What the heck is Depression anyway?

30 Oct crying

Depression is not a choice. Now, before you throw your arms up and start yelling at me I ask that you consider what is and is NOT depression. With all the current light shed on to depression, suicide, and mental health I have been asked much more lately my professional stance on depression. I want to break it down much further beyond just outlying the symptoms and signs of depression. I mean, after all, we could all look at the diagnostic criteria of depression and slap ourselves with a hefty diagnosis.

Before I dive any further into the nitty-gritty, I want to establish an overriding concept that ought to be pervasive for ALL mental health diagnoses. No one is “a depressed person”, “an ADHD kid”, or “the bipolar guy.” In essence, I am saying no one is the diagnosis that is present in their life. You are you, not a diagnosis. Identifying oneself by a diagnosis forfeits the reality of who you are as a human being and causes you to limit yourself to the restrictions associated with depression. I had to put that out there before we go any further!

What is the difference between stress, sadness, and depression? Well, just because you have stress does not mean you are “depressed.” Stress means you are alive, your heart is beating. Stress drives us to perform. Too much stress overtime can possibly lead to depression but not always. A few days of stress does not indicate you are experiencing depression. Therefore, enjoy stress and try to limit it at the same time. Good luck with that ☺ Moving on to sadness. Just because you are sad does not mean you are experiencing depression. Sadness is not necessarily a negative emotion. Sure, it hurts at times, but if we didn’t  have sadness would you enjoy happiness and know what being happy even is? No! Now, if sadness carries on for an extended time you might be falling in to a depressive episode. Basically, the point I want to drive home first here is that stress and sadness happen to everyone and it does not mean you are experiencing depression.

We always see the criteria listed for depression, which are simple signs/symptoms that might indicate one is experiencing a depressive episode. That is, when one has a loss of interest or pleasure in ordinary activities for at least two weeks, accompanied by at least four of the following symptoms:

  1. Significant weight loss when not dieting, or weight gain, or change in appetite.
  2. Insomnia or hypersomnia nearly everyday
  3. Activity level slow down or increases
  4. Fatigue of loss of energy
  5. Feelings of worthlessness or excessive guilt
  6. Diminished ability to think , concentrate, or make decisions
  7. Recurrent thoughts of death or suicide, or suicidal ideation, or a suicidal plan or attempt.

(The symptoms must not be due to the direct effects of medications, druges, or a physical condition, and must not be a simply grief reactions.)

***It is important to note that these symptoms best describe how depression presents in females. Frankly, psychiatry has done an awful job of describing how depression manifests in males. Thus, I am currently writing a book on “Manpression.” 

I teach graduate students how to diagnose and my question is always so what do these symptoms really mean? What the crud is really going on? Is he/she just choosing to be negative or stay sad? I want to get in to that… the stuff that is rarely talked about. The actual process that is happening physically, physiologically, biologically, neurologically, and so on. Also, what is happening with the heart rate? What is happening with hormones? The whole purpose in asking these questions, and answering them, is so you can see what depression really is. It is not just some set of symptoms.

Neurochemicals: What’s that got to do with it? Everything! 

I always hear people say that the depression they are experiencing is not just depression; rather, it is a chemical problem. #thetruth: Depression always involves chemical imbalances. When your body and brain experience ongoing (at least 2 weeks)/ excessive sadness, guilt, and other depressive symptoms neurochemicals are going to reduce in production. Your dopamine, norepinephrine, and serotonin decrease. Now, on the flip side it could be that an unkown reduction of these neurochemicals could lead to inexplicable depressive symptoms. This means something else in your mind/body could have led to reduction of these chemicals resulting in other depressive symptoms. Its kind of that whole chicken or the egg thing. So, it always has something to do with chemical imbalances, but that does not mean you can just use medication to overcome it. And no, I am not saying psych medication is totally bad. I am just saying depression is so complex that it would be foolish to only depend on one method ( and a method that is most often placebo)  to overcome such a complex problem.

A Medical Issue?

