WEBVTT
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Hello, hello, hello friends.
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You are listening to Simpli Mental.
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Welcome to the podcast where we simplify everything about mental health.
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Just kidding.
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But here's what we are gonna do.
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We're gonna sit down together, a licensed mental health professional, that's me, and a regular old Joe, as my husband Garth would describe himself.
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We're gonna talk about the nitty-gritty of the MBR, some nervous system mapping, how couples can help each other heal, what's healthy parenting actually look like, maybe a little bit of good old banter mixed in.
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All with the goal of making mental health a little bit simpler for you.
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Quick note, because my lawyer says that I have to, I'm a therapist, but not your therapist, unless I am.
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Even if I am, this is still just a podcast, okay?
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Now have a good listen.
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Hello, friends.
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Thank you for joining us today.
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We are continuing our series on EMDR 4.
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And today we are talking about EMDR for depression.
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Yay!
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So we are, as always, going to try to keep it short.
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But if you've listened to at least one other episode, you know that that is not typically how this plays out.
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We bant a little bit at the beginning.
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So if you want to try to uh roll right through that, you can.
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But we will bant and then we will go over the primary things that I want to focus on today, Garth, or how do we approach depression differently with EMDR when we are dealing with an actual diagnosis of major depressive disorder and when we're dealing with depressive symptoms as a result of trauma.
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So I want to chat about that a little bit.
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Our goal in this EMDR 4 series is not that we cover everything about how we would address depression with EMDR, but we just give you a couple nuggets of things to really take away and think on.
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We did the same with EMDR4 anxiety in our last episode.
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There's no way that we're going to cover everything related to that in 20 to 30 minutes, but we'll talk about what I find most interesting and then see what comes up for you.
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Sound good?
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Yep.
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I ask questions.
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Okay.
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Well, speaking of, what is your bant question for the day?
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All right.
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This one we're gonna try to keep it brief, but this may take some explanation.
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Oh boy.
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What is your favorite pizza?
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Not place, but like describe it.
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What what makes a good pizza to you?
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This is kind of sad.
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We're having pizza for dinner tonight.
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So my gluten-free self misses very few things, but pizza is one of them.
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Yes.
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What describes a perfect pizza to me?
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Like if I'm wanting to have like what I think is legitimately the best pizza, obviously it wouldn't be gluten-free, and it would be a deep dish Chicago pizza.
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Yeah.
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Lots of mushrooms.
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Like lots and lots and lots of mushrooms.
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A beef sausage mix.
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It's really the only time I like sausage, is whenever it's on a pizza.
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Some, you know, really, really well cooked peppers.
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Don't like them to be crispy at all.
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Like them to really like see, I didn't know that.
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I thought you liked the crunch of the peppers.
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I in other dishes I do, but in pizza, I want it to be like soft.
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I'm actually fairly particular about pizza.
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I know what I like with pizza.
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You know this about me.
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I'm not much of a food eater.
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Yeah, you joke all the time, like I don't care what it tastes like, but boy, water is your number one.
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My gosh.
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For someone that doesn't really care what food tastes like very much, you get a glass of water that it has any sort of a mineral combination you don't like.
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Pizza's probably the same way.
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I dissect pizza.
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Like I really, really love pizza.
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Okay.
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So for thing, I really, really love water too.
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That's true.
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If you're passionate about it.
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So anyway, yeah, if I were to choose the perfect pizza, it would be deep dish Chicago style, lots and lots of cheese, lots and lots of mushrooms, well-cooked peppers and onions, and some beef and sausage mix.
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That would be Chef's Kiss.
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What about you?
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What would you make, Chef?
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Man, so I I'm a really, I guess, simpler person when it comes to pizza.
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Like a perfect pizza to me, you have to have really good dough, right?
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The crust has to be like chewy and bubbly and stretchy but crisp on the outsides and the bottom.
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And then as far as toppings, man, hit me with some cheese and maybe just like a little bit of pepperoni.
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Yeah.
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If it's like good, if it's all good, that's can't beat that.
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Yeah.
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You know, bacon and sausage, pretty good too.
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Some mushrooms, onions.
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Bacon jalapeno is a good combo.
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I like a good bacon jalapeno, but yeah.
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For me, it's more about the crust.
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What the toppings are kind of the it's yeah.
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The the crust is where it's at for me.
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I I would actually agree, and I didn't really comment on the crust other than I'd want a deep dish pizza.
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And this makes me think I have mastered pie crust, gluten-free pie crust.
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I should make pizza for the family one night with my gluten-free pie crust and just see what happens.
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Yeah, see how it goes.
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Yeah.
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Because I really, really love my well, it's my grandma's pie crust recipe just amended with gluten-free flour a little bit.
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So anyway.
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Yeah.
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Okay.
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Okay.
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There we go.
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Now you know a little bit about our pizza preferences.
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If you want to lure me into a dark alley, just talk about the chewiness of the crust and I'll come check it out.
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I will not follow you into a dark alley for pizza.
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But yeah, Garth will.
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So lure lure him.
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Okay.
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So bant, done.
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Pizza, wonderful.
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I think we can all agree.
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Are you ready to roll into our topic for the day?
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I am ready.
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Okay.
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So for simplicity's sake, I'm going to talk about how depression, how depressive symptoms show up in PTSD, post-traumatic stress disorder, and MDD, major depressive disorder.
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Okay.
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So when people say they're diagnosed with depression, often it's major depressive disorder.
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Sometimes it's dysthymia.
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But for the sake of this podcast, we're not going to get into the different depressive diagnoses that someone could receive.
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We're just going to focus on PTSD and MDD.
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Sounds great.
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Okay.
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So PTSD, we've talked a lot about on the podcast, but it's a condition that develops after exposure to trauma.
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The brain and the body stay stuck in threat mode even after the danger is over and sometimes long, long over.
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Major depressive disorder is a move disorder.
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You know, is characterized by persistent depression, which can show up as like a loss of interest in things that somebody typically enjoys, changes in sleep patterns, changes in appetite, being fatigued, having low energy, feeling guilty, worthless, sometimes having suicidal thoughts as well.
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The criteria for this is that it lasts more than two weeks.
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Oftentimes, by the time a client actually comes into therapy, it's lasted much longer than two weeks.
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But that's the minimum that has to be met.
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Okay.
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So depressive symptoms can show up, and they do oftentimes show up within PTSD.
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So the depressive symptoms are showing up within both of these disorders.
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It can be very difficult to differentiate between the two of them.
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The good thing is, before we kind of get into the nitty-gritty of how we respond to both of these disorders, the good thing is that therapists' clinicians don't have to get a diagnosis accurate right off the bat in order for EMDR to be effective in treating depressive symptoms.
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Okay.
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So if, for instance, a clinician would misdiagnose you with PTSD, but a more appropriate diagnosis would be major depressive disorder, you likely have some trauma in your history that is exacerbating, that's making worse your depressive symptoms, even though your diagnosis, your primary diagnosis is major depressive disorder.
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In doing EMDR with this clinician, as long as it's done effectively, you're still going to have symptom reduction.
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It's just that if your primary diagnosis is major depressive disorder, EMDR is more of a helper in your treatment for that.
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It's not the primary treatment.
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And so if you are going to therapy and you've done a lot of EMDR work and you've noticed some symptom reduction, but you're not noticing as much symptom reduction as you would like, maybe it's because you don't meet criteria for a PTSD diagnosis and something like major depressive disorder is more appropriate.
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So I just wanted to throw out there before we kind of get in the nitty-gritty of all of this that you don't have to know what's going on right off the bat for EMDR to help.
