE TO READ YOUR
BODY, YOU HAVE TO READ YOUR TONE, I HAVE TO --
>> YEAH.
>> COGNITIVELY INTERPRET YOUR WORDS, IT IS ALL KINDS OF BRAIN
FUNCTION BEING TURNED ON AND WE DON'T REALIZE IT WHEN WE DO THAT.
IT IS AN ULTIMATE EXERCISE FOR THE BRAIN.
>> YES, IT IS.
ONE OF THE OTHER THINGS THAT PEOPLE TALK ABOUT FOR THE
ELDERLY THAT I LOVE IS THE ANIMALS, YOU KNOW, THERE'S
PARAKEETS, ALL THESE DIFFERENT KINDS OF BIRDS IN THE NURSING
HOME THAT I THINK IS -- I SEE PEOPLE STANDING THERE AND I
STOP AND STAND AND WATCH THESE BIRDS, THAT'S GREAT.
BUT THE DOGS, I MEAN, WE HAVE A DOG AT HOME AND, OH, THAT DOG
BRINGS -- I CAN SEE WHAT THE DOG BRINGS TO OUR DAUGHTER AND
TO OUR -- THE SON THAT'S HOME AND TO MY WIFE AND MYSELF, I
MEAN, THE DOG BRINGS THIS JOY.
>> YEAH, I ABSOLUTELY AGREE.
I THINK ANIMALS, PETS, ARE FANTASTIC COMPANIONS.
>> THEY CAN POOP PLACES YOU WOULDN'T WANT THEM TO BUT, OTHER THAN THAT...
>> I THINK WE SHOULD HAVE AVOIDED THAT TOPIC BUT, OKAY, MOVING ON.
>> OKAY.
LET'S TALK ABOUT A TREATMENT.
ONE OF THE THINGS THAT WE HAVE CHATTED ABOUT IS EXERCISE AND,
YOU KNOW, LIFESTYLE THINGS.
WE CAN TALK ABOUT SLEEP-RELATED TREATMENT, WE CAN TALK ABOUT
MEDICATIONS, WE CAN TALK ABOUT NON-MEDICINAL THERAPIES.
>> SO, SLEEP, LET'S TALK ABOUT THAT BECAUSE I THINK IT IS A
CRITICAL RESTORATIVE FACTOR FOR OUR BODY AND ONE OF THE THINGS
AS YOU KNOW, AS WE GET OLDER, OUR SLEEP CYCLE TENDS TO
SHORTEN AND IS OFTEN DISRUPTED FOR A VARIETY OF REASONS.
YOU MENTIONED, WHEN WE WERE TALKING EARLIER, SLEEP APNEA,
FOR INSTANCE, WHICH IS A FORM OF MEDICAL DISORDERS THAT CAN
DISRUPT YOUR SLEEP.
BUT EVEN WITHOUT SLEEP APNEA, AS YOU GET OLDER, YOU TEND TO SLEEP LESS.
YOU TEND TO REQUIRE LESS SLEEP TO A DEGREE.
>> RIGHT.
>> BUT I THINK PEOPLE UNDERESTIMATE THE VALUE OF A
GOOD NIGHT'S SLEEP AND I THINK ONE OF THE THINGS WE DON'T DO
WELL IS PRACTICE GOOD SLEEP HYGIENE WHICH IS KIND OF THAT,
GAPE, LIKE WE TALKED ABOUT, DO WE REALLY ENGAGE IN
PROPHYLACTIC MENTAL HEALTH CARE, TRYING TO PREVENT --
WELL, GOOD SLEEP HYGIENE IS THE WAY YOU PREPARE FOR SLEEP AND
YOU DO IT EVERY NIGHT AND YOU TRAIN YOUR BODY TO BE READY TO
FALL ASLEEP AND THEN YOU TRY TO STAY ON THE SAME PATTERN SO, YOU KNOW --
>> EVEN ON THE WEEKENDS?