Depression symptoms could be a result of several medical issues. I do not feel comfortable treating a client if they have not done lab work with their med doc. Specifically, I like to hear about thyroid levels, testosterone, and vitamin D. I also would like clients to look at adrenal malfunction, Addison’s disease. In females, you will want to check your estrogen levels, just as important as men checking testosterone. I would also like to hear about Vitamin B levels. I would like to find out if the client has had concussions or suffered seizures. These are just a few things to consider. Basically, I am suggesting that you don’t want to just chalk your symptoms up to depression. Looking at all possibilities, including medical issues is absolutely imperative.

Yes, Your Food Could be a Problem

The Brain Bio Centre reports that the most significant problem in regards to nutrition causing mood symptoms is unbalanced blood sugar levels. So, What does that mean? Well, when we eat carbohydrates they turn into glucose and raise our blood sugar levels. If we eat too much carbs, or carbs loaded with gluten, our blood sugar levels spike and come down hard. This causes mood instability. Furthermore, going an entire work day without eating causes a major drop in blood sugar levels and problems with mood. Then after you don’t eat all day and get in a load of carbs at night you spike your blood sugar and then drop drastically. Continuing to do this day after day your body is dysregulated… how do you expect to have a stable mood. My advice, stop acting like your food doesn’t matter. It is your fuel.

You might also want to consider the fact you are not supplying your body with sufficient amounts of chromium, a mineral that helps insulin pump properly. Foods that can help with this are broccoli, barley, oats, green beans, tomatoes, romaine lettuce, and black pepper.

You might also consider the fact your not getting sufficient sources tryptophan, an amino acid that is converted into the neurotransmitter serotonin (5HTP). Foods you might want to consider would be spinach, eggs, sesame seeds, halibut, lobster, crab, quail, turkey, and soy protein….just to name a few.

We could go on and on about nutrition and mood; however, I would consider the above mention items if you feel depressive like symptoms. Actually, I would highly recommend being proactive  and getting these in to your nutrition plan now!

Could it be a Spiritual Problem?

Whether you are religious or not, is not the debate here. We are all spiritual beings for whatever that means to you. Some believe in God, Buddha, higher power, the universe, energy, and so on. The fact of the matter is that if you are out of balance/touch with your spirituality it can become a problem. This can start to look like a mild depression and make your question yourself and the world around you. It is not taboo to consider how your spirituality is affecting your mood. In fact, you need to seriously reflect on your sense of personal spirituality.

A Neurological Perspective

Technology has advanced in a tremendous manner! Those who can afford it may seek out a fMRI, which measures brain activity by looking at changes in blood flow in the brain. This a costly measure, but due to ongoing research, specialists are able to identify multiple mental health disorders through use of fMRI.

At the end of the day, depression can look like all sorts of issues. At the same time, it is important to not mistake a different medical or external stressor as organic depression. I hope this post can help you see that depression is not just simply a way of thinking. It is serious; however, it is not a life sentence to sadness or anger. It is treatable and can be overcome. Sometimes it just takes a little more than will power. One can choose to Endure and find their way forward!

Overcoming Stagnation- Pony Express 100

27 Oct

IMG_0622The opposite of success is NOT failure. Rather, the opposite of success is indifference, or stagnation. I was faced with this the past few months. Walking off the course of an ultramarathon is something I do not do. However, this September at mile 46 in the Bear 100 I earned a DNF while walking off the course. It was an awful day. Out of 18 ultras I had only earned a DNF one time, due to having the flu.

For a few days post Bear 100 I felt crummy and considered just not getting back out for an ultra next year and giving up on my goals. Yeah, that lasted about 72 hours. Quickly, I realized I was doing more than failing, I was settling with the pathetic state of indifference and stagnation. A sickening recognition. Accepting failure is okay but becoming apathetic and indifferent is the true problem here and a fast moving trap waiting to suck us, as humans, down.

So, Tuesday after the Bear 100 I signed up for the Pony Express 100, which was 2 1/2 weeks away. Uh oh! Taking my first steps back out of temporary stagnation. The excitement  crept back in to me. I am a true believer in the theory that behavior precedes motivation. This behavior of signing up was the only behavior I needed to start feeling motivated.