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And your therapist doesn't even have to know right off the bat what's going on.
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It's all about symptom reduction.
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Do I eventually want clinicians to arrive at an accurate diagnosis?
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Yes.
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And I will say we can misdiagnose in other instances and it be very harmful.
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And in the extreme cases, even in this instance, right?
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Like if I if I go see a clinician and I'm experiencing really significant suicidality and they're just treating me for PTSD when I actually have major depressive disorder, that's a a problem.
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That's a problem.
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Yeah.
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Yeah.
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And likewise, if I'm being put on an antidepressant, especially like for adolescents that are misdiagnosed with major depressive disorder and they actually have PTSD, if I'm being put on an antidepressant and I actually have PTSD, but you know, that could lead to increase in symptoms.
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So there are extreme cases where that misdiagnosis can cause problems.
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But oftentimes we don't have to get that diagnosis exactly right in order for EMDR to be effective and for it to lead to harm reduction.
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So I just want to take that pressure certainly off clients, but to some degree off clinicians as well.
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Okay.
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So what's going on with PTSD?
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Why would someone with PTSD be presenting with depressive symptoms?
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So we talked in the last episode about why someone who had experienced trauma would present with anxiety.
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Yeah.
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We had talked about if I'm perceiving the world as unsafe, if I have the thought process that I'm never going to be able to keep myself safe, we better hope that my body responds with anxiety.
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Right.
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Right.
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So the same system that creates feelings of anxiety as a result of trauma is the system that creates depressive feelings as a result of trauma.
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The system with anxiety is very activated, and the system with depressive symptoms is very fatigued.
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Okay.
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Okay.
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So the stress system is the HPA axis.
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So the HPA access is again activating anxiety for us.
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But when that HPA axis becomes fatigued, but we have stressors, it results in depressive symptoms.
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What what's the HPA axis?
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Yeah.
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As I raise my hand.
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I was just going to say as he raises his hand in the air.
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Okay.
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So the HPA axis is a communication loop between the hypothalamus, the pituitary gland, and the adrenal glands.
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Okay.
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Okay.
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So the hypothalamus is a control center in the brain.
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The pituitary gland is the brain's hormone messenger, and the adrenal glands actually sit on top of our kidneys.
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Huh.
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Yeah.
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So this is a real, like actual physical loop.
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Well, that's not in your brain.
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Right.
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Oh my goodness, you're the rest of your body's involved in like a stress response.
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I don't believe it.
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You're kidding me.
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So it's an actual physical loop, but it's a feedback loop.
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Its job is to detect danger, release stress hormones, particularly cortisol.
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It can help you in small doses to wake up, to focus, in larger doses to react to threats.
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In a healthy system, our cortisol is naturally rising in the morning.
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It's dropping at night.
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It's spiking briefly during stress.
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And then it's returning to baseline pretty quickly.
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Okay.
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A fatigued system is not going to function in that way.
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So a trauma or prolonged stress is signaling to the body there's danger, there's danger, there's danger.
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The HPA axis stays activated way too long.
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I've talked about this book before, but I want to reference the deepest well.
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If you want to have some really good examples of the HPA axis being activated too long, Dr.
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Nadine Burkaris walks you through it really well.
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I would recommend giving her book, The Deepest Well, a read.
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So the HPA axis stays activated for way too long.
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Cortisol release becomes dysregulated.
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It's not in its normal rhythm that we just described.
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It's just kind of all over the place.
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And the body never really fully returns to a rest and repair state.
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So eventually we get to this place called cortisol fatigue.
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The more accurate term really is HPA access dysregulation.
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The system is misfiring rather than really burned out.
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What happens from there?
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Yeah.
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What happens from there?
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You are on top of it today.
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What happens from there is we are constantly alert, hyper-vigilant, or we're in emotional shutdown.
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Which is that depressive.
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So it's kind of two sides of the same coin.
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Like Yep.
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Anxiety and again, the same system that's causing anxiety as a result of trauma is also causing a depressive state because of trauma.
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Poor sleep, memory and concentration problems, immune and inflammatory issues, deep physical and mental exhaustion.
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Yeah.
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The exhaustion can look a lot like depression, but it is coming from a survival system that will not turn off.
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You are, this oversimplifies it, but you are internally running a marathon on that HPA axis.
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Now I think that when I have read a little bit about cortisol fatigue, it's almost it can be presented like we hit this point where we dip into cortisol fatigue.
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And that that is true, but what I what I want to make clear today is it's not like this system gets exhausted and then it stays exhausted and you're in a depressive state all the time.
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As a result of trauma, people can switch back and forth between anxiety symptoms, depressive symptoms, anxiety symptoms, depressive symptoms.
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Does that make sense?
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Yeah, it does.
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It also makes sense that it might be what you're saying is that don't think of this loop as turning on and then turning off.
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Think of it as it's on and it's working over time.
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It's on and it's working over time, and that's the anxiety.
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It's constantly firing versus it's on all the time, but it's like spinning your wheels stuck in snow.
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You know, it's funny.
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Yes.
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I was going to say as you were starting, we paused for a second, and our almost nine-month old is with us now, so you might hear her in the background.
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But as we were processing for a second, the example I was thinking of was like horses drawing, horses, horses pulling a cart.
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Yeah, yeah.
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Right?
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That they're pulling it always, but sometimes they're going uphill in the mud, right?
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And so, yeah, similar example.
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Yes.
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So with PTSD, the core problem is the nervous system is stuck in survival mode.
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Common depressive symptoms, emotional numbness, clients will sometimes describe like just feeling blank, exhaustion that sleep doesn't ever seem to fix, depression that flares with stress or reminders of a traumatic event, dissociation, so feeling unreal or detached from your body, that could be an entire episode in and of itself.
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And then physical symptoms, pain, gut issues, unexplained headaches, things like that.
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Really important differentiation: mood improves when the nervous system feels safer, even temporarily.
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Okay.
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So there are a few things that we want to watch out for that would indicate that this is PTSD with depressive symptoms versus a depressive disorder like major depressive disorder.
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And that is really the starting point.
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Does the mood of the client improve when the nervous system feels safer?
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Yeah.
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Even temporarily?
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So I'll give you an example that's come up with a lot of my clients.
00:19:06.160 --> 00:19:14.160
I work with a lot of clients that are very high achieving, and in their childhoods, they were their families were impoverished.
00:19:14.480 --> 00:19:24.640
And whenever they have something come up that impacts their finances, they will oftentimes notice a significant increase in depressive symptoms.
00:19:24.880 --> 00:19:32.240
And then whenever something shifts financially for them, those depressive symptoms almost immediately subside.
00:19:32.400 --> 00:19:33.759
Well, why is that?
00:19:38.000 --> 00:19:38.640
Right.
00:19:39.039 --> 00:19:39.359
No.
00:19:39.680 --> 00:19:45.279
It was dealing with a threat that has now been negated.
00:19:45.359 --> 00:19:48.480
And ready to resolve, yeah, whatever you want to call it.
00:19:49.119 --> 00:19:49.359
Yeah.
00:19:49.680 --> 00:19:50.400
Does that make sense?
00:19:50.640 --> 00:19:50.960
Makes sense.
00:19:51.920 --> 00:19:52.319
I think so.
00:19:52.559 --> 00:19:59.200
So then with MDD, the core problem is a disruption in the mood and reward systems of the brain.
00:19:59.359 --> 00:20:03.839
So same symptoms or similar symptoms, totally different issue.
00:20:04.000 --> 00:20:07.839
So with MDD, we have a problem with neurotransmitters.