>> YEAH, IT IS -- YOU KNOW, OUR BODIES JUST DO BETTER WITH A REGULAR PATTERN.
IN FACT, WE RECOGNIZED FOR YEARS THE DISRUPTIVE EFFECT ON
MENTAL HEALTH AND PHYSICAL HEALTH WITH SHIFT WORKERS IN FACTORIES, FOR INSTANCE.
>> RIGHT, TERRIBLY DISTURBED.
>> AND IT'S JUST THAT MUCH MORE POWERFUL AS YOU GET OLDER AND
YOUR RESILIENCY DECREASES, SO I THINK THAT'S A CRITICAL FACTOR.
AND I'M -- YOU KNOW, WE HAVE MANY DRUGS -- WE KNOW HOW
IMPORTANT SLEEP IS TO THIS SOCIETY BECAUSE WE LOOK AT THE
NUMBER OF SLEEP MEDICATIONS OUT THERE, BUT I'M NOT A HUGE
PROPONENT -- I DO PRESCRIBE THEM, I HAVE PRESCRIBED THEM.
I THINK --
>> MORE SHORT TERM.
>> YEAH, DO EVERYTHING YOU CAN TO NATURALLY IMPROVE YOUR SLEEP.
I THINK IT'S DIFFICULT ONCE YOU START RELYING ON THE MEDICATION.
>> IF YOU TAKE AMBIEN, FOR EXAMPLE -- I CAN'T REMEMBER THE
GENETIC TERM FOR IT, THOSE ARE ADDICTIVE.
THE VALIUM-LIKE MEDICINES CAUSE DEPRESSION AND MAKE THE
DEPRESSION WORK -- YOU'VE GOT TO BE CAREFUL.
>> YOU DO HAVE TO BE CAREFUL AND IT'S A DIFFERENT SLEEP ARCHITECTURE.
SO THE PHASES OF SLEEP AS YOU GO THROUGH ARE CHANGED.
IT'S NOT THE SAME AS IF I WERE ABLE TO HAVE, YOU KNOW, A GOOD
DIET, A GOOD DAY OF EXERCISE AND A GOOD NIGHT'S SLEEP.
IT IS DIFFERENT WHEN IT'S MEDICATION-RELIANT.
>> AND IF YOU HAVE A MEDICATION THAT YOU'VE BEEN TAKING
REGULARLY FOR A SLEEP, YOU CAN'T STOP IT BECAUSE YOU WILL
HAVE WITHDRAWAL SLEEPLESSNESS, SOME HAVE TO TAPER VERY SLOWLY,
LIKE OVER TWO MONTHS.
>> I TELL MY PATIENTS, IF YOU HAVE BEEN RELYING ON WARM MILK,
YOU CAN'T STOP THAT ABRUPTLY.
WHATEVER YOU DO, IT HAS TO BE GRADUAL.
>> SO LET'S TALK ABOUT OTHER KINDS OF THERAPY FOR DEPRESSION.
I MEAN, THE NON-MEDICINAL THERAPIES.
YOU STARTED ON MAGNETIC THERAPY.
EXPLAIN THAT.
>> SO, TRANSCRANIAL MAGNETIC STIMULATION.
THE BEST ANALOGY IS, IT'S LIKE M.R.I., WHICH WE'VE ALL KIND OF
BECOME FAMILIAR WITH, WHERE AN ELECTROMAGNET SPINS AT A HIGH
SPEED AND CREATES AN ELECTROMAGNETIC FIELD OF ENERGY.
SO WE'RE ABLE TO APPLY THAT TO THE LEFT PREFRONTAL CORTEX AND
EACH TREATMENT TAKES ABOUT 37:30.
YOU NEED TO GET 3,000 PULSES OF THIS ELECTROMAGNETIC
STIMULATION, AND YOU DO THAT ABOUT 30 TREATMENTS, MONDAY
THROUGH FRIDAY FOR SIX WEEKS.
