Depression

0:00Let's keep going with the next class in the mental health module.

0:08And for this class, we're going to be talking more about mental health, specifically having

0:18to do with pretty routine diagnoses and skills that we can use to hopefully help us cope

0:25with some of that within reason.

0:27Students by the end of this class should have a greater knowledge and understanding

0:31of the main mental health diagnoses, as well as specific sexual diagnoses

0:36within the realm of the DSM, what's there, what's maybe missing.

0:42And we'll have a clear indication of the types of diagnoses and symptomology

0:47that would indicate a higher level of care or intensive therapy is needed,

0:52as well as some of the skills associated with those things.

0:54So, as we are talking about common diagnoses, it's important that we start or have a foundation

1:07in some of what this terminology will mean.

1:12And the first part of that is that it's important that you know that the DSM is just a cluster,

1:20a book with a cluster of symptoms that indicate what's going on.

1:24It usually requires some specific length of time, but it's also not the most comprehensive

1:32or inclusive set of criteria in existence.

1:35So, LGBTQIA+, doesn't always necessarily get included in this symptomology.

1:44Hysteria used to be in there.

1:47Men are not always demonstrating or exhibiting the same set of symptoms that women are.

1:54So, we want to understand what the DSM is, why we use it, but also use it judiciously

2:02and use it wisely when we're talking about those kinds of things.

2:08And when we're talking about diagnostic criteria.

2:11Now, if you're an existentialist, you're going to ask why the DSM even matters,

2:17because we are dealing with a set of symptoms that's unique to the individual.

2:21So, take that for what you will, but what we want to make sure or ensure is that it

2:27doesn't always encompass some of the behaviors that are known to be exhibited within the

2:35realm of male mental health.

2:37It's not saying that the DSM is solely based on women and that males weren't included

2:42or acknowledging some of the sexism that happened.

2:47But what we are saying is that it's not completely gender inclusive and that what we know about

2:52male behavior is that males tend to exhibit more externalized behavior, particularly when

2:59we are talking about mental health symptoms.

3:03And as you'll see, when we go through this process, it's not always included.

3:08The first thing that we want to talk about is depression.

3:12Now, depression, very vague.

3:17It's a very broad and all encompassing term.

3:21And so, we're going to go through some of the criteria here, but also the variations

3:28of symptomology.

3:30Now, here's what we're going to say.

3:31Most things happen in the DSM on a spectrum, low level or low grade all the way up to very

3:39severe on the other end.

3:40And really the only thing, a majority of the time that separates low grade and severe is

3:47the length of time or duration of the symptom presentation.

3:53So, when we're talking something like a major depressive disorder diagnosis, that's going

3:59to be having lasted at least six months, if not longer.

4:03When we're talking about a major depressive episode, we're talking at least two weeks,

4:09but somewhere around two weeks, but significantly less than six months.

4:16So, the spectrum here is a major depressive episode, a minor depressive episode,

4:24dysthymic disorder, and major depressive disorder.

4:28Dysthymic disorder is that you're depressed most of the time, but essentially it's so

4:34mild that it doesn't meet the symptomology for a major depressive episode, but it doesn't

4:40mean that you're not experiencing those symptoms.

4:43A major depressive episode is that you're having these symptoms and they have lasted

4:48at least six months, if not longer in duration.

4:51Symptoms include loss of pleasure.

4:55Now, we need to focus on this.

4:57Why?

4:58Loss of pleasure doesn't mean that you don't have motivation or you don't like doing the

5:02things that you once did.

5:04It is the loss of the ability to enjoy things the way that we once did.

5:13Pleasure is a huge part of sexual satisfaction.

5:15So, we're going to talk about some of the side effects or the problems that could happen

5:20as a result of this.

5:21You could also have weight loss or weight gain.

5:27And it could go one of either way.

5:31Some people withdraw, and that includes withdrawal from healthy appetite.

5:35Some people overindulge, and that includes overindulging in food-related behavior.