00:20:08.079 --> 00:20:17.039
Serotonin impacts mood stability, dopamine impacts motivation and pleasure, neuroepinephrine impacts energy and alertness.
00:20:17.200 --> 00:20:21.279
So when we look at all these things, mood stability, motivation, energy and alertness.
00:20:22.400 --> 00:20:35.519
The opposite of those, mood instability, decreased motivation and enjoyment, fatigue and difficulty concentrating, that's depression.
00:20:35.680 --> 00:20:35.920
Yeah.
00:20:36.160 --> 00:20:36.480
Right.
00:20:36.640 --> 00:20:43.839
And so if we're having a problem with this mood and reward system, then we have a depressive disorder.
00:20:44.079 --> 00:20:52.400
So serotonin, dopamine, noroepinephrine, these are all brain chemicals that are used and that communicate with one another.
00:20:55.599 --> 00:21:19.279
Okay, some common symptoms that result because of MDD persistent sadness or heaviness, loss of interest or pleasure, low self-worth, guilt or shame, slowed thinking or movement, suicidal thoughts tied to hopelessness, depression feels constant, not threat triggered.
00:21:19.359 --> 00:21:29.920
So remember we said earlier that if the symptoms are as a result of a threat increasing, then it's likely due to PTSD.
00:21:32.799 --> 00:21:46.319
Okay, so Garth, without going over everything, before we move on, I want to kind of summarize what we see as the key differences between PTSD related depression and MDD.
00:21:46.880 --> 00:21:47.759
Lay it on me.
00:21:47.920 --> 00:21:48.240
Okay.
00:21:48.720 --> 00:21:50.400
PTSD related depression.
00:21:50.559 --> 00:21:56.079
Symptoms rise and fall with perceived safety, stress levels, interpersonal conflict.
00:21:56.240 --> 00:21:58.400
So conflict within relationships.
00:21:58.799 --> 00:21:59.519
MDD.
00:22:00.240 --> 00:22:01.839
Can start without trauma.
00:22:02.000 --> 00:22:11.039
Episodes can recur even during calm or happy periods, less sensitive to external safety cues.
00:22:11.279 --> 00:22:19.119
I want to make a note that I didn't make earlier, and that is sometimes people are very unaware of their triggers.
00:22:19.279 --> 00:22:20.480
Like very unaware.
00:22:20.880 --> 00:22:21.119
Yeah.
00:22:21.359 --> 00:22:28.160
And so they can assume that we're dealing with MDD or a depressive disorder.
00:22:28.559 --> 00:22:31.279
When it's just something that is like in their life all the time.
00:22:31.519 --> 00:22:35.680
When it when it's actually PTSD related depression, they just don't know what their triggers are.
00:22:35.839 --> 00:22:38.480
They don't know their triggers well enough to know that they're being triggered.
00:22:38.559 --> 00:22:39.119
Does that make sense?
00:22:39.279 --> 00:22:40.000
That makes complete sense.
00:22:40.240 --> 00:22:46.000
So that's one of the ways in which a client reporting can result in misdiagnosis.
00:22:46.240 --> 00:22:49.200
And again, that happens.
00:22:49.440 --> 00:22:51.599
It it can be okay.
00:22:51.839 --> 00:23:04.240
I don't want to spend too much time discussing that again because I did at the beginning of the episode, but those are the key differences between PTSD-related depression and MDD.
00:23:04.880 --> 00:23:07.039
Okay, why do they overlap so much?
00:23:07.200 --> 00:23:11.119
PTSD-related depression can meet full criteria for MDD.
00:23:11.599 --> 00:23:13.680
Many clinicians diagnose both.
00:23:13.839 --> 00:23:16.960
There is no blood test that cleanly separates them.
00:23:17.200 --> 00:23:20.640
Long-term stress can cause true MDD over time.
00:23:21.359 --> 00:23:23.359
So this isn't either or.
00:23:28.000 --> 00:23:29.200
That also makes sense.
00:23:29.519 --> 00:23:30.640
It also makes sense.
00:23:30.880 --> 00:23:47.279
I say all that to say, like, okay, if you experienced chronic relational trauma in childhood, could that eventually disrupt your system to the degree that you are having trouble with those neurotransmitters that we discussed earlier?
00:23:47.440 --> 00:23:49.680
serotonin, dopamine, norepinephrine?
00:23:49.920 --> 00:23:50.480
Yes.
00:23:50.720 --> 00:24:03.839
And then at that point, even if your trauma is desensitized, do we right away get back to normal functioning in neurotransmitters?
00:24:04.079 --> 00:24:04.400
No.
00:24:04.880 --> 00:24:05.519
Right.
00:24:06.400 --> 00:24:21.039
And I want to also say that I think that some clinicians are starting to approach diagnoses as all always completely trauma-based, that there's always a trauma foundation.
00:24:21.359 --> 00:24:21.680
Okay.
00:24:21.920 --> 00:24:30.799
And where I want to push back on that is we can be born with different functioning in all of our body.
00:24:31.039 --> 00:24:40.319
And I think when it comes to like our kidneys, of course, someone would accept that our not everyone's kidneys function exactly the same at birth.
00:24:40.559 --> 00:24:44.799
People have different functioning kidneys on a spectrum, right?
00:24:45.119 --> 00:24:45.599
Yeah.
00:24:45.920 --> 00:24:52.720
And in the same way, people are born with different functioning of these neurotransmitters.
00:24:52.960 --> 00:25:00.319
And so some people have beautiful childhoods and their neurotransmitters are still not functioning optimally.
00:25:00.559 --> 00:25:01.680
Yeah, that makes sense.
00:25:02.000 --> 00:25:10.880
And so they are probably going to eventually want to do a treatment like start an antidepressant.
00:25:11.119 --> 00:25:17.279
They are wanting wanting, going to want to do, excuse me, more cognitive-based therapies.
00:25:17.519 --> 00:25:24.000
They're going to want to do behavioral activation where they gradually like re-engage with life.
00:25:24.160 --> 00:25:27.200
Now, can EMDR be a component for them?
00:25:27.519 --> 00:25:28.400
Probably.
00:25:28.640 --> 00:25:35.759
But they're going to want to focus on other treatments if EMDD, if EMDD is their primary diagnosis.
00:25:35.920 --> 00:25:37.599
Oh, I am starting to trip up on words.
00:25:37.680 --> 00:25:38.480
I'm trying to talk fast.
00:25:38.880 --> 00:25:39.920
So many acronyms.
00:25:40.160 --> 00:25:40.799
I know.
00:25:41.680 --> 00:25:42.000
Okay.
00:25:43.519 --> 00:25:46.559
So here's where we're going to wrap up.
00:25:46.960 --> 00:25:50.720
I feel like we've done this justice.
00:25:51.680 --> 00:26:02.160
EMDR can be helpful in reducing depressive symptoms in a majority of cases, a majority of clients that clinicians see.
00:26:03.200 --> 00:26:11.359
As far as differentiating between the two diagnoses, ask yourself: did this begin after a trauma or prolonged stress?
00:26:11.519 --> 00:26:14.880
That's harder to determine when the trauma is chronic trauma.
00:26:15.440 --> 00:26:24.480
Does safety or calm in the client's life reduce symptoms pretty dramatically and pretty quickly?
00:26:25.039 --> 00:26:28.160
Does stress make symptoms dramatically worse?
00:26:28.559 --> 00:26:31.440
Those are three really important questions.
00:26:31.839 --> 00:26:42.319
Depression, if it feels persistent, self-generating, detached from circumstances, EMDD is probably the primary diagnosis.