Nothing like arriving in Salt Lake City at 11:30 pm and waking up for the race at 3:30am! Oh well, it worked. I slept the whole 60 minute drive from my sisters house to the start line. Rolling out of the car a few minutes before running a 100 miler is the way I prefer anyway. After all, I have all day long to stretch out and get moving. :)

Pony Express 100 is flat and fast. The danger on this course is moving too fast those first 50-60 miles. By mile 20, about 3hours and 20 minutes in to the race I was convinced that I was in accordance with my strategy to Endure the entire 100. I had not been anaerobic and was feeling relaxed. I had avoided the pit fall of moving too fast and stayed steady. Sure, I could have kept my miles to below 8 min/miles; however, that is short-sided thinking and short-sided thinking is rarely helpful in life.

Nutrition and gait! That was my mantra during the first 60 miles. I wanted to get to mile 95 and still have to pee. So, I did just that! Hydration while running  an ultra is not just as simple as drinking water. Rotating between electrolyte drink and water is essential. However, I hit a small problem with that whole keeping a balanced gait…

IMG_0630Mile 38, I hit a hole in the trail and my knee popped. One of those “pops” where you can feel and hear it. Ouch! I convinced myself that it was just a little pain and all would be well. By Mile 50 (about 10 hours in to the race), I started to feel the pain in the knee and asked Shayna for ibuprofen. I do not typically take NSAID’s during races but I had no choice. My knee pain was causing nausea and pain was radiating down my legs.

IMG_0632Also around mile 50 my sister, Heidi, started running with me. Yay!! I love running with Heidi. She is so experienced and frankly should be paid for how well she can get in my head and keep me moving. She is a stick of dynamite. Between her and Shayna keeping me positive during the ENTIRE race, I was truly blessed!

IMG_0671 IMG_0672Heidi and I took off and from miles 48-62 we maintained good pace. Nausea came back and kicked me in the face for about 6 miles. Mile 68 is the only place on the course with a real aid station. I told Heidi and Shayna to get me a blanket and chair and I needed 20 minutes to sleep and get my pain and nausea down. So, I quickly fell asleep. Getting out of that chair and moving again was awwwwwwful! Some really nice cheery fellow was trying to speak Spanish to me, which I typically love to converse in Spanish, but I had to tell him I could barely even comprehend English at this moment. I tried to start walking and my knee was so swollen and stiff. I wanted to throw up. I contemplated just throwing up and getting on with it. Instead, Heidi told me to take a minute and reminded me to just be steady and the race was going to develop well. I am a strong night runner and the night was upon us!

Nothing like a nap on a rock. About mile 76, I found myself very sleepy. Caffeine was doing nothing for me. I think the hectic week leading up to the race was wearing on me. I could not settle for sleepiness slowing me down. After all, I would have several months after the race that I could sleep! But, I asked Heidi to give me three minutes to sleep on this comfy rock along the trail. I had a few nice dreams and she awoke me! It was time for a nice little climb up the pass!

Made it up to the top of the climb (mile 80) at 1am. I felt so good knowing that I had 5 hours to make it 20 miles. We kept a decent pace from miles 80-84. Then the pain was screaming at me. Usually, in a 100 mile race I accept pain as part of running a far distance. This time it was more than that. My knee was not wanting to move. I was dragging it along. I got slower and slower and was trying to just keep a forward motion. I could not become stagnant.

Heidi has dealt with a number of hip issues over the past years and her hip was getting tight. I could see how she was dealing with her pain… and she was doing it for nothing more than to see me finish. Frankly, that was enough motivation to keep moving forward. Her and Shayna were up for the entire 25 hours that I was out there! No excuse to quit when people are sacrificing. Besides, it was actually a lot of fun being out there and enduring and accomplishing.

25 hours, 27 minutes later… I finished and prepared myself for a nice nap! I had overcome the glimpse of stagnation and pushed myself forward! Thank you everyone both near and far for your positive thoughts, prayers, and energy!

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Running THROUGH Trauma

24 Sep

005My answer never changes. You ask, “Drew, why do you run 100 miles?” I respond, ” Funny you ask, I was just wanting to ask why you don’t run 100 miles.” If we are built to move and built to run it’s really not so abnormal. Maybe the real abnormal is what we have normalized… physical inactivity. Okay, that is just a rant to get some emotion going. Think what you want about my opinion :) I guess before I truly stop that rant I must say I am not necessarily suggesting that everyone must run 100 miles; rather, I am arguing that moving for an extended period of time is not all so bad.