>> HOW EFFECTIVE --
>> YOU KNOW, IN OUR -- SO WE KEPT TRACK OF OUR FIRST
APPROXIMATELY 35 PATIENTS.
I'LL GIVE YOU THE F.D.A. DATA FIRST.
THEY SAID IT WAS ABOUT 50% EFFECTIVE WITH ABOUT 35% OR SO
GETTING INTO REMISSION.
IN OUR CLINIC, WE'VE HAD ABOUT 80% RESPONSE WITH ABOUT 50%
GOING TO REMISSION BUT THE INTERESTING THING ABOUT THIS,
RICK, THESE WERE DIFFICULT PATIENT.
THE AVERAGE NUMBER OF MEDICATIONS THEY'D BEEN ON WERE
ABOUT TEN DIFFERENT ANTIDEPRESSANTS AND THE AVERAGE
NUMBER OF YEARS WAS CLOSE TO 20 THAT THEY HAD SUFFERED.
>> DID YOU GET THEM OFF THE MEDICINES.
NOT NECESSARILY OFF BUT WE CAN -- OUR FIRST GOAL IS TO GET
THEM WELL AND MANY PATIENTS WANTED REDUCED BUT FOR EXACTLY
THE REASONS I TALKED ABOUT, WE'RE GOING TO SLOWLY REDUCE.
WE DON'T DO ANYTHING QUICKLY.
AND HONESTLY, DURING THAT SIX WEEKS OF TREATMENT, I KIND OF
COUNSEL AGAINST MEDICATION CHANGES BECAUSE -- THEY GET
CONFUSED WHETHER IT'S THE MED CHANGE OR THE CMS.
LET'S SEE WHAT THIS SPECIFIC TREATMENT DOES FOR YOU.
>> DOES INSURANCE PAY FOR THAT?
>> IT IS GETTING MUCH BETTER.
MORE HEALTH PLANS DO, MEDICARE NOW DOES SO THAT WAS OUR BATTLE EARLY ON.
SO IT IS BECOMING MUCH MORE AVAILABLE.
>> OKAY.
AND HOW ABOUT MEMORY LOSS ASSOCIATED WITH IT?
>> THE WONDERFUL THING ABOUT THIS IS YOU'RE AWAKE, THERE IS
NO ANESTHESIA, THERE IS NO -- NOTHING LIKE THE CONCERNS WITH
ELECTRIC CONVULSIVE THERAPY WHERE PEOPLE FEEL THEIR MEMORY IS IMPACTED.
IN FACT, WE TRY TO TEACH YOU THINGS AND DO SOME LIFE SKILLS
COACHING WHILE YOU GET THE TREATMENT, WE WANT TO KEEP YOU
AWAKE AND ACTIVE DURING THIS AND WHAT A GREAT OPPORTUNITY.
WE'VE GOT YOU FOR FIVE DAYS A WEEK FOR SIX WEEKS, WE'RE GOING
TO DO SOMETHING WITH THAT TIME WHILE YOU'RE SITTING IN THE CHAIR.
>> SO -- AND IT'S REMARKABLY EFFECTIVE AND IT IS SOMETIMES
COVERED BY INSURANCE, THAT'S WONDERFUL.
THAT'S WONDERFUL AND IT IS AN ADVANCEMENT THAT'S COMING AND I
LOVE TO HEAR IT AND NON-MEDICINAL.
>> IT'S NOT LIKE DRUGS, DOESN'T AFFECT ANY OTHER ORGANS IN YOUR
BODY, WHEN WE SHUT THE ENERGY OFF, IT'S NOT STILL CIRCULATING.
FOR PEOPLE WHO HAVE NOT TOLERATED DRUGS, I THINK IT IS
THE NEXT LOGICAL STEP TO TRY.
>> DO WE HAVE ANY REASON WHY IT WORKS?