00:26:42.559 --> 00:26:47.839
Thank you, Miss almost nine-month-old for joining us.
00:26:48.079 --> 00:26:48.720
Yeah.
00:26:48.960 --> 00:26:49.359
Yeah.
00:26:49.519 --> 00:26:51.920
Are you about done with this podcast?
00:26:52.240 --> 00:26:53.599
Are you about done?
00:26:53.839 --> 00:26:57.279
Okay, we are being directed to wrap up.
00:26:57.519 --> 00:26:57.839
Yep.
00:26:58.000 --> 00:26:59.519
Producer says it's time to go.
00:27:01.119 --> 00:27:02.480
This was a lot of information.
00:27:02.640 --> 00:27:04.319
We really tried to run through it.
00:27:04.480 --> 00:27:07.519
Thank you for listening to our EMDR 4 series.
00:27:07.680 --> 00:27:13.519
If you are a clinician and you want to reach out for consultation, I am an EMDR consultant now.
00:27:13.680 --> 00:27:24.400
You can go to my website, scenTherapy.org, and click on any of the buttons that are prompting you to click on them and set up some consultation with me.
00:27:24.640 --> 00:27:33.519
If you are a potential client and you heard some symptoms that sound really familiar today, we are also happy to serve you.
00:27:33.920 --> 00:27:35.839
Thank you so much for listening.
00:27:36.079 --> 00:27:37.200
Have a great day.
00:27:37.359 --> 00:27:38.559
We appreciate you all.
00:27:38.720 --> 00:27:39.279
Bye-bye.
00:27:39.519 --> 00:27:40.000
Bye.
00:27:40.799 --> 00:27:42.400
Well, that's all, folks.
00:27:42.559 --> 00:27:47.039
Please see our show notes for ways to connect with us or go give us a follow on Instagram.
00:27:47.200 --> 00:27:49.279
You can find us at Simply Mental.
00:27:49.440 --> 00:27:52.400
If this episode resonated with you, send it over to a friend.
00:27:52.559 --> 00:27:59.039
Give us a five star rating, subscribe, download all the things the cool kids are doing these days.
00:27:59.279 --> 00:28:00.720
Thanks for having me listen.
00:00:00.239 --> 00:00:01.840
Hello, hello, hello friends.
00:00:01.919 --> 00:00:04.320
You are listening to Simpli Mental.
00:00:04.480 --> 00:00:08.160
Welcome to the podcast where we simplify everything about mental health.
00:00:08.480 --> 00:00:09.199
Just kidding.
00:00:09.359 --> 00:00:10.560
But here's what we are gonna do.
00:00:10.720 --> 00:00:18.239
We're gonna sit down together, a licensed mental health professional, that's me, and a regular old Joe, as my husband Garth would describe himself.
00:00:18.399 --> 00:00:29.199
We're gonna talk about the nitty-gritty of the MBR, some nervous system mapping, how couples can help each other heal, what's healthy parenting actually look like, maybe a little bit of good old banter mixed in.
00:00:29.359 --> 00:00:33.039
All with the goal of making mental health a little bit simpler for you.
00:00:33.359 --> 00:00:38.719
Quick note, because my lawyer says that I have to, I'm a therapist, but not your therapist, unless I am.
00:00:38.880 --> 00:00:41.840
Even if I am, this is still just a podcast, okay?
00:00:42.159 --> 00:00:43.759
Now have a good listen.
00:00:44.960 --> 00:00:46.880
Hello, friends.
00:00:47.520 --> 00:00:49.439
Thank you for joining us today.
00:00:49.600 --> 00:00:54.320
We are continuing our series on EMDR 4.
00:00:55.759 --> 00:01:00.079
And today we are talking about EMDR for depression.
00:01:01.119 --> 00:01:01.759
Yay!
00:01:04.799 --> 00:01:09.120
So we are, as always, going to try to keep it short.
00:01:09.200 --> 00:01:14.879
But if you've listened to at least one other episode, you know that that is not typically how this plays out.
00:01:15.200 --> 00:01:17.040
We bant a little bit at the beginning.
00:01:17.120 --> 00:01:21.040
So if you want to try to uh roll right through that, you can.
00:01:21.280 --> 00:01:43.760
But we will bant and then we will go over the primary things that I want to focus on today, Garth, or how do we approach depression differently with EMDR when we are dealing with an actual diagnosis of major depressive disorder and when we're dealing with depressive symptoms as a result of trauma.
00:01:44.159 --> 00:01:46.799
So I want to chat about that a little bit.
00:01:46.959 --> 00:02:01.280
Our goal in this EMDR 4 series is not that we cover everything about how we would address depression with EMDR, but we just give you a couple nuggets of things to really take away and think on.
00:02:01.439 --> 00:02:04.719
We did the same with EMDR4 anxiety in our last episode.
00:02:04.879 --> 00:02:15.759
There's no way that we're going to cover everything related to that in 20 to 30 minutes, but we'll talk about what I find most interesting and then see what comes up for you.
00:02:16.000 --> 00:02:16.560
Sound good?
00:02:16.800 --> 00:02:17.039
Yep.
00:02:17.120 --> 00:02:18.319
I ask questions.
00:02:18.560 --> 00:02:18.879
Okay.
00:02:20.319 --> 00:02:24.000
Well, speaking of, what is your bant question for the day?
00:02:24.240 --> 00:02:24.639
All right.
00:02:24.960 --> 00:02:29.439
This one we're gonna try to keep it brief, but this may take some explanation.
00:02:29.599 --> 00:02:30.240
Oh boy.
00:02:30.479 --> 00:02:33.120
What is your favorite pizza?
00:02:33.360 --> 00:02:35.680
Not place, but like describe it.
00:02:35.840 --> 00:02:38.159
What what makes a good pizza to you?
00:02:39.680 --> 00:02:40.719
This is kind of sad.
00:02:40.800 --> 00:02:42.479
We're having pizza for dinner tonight.
00:02:42.960 --> 00:02:48.400
So my gluten-free self misses very few things, but pizza is one of them.
00:02:48.800 --> 00:02:49.360
Yes.
00:02:49.680 --> 00:02:53.120
What describes a perfect pizza to me?
00:02:54.479 --> 00:03:03.759
Like if I'm wanting to have like what I think is legitimately the best pizza, obviously it wouldn't be gluten-free, and it would be a deep dish Chicago pizza.
00:03:04.159 --> 00:03:04.479
Yeah.
00:03:04.719 --> 00:03:06.240
Lots of mushrooms.
00:03:06.479 --> 00:03:09.599
Like lots and lots and lots of mushrooms.
00:03:09.919 --> 00:03:11.360
A beef sausage mix.
00:03:11.439 --> 00:03:15.759
It's really the only time I like sausage, is whenever it's on a pizza.
00:03:16.560 --> 00:03:21.840
Some, you know, really, really well cooked peppers.
00:03:22.400 --> 00:03:24.080
Don't like them to be crispy at all.
00:03:24.400 --> 00:03:26.400
Like them to really like see, I didn't know that.
00:03:26.479 --> 00:03:28.400
I thought you liked the crunch of the peppers.
00:03:28.639 --> 00:03:32.719
I in other dishes I do, but in pizza, I want it to be like soft.
00:03:32.800 --> 00:03:34.800
I'm actually fairly particular about pizza.
00:03:34.960 --> 00:03:36.240
I know what I like with pizza.
00:03:36.319 --> 00:03:37.039
You know this about me.
00:03:37.120 --> 00:03:38.159
I'm not much of a food eater.
00:03:38.400 --> 00:03:44.719
Yeah, you joke all the time, like I don't care what it tastes like, but boy, water is your number one.
