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Restoration Beyond the Couch
The Beyond the Couch with Dr. Lee Long podcast is intended solely for general informational purposes and does not represent the practice of medicine, therapeutic and psychiatric services, nursing, or other professional health care services. It also does not constitute the provision of medical, therapeutic or psychiatric advice, and no doctor/patient relationship is established. The information on this podcast and any materials linked from it are used at the user's own risk. The content provided through this podcast should not be considered a replacement for professional medical, therapeutic, or psychiatric advice, diagnosis, or treatment. It is important that users do not ignore or postpone seeking medical, therapeutic, or psychiatric advice for any health or mental health condition they might have, and should always consult with their health care professionals regarding such conditions.
Restoration Beyond the Couch
Unraveling Depression: A Deep Dive into Mental Health with Dr. Debra Atkisson
In this episode of Restoration Beyond the Couch, Dr. Lee Long welcomes back Dr. Debra Atkisson for a new conversation on depression and mental health. This episode dives deeper into psychiatry, exploring how medications and talk therapy work together and addressing common questions about treatment.
This episode offers fresh insights and practical strategies for navigating mental health challenges. Don’t miss this engaging discussion.
Welcome to Restoration Beyond the Couch. I am Dr Lee Long and I'm excited to welcome back Dr Deborah Ackeson, a board-certified psychiatrist and author of Mastering your Storm. In her previous episode, we explored her insights into building resilience and mental health. Today we're shifting gears to answer some of the most common questions about psychiatry, discuss the role of medications and talk therapy in mental health treatment and provide practical strategies for improving overall well-being. We also touch on new insights from her book and how they apply to real-life challenges. This episode offers a fresh perspective on mental health care. Your path to mental wellness starts here. Okay, well, welcome back, dr A.
Speaker 1:Hey, it's great to be here yeah thanks for coming again and I'm so happy that we're here to talk about your book, about mental health, about all kinds of fun things. Hey, leave it to the two of us when we get together. God only knows what we're going to talk about.
Speaker 2:Isn't that the truth? We were chatting right at the beginning, and I think, we have several different topics. We'll probably be interweaving throughout our conversation today.
Speaker 1:I think it makes sense. So a few of our listeners had some questions that they wanted to throw out to you. So if you're cool with us starting there, I'm glad to answer anything I can. Okay, well, I think you can. One question was the safety and efficacy. Maybe we'll start with safety of like certain meds, like an SSRI, like a Zoloft, a Lexapro, you know a Welbutrin Are those medications from your perspective? Are those medications safe to be on for extended amounts of time?
Speaker 2:It's a great question. It's a question I often have people ask me and I want to start by saying in today's world we know that depression is a very common issue Boy is it and that there are, of the subsets of people who have depression. There's a percentage of people who have chronic, recurrent depression. And the way we like to think about that in mental health is whether somebody needs to be on medications long term. If someone has one episode of depression, we will look at that individual, we will talk with them, we will treat them and, just as a kind of a rough estimate of how long they're on a medication, it's approximately a year. It can be a little bit longer, depending on what factors are going on in their lives and then depending on how well they're doing, how well they have used therapy, how well they've developed coping skills, then we can look at trying them off medication. Developed coping skills, then we can look at trying them off medication. And I want to pause here to say the purpose of the medicine is to help people be able to not only more emotionally feel better, but it's actually to help a number of functional areas in their lives, such as sleep, appetite, motivation, concentration, because all of those things get pardon my language, they get whacked by depression. I mean depression is a brain-based illness and it goes in and, with all those brain connections, to all the areas, almost every area of your life gets impacted by depression. And we know and this leads into some of the work you do in therapy, we know that when people have chronic depression that has gone untreated, it changes their internal narrative and it changes their help me out here intra-psychic way of viewing themselves and their intrapersonal way of viewing themselves, which then impacts their interpersonal relationships with other people.
Speaker 2:Did I get that right, dr Long? Spot on, because you wrote a thesis on that. Right, dr Long? Cause you wrote. You wrote a thesis on that, I believe.
Speaker 1:I did, I did, and there's a whole theory that is an interpersonal. It's a. It's a interpersonal. Ipt is the is the acronym for it's interpersonal therapy, therapy and CBAS, which is what I wrote my dissertation on in in a theory that my mentor wrote. He authored. It is all about interpersonal understanding and awareness, and so you're, you're, you're spot on that. When, when you are in a space of needing medication, it's not to pull you out of the depression. I've always seen it as well and Lila, one of our therapists, always uses the analogy that when you are struggling with depression, it's like you're in a smoke filled room and the medication just opens the window and allows the smoke to leave. You still need to have the skills to go about living life in that room. It's just that the medication helps alleviate the smoke out of the room 100%.
Speaker 2:It's a beautiful metaphor.
Speaker 1:And.
Speaker 2:I think it shows that very clearly how it works. So I talked about if people use therapy and they do the work, there is a very large percentage of people who are not going to need to be on medications long term. So they take them. Of individuals who've had one episode of depression, if they have a second episode of depression later, that is of the severity that they need to go back on medications. And, by the way, this can happen with people who've done great therapy, have enormous insights. But if they have a significant biological basis for their depression that has to do with how their neurons are wired, they're going to have recurrent depression even if they do all the work. So with that second episode we go back on another course of antidepressants. Then at that point we have a branch point. Often it depends on how severe the depression has been, it depends on how well they're functioning again. But there's an option for them to go back off meds again. So we think of it. When a person has a third episode of significant depression, that's when we want to look at them being on medications very long term.