5:44Likewise, it can be insomnia or hypersomnia.

5:48You sleep way too much.

5:50You sleep way too little.

5:52Same thing happens with how you speak or how you move.

5:55You can move way too slow, like you're a turtle, or like moving through water, or way too fast

6:01where it feels unnatural.

6:05Energy issues are very common, and I say this a lot with depression, that depression is

6:10an energy problem, not necessarily a motivation problem.

6:14People say I'm not motivated.

6:16And I think a lot of times what they're talking about is that loss of pleasure, right?

6:20Dopamine happens when we get that boost.

6:23We want to engage in it again, and it builds this motivation, but it's based on a pleasure

6:28principle.

6:29If we don't have pleasure, it's not that you're not motivated.

6:33It's the absence of.

6:36And so, it's really an energy problem.

6:37Do we have the energy to do those things?

6:40And do we have the discipline?

6:41Because a lot of times with depression, it's hard to even get out of bed.

6:45So, if you're out of bed dressed in at work, you're probably not going to go, you know,

6:49play Frisbee golf in the afternoon.

6:51And it's not because you don't want to.

6:53It's not because you don't want social support.

6:55It's a lack of energy.

6:57And that absence of, I'm not getting anything out of that experience.

7:03We also may have feelings of worthlessness or excessive guilt in a PHQ-9, which is what

7:09measures our depression, that scale, excessive guilt and feelings of worthlessness.

7:14Feelings of worthlessness could lead to suicidal ideation, but that's not always the case.

7:20A diminished ability to think, concentrate, or characterized by indecisiveness.

7:25So, are you having trouble thinking things through?

7:29Are we having some thought blocking where we're receiving information, but it's not

7:34like computing or translating, or there's a block between us understanding and us being

7:38able to articulate something.

7:41In more severe cases, there are recurrent thoughts of death or being better off not

7:46being here or what's the point.

7:48Again, that doesn't always mean that you are suicidal or want to die.

7:52It just means that sometimes it's a really good cue that we don't see another way out

7:56and that we're feeling miserable.

7:59Now, the problems here.

8:01Misdiagnosis can happen if you see a provider or have seen a provider in the past during

8:08only a major depressive, let's say, episode.

8:11So, one of the things that really needs to be asked and that you really need to look

8:17at yourself is how long have these symptoms persisted?

8:21If you've been with another person or a partner for a while, we might ask their input.

8:27How long does it feel like this has been going on?

8:29Because sometimes this can be misdiagnosed.

8:32An example is if you're bipolar, which is categorized by kind of like being outside

8:38of your window of tolerance at all times, and you're seeing somebody when you're bottomed

8:43out, it's going to look like depression to them unless they're able to collect a full

8:47history or you recognize that you had mania in the past.

8:54Agitated depression is also a thing that is typically more associated with men than women,

9:00but it is marked more by irritability, anxiety, or an anxious presentation, or restlessness,

9:07outbursts, and racing thoughts.

9:10So, yeah, speaking too fast, energy issue, but nowhere in that list of symptoms did we

9:16see irritable.

9:17Nowhere in that list of symptoms did we see restlessness, although moving too quickly

9:24could be considered, I guess, restlessness.

9:26But those things are missing, and men are more likely to experience agitated depression

9:31than they are just run-of-the-mill depression.

9:35So something to keep in mind.

9:38The next diagnosis we're going to talk about is anxiety.

9:40There are lots of different kinds of anxiety that are worth talking about, but that's what

9:46we're going to talk about a little bit more in the next segment.

9:49Why is it important?

9:50Well, because a lot of folks don't understand that they are depressed or they'll be told

9:55they're angry, let's say, when they have an agitated depression.

9:59And if you're trying to just deal with your anger and what you're actually experiencing

10:05is depression and you need an SSRI or you need some other kind of coping skills to boost

10:11dopamine, then you're not actually going to get the help that you need.

10:16So it's important that we pay attention to these things, especially when we feel like

10:20they are problematic or have been causing some issues in our relationship.