DO WE KNOW WHY IT WORKS?
WHY DID WE THINK TO DO IT?
>> WELL, THAT'S A GOOD QUESTION.
I THINK THAT WE THOUGHT TO DO IT BECAUSE ELECTROCONVULSIVE
THERAPY, WHICH IS A LOT MORE INVASIVE AND DRAMATIC, HAS BEEN
EFFECTIVE, SO THE IDEA THAT, WELL, IF WE STIMULATE THE
CORTEX BUT MAYBE A LITTLE LESS SEVERELY, MAYBE INSTEAD OF A
TOTAL REBOOT, WE TRY TO REHAB.
THAT'S KIND OF THE ANALOGY I USE.
THIS IS MORE OF A REHABBING A MUSCLE THAT'S KIND OF ATROPHIED
ON YOU, GOTTEN A LITTLE WEAK.
IT'S THIS AREA OF THE BRAIN --
>> STIMULATE THAT BRAIN TO GET GOING A LITTLE BIT, AND IT DOES IT.
>> AND WE DO IT AND I THINK THAT'S WHY IT TAKES SIX WEEKS
OF REPETITIVE STIMULATION.
LIKE A MUSCLE, YOU DON'T RETRAIN A MUSCLE WITH ONE OR
TWO EPISODES OF EXERCISE, IT TAKES REPEATED WORK.
>> RIGHT.
YOU GAVE AN EXAMPLE OF IT'S SORT OF LIKE WORKING SOME
REWIRING OF YOUR CAR AND IT MAKES IT A KIND OF CHANGE AS
COMPARED TO STARTING THE CAR ON A HILL, LETTING THE CLUTCH OUT...
[Laughter]
>> POPPING THE CLUTCH ON A DOWNHILL, AFTER BEING PUSHED BY
SIX OF YOUR BUDDIES.
SO LET'S GO TO THE ECT, THE ELECTRIC --
>> ELECTRIC CONVULSIVE THERAPY.
>> RIGHT, THAT'S THE SHOCK THERAPY, THAT "ONE FLEW OVER THE CUCKOO'S NEST" STORY.
>> WHICH IS NOTHING LIKE THAT BUT THAT'S WHAT MOST PEOPLE ASSOCIATE IT WITH.
>> THAT'S DONE A GREAT DEAL OF HARM BY MISINFORMING PEOPLE.
>> LET ME START BY SAYING THAT ELECTROCONVULSIVE THERAPY IS
STILL THE MOST POWERFUL TOOL AGAINST TREATMENT RESISTANT
DEPRESSION AND IT IS POORLY UNDERSTOOD, I THINK, AND
FRIGHTENING TO MANY PEOPLE.
I WILL GRANT YOU, IT IS INVASIVE.
WE USE AN I.V., WE PUT YOU TO SLEEP --
>> SOME HAVE ANESTHESIA.
>> YEP, SO -- BUT WE PARALYZE THE BODY.
WE -- SAFELY, WITH -- THERE IS A PRIMARY DRUG THAT WE USE, SO
THERE IS NONE OF THAT JERKING OR TEETH BITING OR TONGUE BITING.
YOU KNOW, THE PATIENT ESSENTIALLY LOOKS LIKE THEY'RE
ASLEEP WITH A LITTLE BIT OF TREMOR.
WE'RE MONITORING THE BLOOD PRESSURE, PULSE, THE CARDIAC
RHYTHM, THE BRAIN, THE E.E.G., WE MONITOR EVERYTHING DURING
THIS, AND, YOU KNOW, THE EFFECTIVENESS IS THERE --
>> IT WORKS.