00:03:44.879 --> 00:03:45.759
My gosh.
00:03:45.919 --> 00:03:54.400
For someone that doesn't really care what food tastes like very much, you get a glass of water that it has any sort of a mineral combination you don't like.
00:03:54.719 --> 00:03:56.080
Pizza's probably the same way.
00:03:56.400 --> 00:03:57.919
I dissect pizza.
00:03:58.240 --> 00:04:01.120
Like I really, really love pizza.
00:04:01.360 --> 00:04:01.680
Okay.
00:04:01.919 --> 00:04:04.800
So for thing, I really, really love water too.
00:04:05.439 --> 00:04:06.639
That's true.
00:04:07.199 --> 00:04:08.639
If you're passionate about it.
00:04:09.360 --> 00:04:24.480
So anyway, yeah, if I were to choose the perfect pizza, it would be deep dish Chicago style, lots and lots of cheese, lots and lots of mushrooms, well-cooked peppers and onions, and some beef and sausage mix.
00:04:24.560 --> 00:04:26.399
That would be Chef's Kiss.
00:04:26.720 --> 00:04:27.279
What about you?
00:04:27.439 --> 00:04:28.639
What would you make, Chef?
00:04:28.959 --> 00:04:34.000
Man, so I I'm a really, I guess, simpler person when it comes to pizza.
00:04:34.240 --> 00:04:38.639
Like a perfect pizza to me, you have to have really good dough, right?
00:04:38.720 --> 00:04:46.319
The crust has to be like chewy and bubbly and stretchy but crisp on the outsides and the bottom.
00:04:46.639 --> 00:04:55.439
And then as far as toppings, man, hit me with some cheese and maybe just like a little bit of pepperoni.
00:04:55.680 --> 00:04:56.079
Yeah.
00:04:56.319 --> 00:04:59.279
If it's like good, if it's all good, that's can't beat that.
00:04:59.439 --> 00:05:00.079
Yeah.
00:05:00.319 --> 00:05:03.120
You know, bacon and sausage, pretty good too.
00:05:03.279 --> 00:05:04.560
Some mushrooms, onions.
00:05:06.720 --> 00:05:08.639
Bacon jalapeno is a good combo.
00:05:08.800 --> 00:05:12.000
I like a good bacon jalapeno, but yeah.
00:05:12.319 --> 00:05:13.759
For me, it's more about the crust.
00:05:14.079 --> 00:05:17.839
What the toppings are kind of the it's yeah.
00:05:18.000 --> 00:05:19.920
The the crust is where it's at for me.
00:05:20.319 --> 00:05:25.199
I I would actually agree, and I didn't really comment on the crust other than I'd want a deep dish pizza.
00:05:25.279 --> 00:05:29.839
And this makes me think I have mastered pie crust, gluten-free pie crust.
00:05:30.480 --> 00:05:37.759
I should make pizza for the family one night with my gluten-free pie crust and just see what happens.
00:05:38.000 --> 00:05:39.199
Yeah, see how it goes.
00:05:39.439 --> 00:05:39.839
Yeah.
00:05:40.079 --> 00:05:48.000
Because I really, really love my well, it's my grandma's pie crust recipe just amended with gluten-free flour a little bit.
00:05:48.079 --> 00:05:48.800
So anyway.
00:05:49.040 --> 00:05:49.360
Yeah.
00:05:49.600 --> 00:05:49.920
Okay.
00:05:50.240 --> 00:05:50.560
Okay.
00:05:50.800 --> 00:05:51.279
There we go.
00:05:51.360 --> 00:05:53.279
Now you know a little bit about our pizza preferences.
00:05:53.439 --> 00:06:00.560
If you want to lure me into a dark alley, just talk about the chewiness of the crust and I'll come check it out.
00:06:00.879 --> 00:06:03.360
I will not follow you into a dark alley for pizza.
00:06:03.439 --> 00:06:04.639
But yeah, Garth will.
00:06:04.800 --> 00:06:06.879
So lure lure him.
00:06:08.480 --> 00:06:08.800
Okay.
00:06:09.279 --> 00:06:10.959
So bant, done.
00:06:11.120 --> 00:06:12.480
Pizza, wonderful.
00:06:12.639 --> 00:06:14.000
I think we can all agree.
00:06:14.480 --> 00:06:17.279
Are you ready to roll into our topic for the day?
00:06:17.519 --> 00:06:18.240
I am ready.
00:06:18.560 --> 00:06:18.879
Okay.
00:06:19.920 --> 00:06:35.920
So for simplicity's sake, I'm going to talk about how depression, how depressive symptoms show up in PTSD, post-traumatic stress disorder, and MDD, major depressive disorder.
00:06:36.160 --> 00:06:36.399
Okay.
00:06:36.639 --> 00:06:43.199
So when people say they're diagnosed with depression, often it's major depressive disorder.
00:06:43.360 --> 00:06:45.519
Sometimes it's dysthymia.
00:06:45.839 --> 00:06:54.160
But for the sake of this podcast, we're not going to get into the different depressive diagnoses that someone could receive.
00:06:54.319 --> 00:06:56.959
We're just going to focus on PTSD and MDD.
00:06:57.199 --> 00:06:58.079
Sounds great.
00:06:58.319 --> 00:06:58.639
Okay.
00:06:59.600 --> 00:07:06.639
So PTSD, we've talked a lot about on the podcast, but it's a condition that develops after exposure to trauma.
00:07:06.800 --> 00:07:15.519
The brain and the body stay stuck in threat mode even after the danger is over and sometimes long, long over.
00:07:16.079 --> 00:07:18.800
Major depressive disorder is a move disorder.
00:07:19.120 --> 00:07:40.639
You know, is characterized by persistent depression, which can show up as like a loss of interest in things that somebody typically enjoys, changes in sleep patterns, changes in appetite, being fatigued, having low energy, feeling guilty, worthless, sometimes having suicidal thoughts as well.
00:07:40.879 --> 00:07:43.600
The criteria for this is that it lasts more than two weeks.
00:07:43.759 --> 00:07:49.279
Oftentimes, by the time a client actually comes into therapy, it's lasted much longer than two weeks.
00:07:49.600 --> 00:07:52.959
But that's the minimum that has to be met.
00:07:53.439 --> 00:07:53.759
Okay.
00:07:54.240 --> 00:08:03.040
So depressive symptoms can show up, and they do oftentimes show up within PTSD.
00:08:03.360 --> 00:08:07.920
So the depressive symptoms are showing up within both of these disorders.
00:08:08.240 --> 00:08:13.519
It can be very difficult to differentiate between the two of them.
00:08:14.079 --> 00:08:35.919
The good thing is, before we kind of get into the nitty-gritty of how we respond to both of these disorders, the good thing is that therapists' clinicians don't have to get a diagnosis accurate right off the bat in order for EMDR to be effective in treating depressive symptoms.
00:08:36.159 --> 00:08:36.480
Okay.
00:08:37.200 --> 00:09:07.919
So if, for instance, a clinician would misdiagnose you with PTSD, but a more appropriate diagnosis would be major depressive disorder, you likely have some trauma in your history that is exacerbating, that's making worse your depressive symptoms, even though your diagnosis, your primary diagnosis is major depressive disorder.
00:09:08.559 --> 00:09:15.759
In doing EMDR with this clinician, as long as it's done effectively, you're still going to have symptom reduction.
00:09:16.080 --> 00:09:25.919
It's just that if your primary diagnosis is major depressive disorder, EMDR is more of a helper in your treatment for that.