Two and a half weeks ago I ran the UROC 100k, a grueling 62 miles on the Colorado Trail and Copper Mountain trail system found in the heart of the Rockies. A race that either went up or down peaking four times close to 13,000 feet. It was a blast! Now, I find myself just 48 hours away from embarking on a journey that feels like a life of its own, the Bear 100.

44,000 feet of elevation change is what I will be attempting in this race. 100 miles of beautiful fall colors through the morning, day, night, and then morning again. Doesn’t that just sound exhilarating? Of course! Here’s what I am really facing though, trauma! Let me explain.

You always hear about the post 100 mile depression that some runners slip in to after completing a 100 mile race. It happens. As a psychologist and an endurance athlete I would venture to say this isn’t exactly termed accurately. I believe it is best defined as acute stress disorder, and I am serious. Acute stress disorder is what happens to someone after a significant trauma in their life and if the symptoms are prolonged for several weeks turns in to PTSD. As enjoyable a long race can be the body and mind experience multiple significant stressors that can be perceived as trauma by the body and deep in the brain, in the limbic system/amygdala to be precise. So, why do I talk this psychobable in relation to my current situation? Just keep reading…

I am not necessarily diagnosing myself with acute stress disorder from my last race, specifically because it is not interfering with my life; however, I am saying it is only natural to have some symptoms related to the trauma my body/mind went through 19 days ago. Now, I am preparing to toe the line in two days and I still get a little panicked when I reflect on the UROC 100k. This means that the moment my body/mind starts to struggle during this race I could be susceptible to a serious low spot and possibly threaten my race. And that, my friend, is why I am attempting two big races so closely together. It is my attempt to see how deep I can go. It is to see if I can Endure. It will only only allow me to grow as a person.

The question is still sitting there unanswered, “How do you prepare for the recent trauma being triggered in this race, Drew?” In the therapy I use most often, Brainspotting, we use a technique called “resourcing.” I adapt it to preparing for this race by spending a few minutes each day reflecting back on sensations in the body I felt during difficult times of the UROC race. When I allow my body to feel those sensations in present moment I then shift my attention to a full body scan to notice where I feel grounded, or tranquility, in any other area of my body. I breathe into that tranquility and ask my body what it needs to generalize that tranquility to the areas in my body that are associated with the traumatic sensations. As this happens, my heart rate slows and my blood flow shifts in my brain that allows me to feel like I am not in a threatening situation and the trauma is no longer happening. This preparation allows me to be ready for the moment during the race when I am triggered I can ground myself in the areas of my body that maintain any bit of tranquility. Geeeez, that is deep!

So, now I am sitting here driving across famous Wyoming. Well, I am not driving… that would be dangerous. I am enjoying this moment with my family and having conversations with my kids about dogs chasing cats, poop, and peeing on the side of the interstate, which is the true joy in life.

I hope you enjoy your week!

Dr Brazier

Running With, Not Away From, Emotion

11 May

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The past few moths have been riddled with high emotions and life challenges. I knew going into this race that I had a lot on my mind and a heavy heart. I could have just not run the race and avoided facing my deep thoughts; however, that would be weak. I could have turned to substances to “numb” the pain, but that is not an option. Instead, I chose to take off into the woods all day and allow myself to process some deep, deep thought and emotion. 

Sitting on a rock about 30 yards off the trail on top of a mountain I found myself on my knees in thought and prayer. About 13 miles into the Quad Rock 50 tears began to fill my eyes and they could not stop. I did not want other runners to worry for me, as ultra runners care about one another and surely would check in on me. Thus, I wandered off course and spent a painful 20 minutes allowing the anguish to run its course. The emotion was strong. However, I could not be hypocritical and try to avoid emotion. After all, I teach people every day the importance of sitting with feelings. There is no such thing as negative emotion. It might be painful but it’s not negative. 

After a good 20 minutes passed I felt more calm and ready to keep running. I thoroughly enjoyed the summit of Horsetooth Mtn. and the steep trails. I found myself experiencing drastic shifts of emotion. I didn’t try to tune out anything.  I wasn’t there to win the race. I was there for training and to finish…and enjoy running in such a gorgeous environment.About every hour I found myself wandering off to a rock sometimes sitting and sometimes kneeling. As the race went on I noticed more energy and good physical strength. I felt, and feel, great physically. 