>> IT'S PHENOMENAL AND I THINK -- IT'S FUNNY BECAUSE WE
HAVE ANESTHESIOLOGISTS AND ANESTHETISTS THAT WORK WITH US,
AND WE HAVE A GREAT GROUP, BY THE WAY, AT AVERA, THEY ENJOY
IT BECAUSE WE KIND OF GET THE SAME NURSE ANESTHETISTS COMING
BACK EVERY TIME, THEY'VE ALMOST BECOME A PART OF OUR TEAM, AND
THEY REALLY ARE, BUT THEY HAVE SEEN THE RESPONSE AND IT'S GOOD
FOR THEM JUST AS MUCH AS IT IS FOR US.
>> SO WE'VE TALKED ABOUT THIS MAGNETIC THERAPY AND THE
CONVULSIVE THERAPY BECAUSE IT SEEMS TO BE THE SEIZURE THAT DOES IT THAT --
>> RIGHT, THAT'S THE COMMON DENOMINATOR, THAT'S THE REBOOT.
>> THE NECESSARY EVENT, RIGHT.
>> IT REBOOTS THE BRAIN FOR SOME REASON OR ANOTHER.
>> YOU DO IT REPEATEDLY OVER A WEEK OR --
>> YEAH, WITH ELECTRIC CONVULSIVE THERAPY OR SHOCK
THERAPY, WE DO IT MONDAY, WEDNESDAY, FRIDAY AND IT
USUALLY TAKES BETWEEN SIX AND TEN CONSECUTIVE TREATMENTS TO GET TO WELLNESS.
IT DO NOT WORK FOR EVERYBODY.
>> 80% SUCCESS OR --
>> YEAH, IT DEPENDS ON WHICH STUDIES YOU LOOK AT BUT IT IS
IN THAT 70 TO 85, 90%, IT'S PHENOMENAL.
AGAIN, NOT EVERYONE BUT --
>> WOW.
AND YOU DON'T STOP DRUGS BUT SOMETIMES YOU CAN.
>> SOMETIMES YOU CAN REDUCE --
>> YOUR MAINTENANCE MIGHT BE --
>> AND THE THING TO REMEMBER IN BOTH OF THESE, UNFORTUNATELY,
WHEN WE'RE TREATING CHRONIC INDIVIDUALS, IT'S NOT A CURE.
IT IS A TREATMENT SO THEY ARE WELL BUT WE STILL HAVE TO DO
USUALLY SOME KIND OF -- NOW, SOME PEOPLE GET WELL AND STAY
WELL BUT OFTEN IT'S THEY'RE WELL FOR SIX MONTH OR A YEAR
BUT THEN WE'LL HAVE TO DO ANOTHER TREATMENT OR THEY HAVE
TO STAY ON MEDICATIONS TO KEEP THE ILLNESS UNDER CONTROL BUT
THESE ARE THE MOST DIFFICULT FORMS OF DEPRESSION, JUST LIKE
BRITTLE DIABETICS, THEY'RE NEVER GOING TO BE ENTIRELY AS
WELL AS THEY WERE BEFORE THE ILLNESS TOOK SHAPE.
>> SO, WHEN WE SAY PSYCHIATRISTS, I ALWAYS THINK ABOUT FREUD.
HERE IS SIGMUND SITTING NEXT TO THE COUCH GOING, HUM.
AND DOING BEHAVIORAL THERAPY, TALKING A PERSON THROUGH WHAT
THEY HAD WHEN THEY WERE GOING THROUGH AS A CHILD, THAT KIND OF A THING.
HOW OFTEN DO WE DO THAT AND IS THAT IMPORTANT ANYMORE?
>> IT HAS VALUE, ABSOLUTELY.
THERAPY HAS VALUE.
LET'S CALL IT THERAPY BECAUSE IT GOES BY DIFFERENT NAMES BUT
IT'S INTERESTING BECAUSE THERE IS A SHORTAGE OVERALL OF HEALTH
CARE, OVERALL HEALTH CARE PROVIDERS.
PSYCHIATRISTS HAVE KIND OF GOTTEN IN THE ROLE OF
DIAGNOSING, PRESCRIBING AND KIND OF BEING AT THE LEAD OF THE TEAM, IF YOU WILL.