00:09:26.159 --> 00:09:28.960
It's not the primary treatment.
00:09:29.200 --> 00:09:52.240
And so if you are going to therapy and you've done a lot of EMDR work and you've noticed some symptom reduction, but you're not noticing as much symptom reduction as you would like, maybe it's because you don't meet criteria for a PTSD diagnosis and something like major depressive disorder is more appropriate.
00:09:52.399 --> 00:10:03.120
So I just wanted to throw out there before we kind of get in the nitty-gritty of all of this that you don't have to know what's going on right off the bat for EMDR to help.
00:10:03.279 --> 00:10:07.759
And your therapist doesn't even have to know right off the bat what's going on.
00:10:09.360 --> 00:10:11.279
It's all about symptom reduction.
00:10:11.840 --> 00:10:16.879
Do I eventually want clinicians to arrive at an accurate diagnosis?
00:10:17.039 --> 00:10:17.679
Yes.
00:10:17.919 --> 00:10:26.159
And I will say we can misdiagnose in other instances and it be very harmful.
00:10:26.639 --> 00:10:29.679
And in the extreme cases, even in this instance, right?
00:10:29.840 --> 00:10:43.200
Like if I if I go see a clinician and I'm experiencing really significant suicidality and they're just treating me for PTSD when I actually have major depressive disorder, that's a a problem.
00:10:43.519 --> 00:10:44.080
That's a problem.
00:10:44.159 --> 00:10:44.399
Yeah.
00:10:44.559 --> 00:10:44.879
Yeah.
00:10:45.039 --> 00:11:04.159
And likewise, if I'm being put on an antidepressant, especially like for adolescents that are misdiagnosed with major depressive disorder and they actually have PTSD, if I'm being put on an antidepressant and I actually have PTSD, but you know, that could lead to increase in symptoms.
00:11:04.320 --> 00:11:09.120
So there are extreme cases where that misdiagnosis can cause problems.
00:11:09.360 --> 00:11:18.960
But oftentimes we don't have to get that diagnosis exactly right in order for EMDR to be effective and for it to lead to harm reduction.
00:11:19.120 --> 00:11:25.600
So I just want to take that pressure certainly off clients, but to some degree off clinicians as well.
00:11:34.000 --> 00:11:34.320
Okay.
00:11:35.519 --> 00:11:38.559
So what's going on with PTSD?
00:11:38.799 --> 00:11:44.320
Why would someone with PTSD be presenting with depressive symptoms?
00:11:44.879 --> 00:11:53.440
So we talked in the last episode about why someone who had experienced trauma would present with anxiety.
00:11:53.679 --> 00:11:54.000
Yeah.
00:11:54.240 --> 00:12:08.399
We had talked about if I'm perceiving the world as unsafe, if I have the thought process that I'm never going to be able to keep myself safe, we better hope that my body responds with anxiety.
00:12:08.559 --> 00:12:08.879
Right.
00:12:09.120 --> 00:12:09.519
Right.
00:12:10.399 --> 00:12:24.720
So the same system that creates feelings of anxiety as a result of trauma is the system that creates depressive feelings as a result of trauma.
00:12:26.320 --> 00:12:34.960
The system with anxiety is very activated, and the system with depressive symptoms is very fatigued.
00:12:35.600 --> 00:12:35.919
Okay.
00:12:36.159 --> 00:12:36.480
Okay.
00:12:36.960 --> 00:12:41.759
So the stress system is the HPA axis.
00:12:41.919 --> 00:12:47.039
So the HPA access is again activating anxiety for us.
00:12:47.120 --> 00:12:55.279
But when that HPA axis becomes fatigued, but we have stressors, it results in depressive symptoms.
00:12:55.600 --> 00:12:57.120
What what's the HPA axis?
00:12:57.279 --> 00:12:57.360
Yeah.
00:12:58.799 --> 00:12:59.679
As I raise my hand.
00:13:00.240 --> 00:13:03.279
I was just going to say as he raises his hand in the air.
00:13:03.600 --> 00:13:03.919
Okay.
00:13:04.399 --> 00:13:11.519
So the HPA axis is a communication loop between the hypothalamus, the pituitary gland, and the adrenal glands.
00:13:11.919 --> 00:13:12.240
Okay.
00:13:12.399 --> 00:13:12.720
Okay.
00:13:13.279 --> 00:13:17.039
So the hypothalamus is a control center in the brain.
00:13:17.200 --> 00:13:24.240
The pituitary gland is the brain's hormone messenger, and the adrenal glands actually sit on top of our kidneys.
00:13:24.480 --> 00:13:24.799
Huh.
00:13:25.039 --> 00:13:25.279
Yeah.
00:13:25.360 --> 00:13:27.200
So this is a real, like actual physical loop.
00:13:27.440 --> 00:13:28.639
Well, that's not in your brain.
00:13:28.960 --> 00:13:29.519
Right.
00:13:29.759 --> 00:13:34.080
Oh my goodness, you're the rest of your body's involved in like a stress response.
00:13:34.480 --> 00:13:35.120
I don't believe it.
00:13:35.519 --> 00:13:37.039
You're kidding me.
00:13:37.360 --> 00:13:40.639
So it's an actual physical loop, but it's a feedback loop.
00:13:40.799 --> 00:13:47.279
Its job is to detect danger, release stress hormones, particularly cortisol.
00:13:47.519 --> 00:13:54.960
It can help you in small doses to wake up, to focus, in larger doses to react to threats.
00:13:55.279 --> 00:14:00.480
In a healthy system, our cortisol is naturally rising in the morning.
00:14:00.879 --> 00:14:02.559
It's dropping at night.
00:14:02.720 --> 00:14:05.759
It's spiking briefly during stress.
00:14:06.159 --> 00:14:09.039
And then it's returning to baseline pretty quickly.
00:14:09.200 --> 00:14:09.519
Okay.
00:14:10.080 --> 00:14:14.799
A fatigued system is not going to function in that way.
00:14:15.120 --> 00:14:22.159
So a trauma or prolonged stress is signaling to the body there's danger, there's danger, there's danger.
00:14:22.320 --> 00:14:26.240
The HPA axis stays activated way too long.
00:14:26.399 --> 00:14:30.159
I've talked about this book before, but I want to reference the deepest well.
00:14:30.559 --> 00:14:36.480
If you want to have some really good examples of the HPA axis being activated too long, Dr.
00:14:36.639 --> 00:14:39.120
Nadine Burkaris walks you through it really well.
00:14:39.279 --> 00:14:42.879
I would recommend giving her book, The Deepest Well, a read.
00:14:43.200 --> 00:14:46.320
So the HPA axis stays activated for way too long.
00:14:46.480 --> 00:14:50.159
Cortisol release becomes dysregulated.
00:14:50.240 --> 00:14:52.879
It's not in its normal rhythm that we just described.
00:14:52.960 --> 00:14:54.559
It's just kind of all over the place.
00:14:54.639 --> 00:14:59.440
And the body never really fully returns to a rest and repair state.
00:15:00.240 --> 00:15:05.279
So eventually we get to this place called cortisol fatigue.
00:15:05.600 --> 00:15:09.919
The more accurate term really is HPA access dysregulation.
00:15:10.159 --> 00:15:17.840
The system is misfiring rather than really burned out.
00:15:18.399 --> 00:15:20.000
What happens from there?
00:15:20.240 --> 00:15:20.559
Yeah.
00:15:20.720 --> 00:15:22.320
What happens from there?
00:15:25.200 --> 00:15:27.279
You are on top of it today.
00:15:27.519 --> 00:15:34.639
What happens from there is we are constantly alert, hyper-vigilant, or we're in emotional shutdown.