I’ve never won an ultra marathon; in fact,  the best I’ve done is 3rd on a 12-hour race. I’ve never been last in an ultra marathon either. Usually, I finish in a reasonable time, and if it’s not reasonable I at least finish :) Nonetheless, I woke up this morning feeling so positive and a much stronger man for allowing myself to experience and not avoid and to finish hard things! 

 

 

The Truth about Running a 100 Mile Race: A Psychologists Take

3 Apr

I hear it all. “You’re crazy.” “You’re killing your body.” “You’re going to die.” “You’re an inspiration.” ….and the list goes on! Realistically, the majority of people inquisitively ask questions with the intent to learn and support. I would imagine you are reading this because you have your own questions. Let me answer questions that I hear all the time… and I’ll do so while wearing my psychologist and endurance runner hats! 

Why do people run for 100 Miles? Are you just addicted to running?

It is possible I’m addicted. In fact, let’s say I am? How bad of an addiction is it if I am home from my training runs in time so that my kids have no idea that I just ran 30+ miles? After all, the rule is no matter how far I train in the morning I cannot be grumpy during the day. So, if it’s an addiction I am going to be grateful I am addicted to this! 

I run 100 miles because…. um…. because why the heck would I not? My candid response to such a question is why aren’t you running 100 miles? 100 mile races are ran typically (well the one’s I most prefer) on dirt trails in the middle of the most beautiful mountains surrounded by incredible landscape and animals of different kinds. Running 100 miles is like hiking on steroids. You get to see soooo much in a short amount of time! 

From a psychologists perspective… I run 100 miles because when I run I feel freedom and control. Control??? You might ask if I am a control freak? Um, nope! In life, control is what we are ALL searching for. We all want to at least feel like something is in control. We get depressed or anxious and it is because we feel like things are out of our control (sure, there is a lot more to it than that but control is a huge part). So, how does running  100 miles give me control? It actually makes you give away most all control in the process but when finished I feel like I can be faced with any challenge and overcome whatever is thrown at me in life. Thus, feeling like I can face life challenges in a more confident and competent manner gives me a sense of control in life. Isn’t it interesting how letting go completely of control and being vulnerable can lead to a greater sense of control? 

Doesn’t it Hurt?

Yes. It hurts. And your point is? It doesn’t injure me though. In fact, I have not missed a scheduled day of running over the past 4 years due to a running induced injury. 

From a psychologists perspective… learning to not avoid pain is key to working with physical pain in life. So, experiencing some pain while running far actually helps me not avoid pain when it comes in other areas of life. Instead, I fully accept whatever pain as an indicator that something is going on and not the end of the world. 

 

Running that Far Ruins Your Knees, Don’t You Know That?

That is a cop out. Seriously, don’t ever ask me that. This kind of a question makes me want to vomit. That’s my answer. :) Frankly, there is no research that I’ve seen that says we weren’t built, as humans, to run and move. So if that is so then why would it be bad to do what we were built to do. 

I hear from my friends who are medical doctors and surgeons that they see people with knee problems and its because of running. Yeah, they don’t have me convinced. There is a thing called “extraneous variables.” If you can cut out all other reasons (i.e. bad running form, arthritis, stupid shoes, torn ligaments, and so much more) and there is still a knee issue then maybe I’ll believe you. But if it’s so bad then why do I see see 60 and 70 year old running friends out on the trails. Maybe you’re running on the wrong surface… dirt won’t hurt! Most of my friends who have been running for years and actually have a good medical doc who knows what they’re saying will tell them their running has strengthened their knees. 

From a psychologists perspective… we all look for excuses. Instead, look for excuses as to why something might be good for you before throwing in the towel. 

Do You Sleep?

Not that I know of. :) Seriously, I am sure I drift in and out of 1st stages of sleep. However, some of my friends will actually lay down and sleep for a bit. 