THE THERAPY HAS MOVED MORE INTO OUR CLINICAL SOCIAL WORKERS,
OUR PSYCHOLOGISTS, A VARIETY OF PEOPLE THAT ARE TRAINED IN
DIFFERENT TALK THERAPY TECHNIQUES.
SO AS A PSYCHIATRIST, WE HAVE SOME TRAINING IN THAT BUT WE'RE
MORE SO LOOKING AT IT FROM THE MEDICAL STANDPOINT, AND THEN WE
WILL USUALLY WORK IN CONJUNCTION WITH A THERAPIST
WHO REALLY, LET'S SAY STANDARD PRACTICE WOULD BE TO MEET WITH
A PATIENT ONCE A WEEK FOR SEVERAL WEEKS AND SOME OF THE
BEST THERAPIES ARE COGNITIVE BEHAVIORAL THERAPY AND DIALECTICAL BEHAVIORAL THERAPY.
>> AND THAT'S --
>> THAT'S GEARED A LITTLE MORE TOWARD A PERSONA DISORDER,
PARTICULARLY A BORDERLINE PERSONALITY DISORDER.
>> WE HAVE A LITTLE TIME LEFT, LET'S TALK ABOUT THE GENETIC
TESTING YOU'RE DOING, YOU'RE LEADING THE COUNTRY, USED TO BE
$2,000, $3,000 FOR TESTING GENETICS.
>> AT AVERA, WE'RE DOWN TO $200 FOR A BEHAVIORAL HEALTH PLAN,
ABOUT $179, PHENOMENAL IMPROVEMENT.
SO ONE OF THE MOST IMPORTANT THINGS ABOUT GENETIC TESTING
IS, THERE'S 36 ANTIDEPRESSANTS OUT THERE IN THE MARKET BUT
EACH OF US HAS A LITTLE DIFFERENT WAY WE'RE GOING TO
METABOLIZE ANY DRUG, NOT JUST ANTI-DEPRESSANTS BUT ANY DRUG.
WE CAN NOW DO A GENETIC TEST THAT WILL TELL ME IF YOU'RE ONE
OF THE 7% OF CAUCASIANS, FOR INSTANCE, THAT IS A POOR
METABOLIZER IN THIS ONE PARTICULAR PATHWAY AND THOSE
DRUGS ARE PROZAC OR HALDOL OR XANAX.
>> SO THIS DRUG MIGHT WORK -- YOU CAN TELL GENETICALLY WHICH
DRUGS ARE THE BEST CHOICE.
>> IT CAN LIMIT -- IT WON'T TELL ME THE PERFECT DRUG FOR
YOU BUT IT WILL ELIMINATE A LOT OF TRIALS THAT WOULD HAVE
EITHER BEEN WORTHLESS TO YOU OR VERY UNCOMFORTABLE FOR YOU.
>> OKAY, 15 SECONDS, BOTTOM LINE, SUMMARIZE THE WHOLE CONVERSATION HERE, MATT.
>> GERIATRIC DEPRESSION IS TREATABLE, WE HAVE TO BE MORE ALERT TO IT.
IT DOES COME WITH A RISK OF SUICIDE.
IT'S BEST TREATED AS A COMMUNITY WITH GREATER
AWARENESS AND GREATER SYMPATHY TO THOSE EPISODES.
>> AND NOW FOR THE ANSWER TO TONIGHT'S PRAIRIE DOC QUIZ QUESTION.
ARE ELDERLY DEPRESSED PATIENTS AT A LOWER RISK FOR SUICIDE THAN YOUNGER VICTIMS?
YES OR NO?
THE ANSWER IS NO!
THOSE WHO ARE ESPECIALLY AT HIGH RISK ARE ELDERLY MALES WHO
HAVE RECENTLY LOST THEIR SPOUSE.
WE LAID IT OUT THERE.