00:15:35.200 --> 00:15:36.720
Which is that depressive.
00:15:36.960 --> 00:15:39.679
So it's kind of two sides of the same coin.
00:15:39.759 --> 00:15:40.480
Like Yep.
00:15:40.639 --> 00:15:50.000
Anxiety and again, the same system that's causing anxiety as a result of trauma is also causing a depressive state because of trauma.
00:15:50.399 --> 00:15:57.360
Poor sleep, memory and concentration problems, immune and inflammatory issues, deep physical and mental exhaustion.
00:15:57.519 --> 00:15:57.759
Yeah.
00:15:57.919 --> 00:16:06.639
The exhaustion can look a lot like depression, but it is coming from a survival system that will not turn off.
00:16:07.200 --> 00:16:15.840
You are, this oversimplifies it, but you are internally running a marathon on that HPA axis.
00:16:16.080 --> 00:16:28.000
Now I think that when I have read a little bit about cortisol fatigue, it's almost it can be presented like we hit this point where we dip into cortisol fatigue.
00:16:29.120 --> 00:16:43.759
And that that is true, but what I what I want to make clear today is it's not like this system gets exhausted and then it stays exhausted and you're in a depressive state all the time.
00:16:44.799 --> 00:16:52.960
As a result of trauma, people can switch back and forth between anxiety symptoms, depressive symptoms, anxiety symptoms, depressive symptoms.
00:16:53.120 --> 00:16:53.840
Does that make sense?
00:16:54.080 --> 00:16:55.039
Yeah, it does.
00:16:55.360 --> 00:17:05.519
It also makes sense that it might be what you're saying is that don't think of this loop as turning on and then turning off.
00:17:06.640 --> 00:17:11.680
Think of it as it's on and it's working over time.
00:17:14.160 --> 00:17:17.839
It's on and it's working over time, and that's the anxiety.
00:17:18.000 --> 00:17:24.799
It's constantly firing versus it's on all the time, but it's like spinning your wheels stuck in snow.
00:17:25.039 --> 00:17:26.160
You know, it's funny.
00:17:26.319 --> 00:17:26.880
Yes.
00:17:27.440 --> 00:17:36.880
I was going to say as you were starting, we paused for a second, and our almost nine-month old is with us now, so you might hear her in the background.
00:17:37.039 --> 00:17:45.920
But as we were processing for a second, the example I was thinking of was like horses drawing, horses, horses pulling a cart.
00:17:46.000 --> 00:17:46.559
Yeah, yeah.
00:17:46.720 --> 00:17:46.960
Right?
00:17:47.200 --> 00:17:51.759
That they're pulling it always, but sometimes they're going uphill in the mud, right?
00:17:51.839 --> 00:17:53.839
And so, yeah, similar example.
00:17:54.079 --> 00:17:54.480
Yes.
00:17:54.960 --> 00:18:01.119
So with PTSD, the core problem is the nervous system is stuck in survival mode.
00:18:01.440 --> 00:18:27.759
Common depressive symptoms, emotional numbness, clients will sometimes describe like just feeling blank, exhaustion that sleep doesn't ever seem to fix, depression that flares with stress or reminders of a traumatic event, dissociation, so feeling unreal or detached from your body, that could be an entire episode in and of itself.
00:18:28.079 --> 00:18:34.240
And then physical symptoms, pain, gut issues, unexplained headaches, things like that.
00:18:34.559 --> 00:18:41.359
Really important differentiation: mood improves when the nervous system feels safer, even temporarily.
00:18:41.599 --> 00:18:41.759
Okay.
00:18:42.000 --> 00:18:52.400
So there are a few things that we want to watch out for that would indicate that this is PTSD with depressive symptoms versus a depressive disorder like major depressive disorder.
00:18:52.880 --> 00:18:55.920
And that is really the starting point.
00:18:56.240 --> 00:19:00.480
Does the mood of the client improve when the nervous system feels safer?
00:19:00.720 --> 00:19:01.039
Yeah.
00:19:01.279 --> 00:19:02.400
Even temporarily?
00:19:02.640 --> 00:19:05.839
So I'll give you an example that's come up with a lot of my clients.
00:19:06.160 --> 00:19:14.160
I work with a lot of clients that are very high achieving, and in their childhoods, they were their families were impoverished.
00:19:14.480 --> 00:19:24.640
And whenever they have something come up that impacts their finances, they will oftentimes notice a significant increase in depressive symptoms.
00:19:24.880 --> 00:19:32.240
And then whenever something shifts financially for them, those depressive symptoms almost immediately subside.
00:19:32.400 --> 00:19:33.759
Well, why is that?
00:19:38.000 --> 00:19:38.640
Right.
00:19:39.039 --> 00:19:39.359
No.
00:19:39.680 --> 00:19:45.279
It was dealing with a threat that has now been negated.
00:19:45.359 --> 00:19:48.480
And ready to resolve, yeah, whatever you want to call it.
00:19:49.119 --> 00:19:49.359
Yeah.
00:19:49.680 --> 00:19:50.400
Does that make sense?
00:19:50.640 --> 00:19:50.960
Makes sense.
00:19:51.920 --> 00:19:52.319
I think so.
00:19:52.559 --> 00:19:59.200
So then with MDD, the core problem is a disruption in the mood and reward systems of the brain.
00:19:59.359 --> 00:20:03.839
So same symptoms or similar symptoms, totally different issue.
00:20:04.000 --> 00:20:07.839
So with MDD, we have a problem with neurotransmitters.
00:20:08.079 --> 00:20:17.039
Serotonin impacts mood stability, dopamine impacts motivation and pleasure, neuroepinephrine impacts energy and alertness.
00:20:17.200 --> 00:20:21.279
So when we look at all these things, mood stability, motivation, energy and alertness.
00:20:22.400 --> 00:20:35.519
The opposite of those, mood instability, decreased motivation and enjoyment, fatigue and difficulty concentrating, that's depression.
00:20:35.680 --> 00:20:35.920
Yeah.
00:20:36.160 --> 00:20:36.480
Right.
00:20:36.640 --> 00:20:43.839
And so if we're having a problem with this mood and reward system, then we have a depressive disorder.
00:20:44.079 --> 00:20:52.400
So serotonin, dopamine, noroepinephrine, these are all brain chemicals that are used and that communicate with one another.
00:20:55.599 --> 00:21:19.279
Okay, some common symptoms that result because of MDD persistent sadness or heaviness, loss of interest or pleasure, low self-worth, guilt or shame, slowed thinking or movement, suicidal thoughts tied to hopelessness, depression feels constant, not threat triggered.
00:21:19.359 --> 00:21:29.920
So remember we said earlier that if the symptoms are as a result of a threat increasing, then it's likely due to PTSD.
00:21:32.799 --> 00:21:46.319
Okay, so Garth, without going over everything, before we move on, I want to kind of summarize what we see as the key differences between PTSD related depression and MDD.
00:21:46.880 --> 00:21:47.759
Lay it on me.
00:21:47.920 --> 00:21:48.240
Okay.
00:21:48.720 --> 00:21:50.400
PTSD related depression.
00:21:50.559 --> 00:21:56.079
Symptoms rise and fall with perceived safety, stress levels, interpersonal conflict.
00:21:56.240 --> 00:21:58.400
So conflict within relationships.
00:21:58.799 --> 00:21:59.519
MDD.
00:22:00.240 --> 00:22:01.839
Can start without trauma.
00:22:02.000 --> 00:22:11.039
Episodes can recur even during calm or happy periods, less sensitive to external safety cues.