From a psychologist perspective…. Um… yeah I don’t know that I sleep. My honest thought is that we are a people full of all kinds of sleep problems. I sleep like a rock several nights a week and I figure it won’t harm me to miss a night of sleep a few times a year. The only side effect I really experience while not sleeping for the night of a race is temporary psychosis. Sure, I have seen turtles in the mountains and gnomes in the forest. But I don’t find that as a problem. It makes for an odd experience is all. 

 

 

 

 

 

Testosterone: ManPression Tip#4

15 Oct

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As I mentioned in the first post of this series, low testosterone can lead to depressive symptoms. If the levels are not normalized, you likely will not overcome these symptoms. 

You are not doomed forever because you have low testosterone (low-T)! There are so many forms of treatment for low-T. You are not being dishonest nor doing something illegal by low-T. That being said, treatment for low-T should not be willy nilly going into some vitamin store and grabbing something off of the shelf. PLEASE, talk with your med doc. Your doc will likely refer you to another medical professional who specializes in low-T. ASK QUESTIONS!!! Learn about alternatives. If you and the professional feel injections is your best option then go with what you two decide… but push the issue to discuss all possible options. 

Some research does state that Low-T can be increased by effective psychotherapy. Frankly, I believe you should get your testosterone checked and monitored by your med doc while engaging in therapy. That would be best case scenario. 

Losing weight (if you have weight to lose) can be helpful with increasing low-T. Belly fat uses more testosterone and can lead to lower levels. So, now might be a good time to start looking at how you can drop a few pounds and let that supplement your efforts!

A couple words of caution… talk with the specialty doc about testosterone and fertility. If you are planning to have more children you will want to make sure that is discussed with your med doc. Also, do not ever entertain the idea of exceeding normal levels of testosterone. Low-T treatment is only intended to restore you to normal levels. 

Here’s to some good testosterone!!! 

Dr. Drew Brazier

 

*If you, or someone you know, are experiencing a mental health emergency please go to the nearest emergency room or dial 911. These tips are not to be used in times of crisis.

Stop it at the 1st Layer: ManPression Tip #3

14 Oct

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Would you think I am off my rocker if I recommended that you might be better off if you just allow yourself to be depressed? Yeah, that could be pretty messed up of me to say! So, hear me out…

Women tend to actually feel the emotions, sensations, and thoughts associated with depressive symptoms. In contrast, us men try to completely avoid the emotions. We avoid the emotions with drinking a few too many cold ones, engaging in reckless behavior, gambling, and by simply pretending that we don’t have emotions. You see the problem here is that we are creating a second layer of depression, which leads to more shame, guilt, and even embarrassment about feeling depressive symptoms.

Boys are taught from a young age to hide emotions. A little girl falls while playing and we typically are quick to console her and accept crying. A little boy falls and we tell him to get up and be tough. This is not because we are just all horrible parents. This is because society trains us to allow women to feel and men should not express what they feel.  I think we should look at some data to see if this is helping… for every 1 women who commits suicide there are 5 men committing suicide. This could tell us that women can express when they feel awful and men cannot express it and just take care of the problem by ending everything.

So, stopping it at the 1st layer might sound overwhelming. It is not a simple task. I am asking you to do more noticing of your emotions and thoughts. In order to do more work on being aware of what is actually going on, you are being asked to stop avoiding, stop pretending :) So, what to do instead? Start exercising. Lets face it… exercise is just as, if not more, effective than antidepressants. That is not just my opinion… that is actual reputable research! My opinion is exercise is much more effective than antidepressant medication!!! Start small. The trick is to exercise before you allow yourself to choose if you want to exercise or not. This means go early in the morning or during lunch. You won’t become motivated to do it until you have been out doing it for 5-10 minutes. Just start with walking each day for 20 minutes.

I would also invite you to start taking a couple of notes. I know… journaling is so lame and only for women, or so they say. Don’t look at it as journaling. I just want you to take some notes :) Each day just write down what you are experiencing physically. Did you have headaches, body aches, stiffness, racing heart, fatigue, etc… Don’t start with your emotions and thoughts. Start with noticing how your body is feeling each day. Just check in a little bit and notice what you are experiencing! Not too hard, right?

Make it a great week!

Dr Drew Brazier

*If you, or someone you know, are experiencing a mental health emergency please go to the nearest emergency room or dial 911. These tips are not to be used in times of crisis.

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