WE'LL BE RIGHT BACK AFTER THIS.
ALL AROUND TOWN FROM, STORES TO PLAYGROUND, BABIES ARE ON THE
MOVE AND THERE ARE DISEASES THAT ARE ON THE MOVE, TOO.
AND SOME OF THESE SPREAD EASILY.
TO PREYED INFECTIONS TO 14 DISEASES BEFORE HE TURNS OLD,
VACCINATE ACCORDING TO THE REGULAR SCHEDULE SO HE CAN GO
ON ABOUT HIS BUSINESS AND YOU CAN HAVE PEACE OF MIND.
FOR MORE REASONS TO VACCINATE, TALK TO YOUR CHILD'S DOCTOR OR
GO TO CDC.GOV/VACCINE.
>> THROUGH MY YEARS OF CARING FOR PEOPLE CAUGHT IN THE
JOY/STARVATION OF DEPRESSION, I HAVE SEEN THE DEVASTATION FROM
THAT AWFUL DIAGNOSIS INVOLVE NOT ONLY THOSE SAD AND
MELANCHOLY BUT GREATLY AFFECT THOSE AROUND THEM.
FOR THOSE 18 TO 45 YEARS OF AGE, DEPRESSION IS THE NUMBER
ONE CAUSE FOR DISABILITY, RESULTING IN AN ESTIMATED
$200-PLUS BILLION OF LOST EARNINGS PER YEAR.
I HAVE LOOKED ON WITH AGHAST WHEN DEPRESSION CAUSED SUCH
HELPLESSNESS THAT THE PATIENT CHOSE TO ESCAPE LIFE WITH SUICIDE.
THERE ARE ABOUT 40,000 DEATHS PER YEAR TO SUICIDE, WHICH
ACCOUNTS FOR ABOUT THE SAME NUMBER OF DEATHS TO BREAST CANCER.
IT IS ALSO SAD THAT RESEARCH TO HELP THOSE WITH DEPRESSION
RECEIVES ONE-HUNDREDTH THE AMOUNT OF FUNDING FOR RESEARCH
THAT OCCURS FOR THOSE WITH BREAST CANCER.
THE THEORETICAL CAUSES FOR SEVERE MELANCHOLY AND DESPAIR
INCLUDE A GENETIC TENDENCY, A LEARNED PROCESS, A STRESSFUL
ENVIRONMENT, A SAD SITUATION, ADDICTION, OR EVEN NOT ENOUGH SUN.
BUT SCIENCE HAS NOT DEFINED EXACTLY WHY DEPRESSION OCCURS.
MOST OF US PERIODICALLY HAVE WHAT IS CALLED "SITUATIONAL
DEPRESSION," SUCH AS THE APPROPRIATE SADNESS THAT
FOLLOWS SEVERE LOSS OR DEATH, FOR EXAMPLE, BUT WHAT IS MORE
TYPICAL OF HARMFUL DEPRESSION IS WHEN THERE IS NO
"SITUATION," NO REASON FOR IT TO HAPPEN, NO SAD STORY TO
EXPLAIN WHY ONE IS FILLED WITH SADNESS.
WHEN THE PATIENT SAYS, "THERE IS NO REASON FOR IT," THEN THE
CLINICIAN KNOWS THERE IS A PROBLEM.
THE DIAGNOSIS IS NOT ALWAYS THAT EASY.
WE SUSPECT DEPRESSION WHEN PEOPLE EXPERIENCE CHRONIC PAIN,
FIND IT HARD TO CONCENTRATE, ARE WITHOUT ENERGY, HAVE FLARES
OF TEMPER, SLEEP TOO MUCH OR TOO LITTLE, HAVE A LOSS OF
APPETITE OR HAVE OVER-EATING BINGES, HAVE UNEXPLAINED CRYING
SPELLS, OR BECOME FILLED WITH ANXIETY FOR MINIMAL REASONS.