00:22:11.279 --> 00:22:19.119
I want to make a note that I didn't make earlier, and that is sometimes people are very unaware of their triggers.
00:22:19.279 --> 00:22:20.480
Like very unaware.
00:22:20.880 --> 00:22:21.119
Yeah.
00:22:21.359 --> 00:22:28.160
And so they can assume that we're dealing with MDD or a depressive disorder.
00:22:28.559 --> 00:22:31.279
When it's just something that is like in their life all the time.
00:22:31.519 --> 00:22:35.680
When it when it's actually PTSD related depression, they just don't know what their triggers are.
00:22:35.839 --> 00:22:38.480
They don't know their triggers well enough to know that they're being triggered.
00:22:38.559 --> 00:22:39.119
Does that make sense?
00:22:39.279 --> 00:22:40.000
That makes complete sense.
00:22:40.240 --> 00:22:46.000
So that's one of the ways in which a client reporting can result in misdiagnosis.
00:22:46.240 --> 00:22:49.200
And again, that happens.
00:22:49.440 --> 00:22:51.599
It it can be okay.
00:22:51.839 --> 00:23:04.240
I don't want to spend too much time discussing that again because I did at the beginning of the episode, but those are the key differences between PTSD-related depression and MDD.
00:23:04.880 --> 00:23:07.039
Okay, why do they overlap so much?
00:23:07.200 --> 00:23:11.119
PTSD-related depression can meet full criteria for MDD.
00:23:11.599 --> 00:23:13.680
Many clinicians diagnose both.
00:23:13.839 --> 00:23:16.960
There is no blood test that cleanly separates them.
00:23:17.200 --> 00:23:20.640
Long-term stress can cause true MDD over time.
00:23:21.359 --> 00:23:23.359
So this isn't either or.
00:23:28.000 --> 00:23:29.200
That also makes sense.
00:23:29.519 --> 00:23:30.640
It also makes sense.
00:23:30.880 --> 00:23:47.279
I say all that to say, like, okay, if you experienced chronic relational trauma in childhood, could that eventually disrupt your system to the degree that you are having trouble with those neurotransmitters that we discussed earlier?
00:23:47.440 --> 00:23:49.680
serotonin, dopamine, norepinephrine?
00:23:49.920 --> 00:23:50.480
Yes.
00:23:50.720 --> 00:24:03.839
And then at that point, even if your trauma is desensitized, do we right away get back to normal functioning in neurotransmitters?
00:24:04.079 --> 00:24:04.400
No.
00:24:04.880 --> 00:24:05.519
Right.
00:24:06.400 --> 00:24:21.039
And I want to also say that I think that some clinicians are starting to approach diagnoses as all always completely trauma-based, that there's always a trauma foundation.
00:24:21.359 --> 00:24:21.680
Okay.
00:24:21.920 --> 00:24:30.799
And where I want to push back on that is we can be born with different functioning in all of our body.
00:24:31.039 --> 00:24:40.319
And I think when it comes to like our kidneys, of course, someone would accept that our not everyone's kidneys function exactly the same at birth.
00:24:40.559 --> 00:24:44.799
People have different functioning kidneys on a spectrum, right?
00:24:45.119 --> 00:24:45.599
Yeah.
00:24:45.920 --> 00:24:52.720
And in the same way, people are born with different functioning of these neurotransmitters.
00:24:52.960 --> 00:25:00.319
And so some people have beautiful childhoods and their neurotransmitters are still not functioning optimally.
00:25:00.559 --> 00:25:01.680
Yeah, that makes sense.
00:25:02.000 --> 00:25:10.880
And so they are probably going to eventually want to do a treatment like start an antidepressant.
00:25:11.119 --> 00:25:17.279
They are wanting wanting, going to want to do, excuse me, more cognitive-based therapies.
00:25:17.519 --> 00:25:24.000
They're going to want to do behavioral activation where they gradually like re-engage with life.
00:25:24.160 --> 00:25:27.200
Now, can EMDR be a component for them?
00:25:27.519 --> 00:25:28.400
Probably.
00:25:28.640 --> 00:25:35.759
But they're going to want to focus on other treatments if EMDD, if EMDD is their primary diagnosis.
00:25:35.920 --> 00:25:37.599
Oh, I am starting to trip up on words.
00:25:37.680 --> 00:25:38.480
I'm trying to talk fast.
00:25:38.880 --> 00:25:39.920
So many acronyms.
00:25:40.160 --> 00:25:40.799
I know.
00:25:41.680 --> 00:25:42.000
Okay.
00:25:43.519 --> 00:25:46.559
So here's where we're going to wrap up.
00:25:46.960 --> 00:25:50.720
I feel like we've done this justice.
00:25:51.680 --> 00:26:02.160
EMDR can be helpful in reducing depressive symptoms in a majority of cases, a majority of clients that clinicians see.
00:26:03.200 --> 00:26:11.359
As far as differentiating between the two diagnoses, ask yourself: did this begin after a trauma or prolonged stress?
00:26:11.519 --> 00:26:14.880
That's harder to determine when the trauma is chronic trauma.
00:26:15.440 --> 00:26:24.480
Does safety or calm in the client's life reduce symptoms pretty dramatically and pretty quickly?
00:26:25.039 --> 00:26:28.160
Does stress make symptoms dramatically worse?
00:26:28.559 --> 00:26:31.440
Those are three really important questions.
00:26:31.839 --> 00:26:42.319
Depression, if it feels persistent, self-generating, detached from circumstances, EMDD is probably the primary diagnosis.
00:26:42.559 --> 00:26:47.839
Thank you, Miss almost nine-month-old for joining us.
00:26:48.079 --> 00:26:48.720
Yeah.
00:26:48.960 --> 00:26:49.359
Yeah.
00:26:49.519 --> 00:26:51.920
Are you about done with this podcast?
00:26:52.240 --> 00:26:53.599
Are you about done?
00:26:53.839 --> 00:26:57.279
Okay, we are being directed to wrap up.
00:26:57.519 --> 00:26:57.839
Yep.
00:26:58.000 --> 00:26:59.519
Producer says it's time to go.
00:27:01.119 --> 00:27:02.480
This was a lot of information.
00:27:02.640 --> 00:27:04.319
We really tried to run through it.
00:27:04.480 --> 00:27:07.519
Thank you for listening to our EMDR 4 series.
00:27:07.680 --> 00:27:13.519
If you are a clinician and you want to reach out for consultation, I am an EMDR consultant now.
00:27:13.680 --> 00:27:24.400
You can go to my website, scenTherapy.org, and click on any of the buttons that are prompting you to click on them and set up some consultation with me.
00:27:24.640 --> 00:27:33.519
If you are a potential client and you heard some symptoms that sound really familiar today, we are also happy to serve you.
00:27:33.920 --> 00:27:35.839
Thank you so much for listening.
00:27:36.079 --> 00:27:37.200
Have a great day.
00:27:37.359 --> 00:27:38.559
We appreciate you all.
00:27:38.720 --> 00:27:39.279
Bye-bye.
00:27:39.519 --> 00:27:40.000
Bye.
00:27:40.799 --> 00:27:42.400
Well, that's all, folks.
00:27:42.559 --> 00:27:47.039
Please see our show notes for ways to connect with us or go give us a follow on Instagram.
00:27:47.200 --> 00:27:49.279
You can find us at Simply Mental.
00:27:49.440 --> 00:27:52.400
If this episode resonated with you, send it over to a friend.
00:27:52.559 --> 00:27:59.039
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00:27:59.279 --> 00:28:00.720
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