OFTEN, PEOPLE MAKE THINGS WORSE BY COVERING UP DEPRESSION WITH
ALCOHOL, SLEEPING PILLS, ANTI-ANXIETY MEDICATIONS, OR
SUBSTANCE ABUSE, AND THESE ALL MAKE THE DIAGNOSIS EVEN MORE DIFFICULT.
ALTHOUGH TWO-THIRDS OF THE PEOPLE WITH DEPRESSION DO NOT
SEEK OR RECEIVE HELP, WHEN THE ONE-THIRD THAT DO GET HELP
FOLLOW THROUGH WITH TREATMENT, 80% ARE BETTER IN FOUR TO SIX WEEKS.
THERE IS HELP AND HOPE FOR THOSE WITH THIS MISERABLE
CONDITION, BUT PEOPLE NEED TO BE OPEN TO THE POSSIBILITY OF SUCH A PROBLEM.
MEN ARE USUALLY THE WORST DENIERS.
TREATMENT INCLUDES A HALF-HOUR OF EXERCISE OR WALKING DAILY,
OFTEN A MINIMAL SIDE-EFFECT, INEXPENSIVE, ANTI-DEPRESSANT
MEDICINE, AND SOMEONE TO TALK TO.
IF YOU ARE POSSIBLY STRUGGLING WITH DEPRESSION, PLEASE GET HELP.
AT LEAST DO IT FOR THOSE AROUND YOU.
WELL, A BIG THANK YOU TO OUR GUEST, MATT STANLEY.
THANK YOU VERY MUCH, MATT.
YOU KNOW, HE INVOLVED TIER TO COME HERE TO OUR STUDIO AT THE
YEAGER MEDIA CENTER AT SDSU AT BROOKINGS TO SHARE HIS
EXPERIENCE WITH US AND WITH ALL THE MONEY THAT WE'RE GOING TO
PAY YOU FOR ALL OF THIS --
[Laughter]
>> IT IS ALWAYS GOOD TO HAVE YOU JOIN US.
COME BACK AGAIN SOON.
>> I WILL.
THANK YOU, RICK.
THAT DOES IT FOR TONIGHT.
FROM ALL OF US HERE AT "ON CALL WITH THE PRAIRIE DOC," UNTIL
NEXT TIME, STAY HEALTHY OUT THERE PEOPLE.
>> MAJOR FUNDING FOR "ON CALL WITH THE PRAIRIE DOC" HAS BEEN PROVIDED BY:
>> AVERA IS A PROUD SPONSOR OF "ON CALL" ON SOUTH DAKOTA PUBLIC BROADCASTING.
LARSON MANUFACTURING IS PROUD TO SUPPORT "ON CALL TELEVISION"
AS IT CONTINUES TO OPEN DOORS FOR IMPORTANT MEDICAL INFORMATION.
AND BY THE SOUTH DAKOTA FOUNDATION FOR MEDICAL CARE,
THE MEDICARE QUALITY IMPROVEMENT ORGANIZATION FOR SOUTH DAKOTA.
AND WITH THE ONGOING SUPPORT OF THESE INDIVIDUALS AND INSTITUTIONS...
For more infomation >> 🔴🔵 [Kuduro] - DJ SISSE - KI KUIA - WELCOME 2018 - Duration: 1:19. 
For more infomation >> 🔥 5 NAJWIĘKSZYCH [FAKE] DONEJTÓW na POLSKIM YouTube! [#3] | ZairoxTV - Duration: 10:09. 
For more infomation >> LIFE IS STRANGE | BEFORE THE STORM | EPISODE 1 (AWAKE) - Duration: 3:54:23. 
For more infomation >> fibromyalgia Overstimulation & Sensory overload - Duration: 7:30. 
For more infomation >> АЛЛЕРГИЯ НА КОЖЕ? ОТКУДА? - Duration: 5:10. 
Không có nhận xét nào:
Đăng nhận xét