Speaker 2:And when you talk about safety, Prozac has been out since the mid to late 80s and Zoloft as well. It followed right behind it, so those are SSRIs. We see that there are people walking around who have been on these medications 30 years and we are not seeing long-term negative effects. As a matter of fact, the one population when we think of using medications that we really are concerned about safety are women who are pregnant, and Zoloft is an antidepressant that we have a lot of pregnancy data with and appears to be fairly safe in pregnancy. It's still a Category C, but it's one that OBGYNs are very comfortable. If someone needs a medication during pregnancy, that's one we may consider. Zoloft is also FDA approved for age 6 and up.
Speaker 2:And so for it to have an FDA approval in the child population. We know that physically it's fairly safe and I would say in the work I've done with treating patients I've used a lot of SSRIs Zoloft, prozac and Lexapro and I can tell you that we use these medications in people who have very serious medical illnesses, such as they may have cancer and be receiving chemotherapy and need an antidepressant, and these are deemed safe for us to use with those patients. So the physical safety of it, of those medications, is fairly well established.
Speaker 1:Which is that's an encouraging thing to know, right, Because I think that you know. Going back to some of the things that you you stated about having an epigenetic you didn't use that term, but I know that's what you're getting at we know now that we have gene SNPs the MAO-B and the MAO-A that are connected to or they are descriptive of these issues, of of it being extra emotional I don't want to say hyper emotional, but there's a depressive gene and then there's a an emotionally sensitive gene and that's the MAOB and the MAOA. And if somebody has those snubs, we we can say we know with some decent confidence that they're going to. They may struggle.
Speaker 2:Yes.
Speaker 1:The other thing that you talked about is the SSRI, which, just for our listeners sake, it's a simple serotonin reuptake inhibitor, that's right. And that's serotonin. It's just it's not enough serotonin on the brain. Yes, it's like a toilet that constantly leaks. It never fills, and so there serotonin manufacturer is never at rest. And something that a friend of mine asked a neuropsych person why is it that the SSRIs, these serotonin reuptake inhibitors, why is it that it takes two to four weeks? Am I giving the right window?
Speaker 2:You are giving the right window Two to four weeks to be effective.
Speaker 1:If the serotonin is immediately on the brain, why then does it take these two to four weeks? And what he said and I'm going to see if we're accurate on this Is that the and I call it the housing mechanism that makes the serotonin needs to trust that that serotonin is going to be there so that it will slow down. And it takes two to four weeks for that mechanism, that manufacturing plant, as I see it in my brain, that manufacturing plant needs to trust that the serotonin is going to stay there before it calms down. And that's the window it takes stressed because of the depression.
Speaker 2:So the serotonin is being moved through very rapidly, so it's being metabolized too quickly and moved down the pike. All these medications do is they go in and they plug some of the places where the serotonin would be attaching and going down, so they can raise the level in the brain. They don't make the brain make more of it, they just regulate it. So you're exactly correct. It takes a few weeks for those mechanisms to the brain's. An amazing machine, if you want to think of it that way.
Speaker 2:But it takes that long for things to really shift and for all the feedback mechanisms that have to go into place in the brain for it to realize okay, great, we don't know why, but for some reason our serotonin level is up, so we're going to go with it. We can calm down a little bit. We don't have to be so distressed and pulling these chemicals through so rapidly.
Speaker 1:I just think it's so fascinating how fearfully and wonderfully we are designed and made.
Speaker 2:Yes.
Speaker 1:That we have all these mechanisms in place as a self-protective and self-healing mechanism and, yes, we need outside care to heal. Oh yes, oh yes, but that our brain, our body wants to cooperate with that healing process.
Speaker 2:Well, I'm going to. I'm going to piggyback off what you just said, because you talked about fearfully and wonderfully made, and so, depending on your view, I am a Christian, so I believe we were designed very uniquely. And the thing I have found fascinating the more I have learned in my career as a mental health professional, the more I realize that the things that help us reset and do better are actually often connected to spiritual matters, for instance, the whole practice of mindfulness. In order for us to be healthy, we need to really learn ways to be mindful and be alive and present in the moment. The reality is, the moment is all we really have, because we don't know what's happening. The past has already happened. We don't know what will be happening. We have to live in a way to prepare ourselves for the future and from that we reflect and learn from the past, but we really only live in the moment.
Speaker 2:And so when you think about mindfulness practices, all the different things that we do with people and mental health to help them, and then you simply shift and think about Prayer, prayer is an act of mindfulness, and when I'm working with people, I'm trying to help them find ways to look at their own mindfulness. I ask their faith tradition, I find out if prayer is something they do and I kind of talk with them about how that's actually a moment of mindfulness and when you do that and you step away from it, think of how you feel. Everything has calmed, everything is in a better place, and that's what mindfulness does for us. So you referenced Fearfully and Wonderfully Made, which is a great book, might I?
Speaker 1:add.
Speaker 2:So it made me think about that and I thought I just have to comment on that.
Speaker 1:Well, I'm glad you did, Because I think that, in order for us to have going back to your comment about intrapersonal awareness, is that that mindfulness takes us back to that and being aware of who I am. Our intrapersonal awareness, or intra psyche awareness, really is just a fancy way to say self-awareness, and I think that there's so much there. We often look at what are memories for right. We think that memories. Often we think that memories are to orient us to the past. They're really not.
Speaker 1:Memories are to orient us to the present, so that we don't have to use so much of this big brain that we've been given to assimilate what is in the present, because our memories help us conceptualize what we're experiencing in the now.
Speaker 1:And so for us to be hamstrung or anchored to the past doesn't allow us to be in the present. And it's not that we want to avoid the thoughts of the past doesn't allow us to be in the present. And it's not that we want to avoid the thoughts of the past. We want to assimilate the thoughts of the past. And that's one of the reasons why I fell in love with the CBASP, the cognitive behavioral analysis systems of psychotherapy that my, that my mentor designed or developed is because it truly is a a deepening awareness of how the present is informed by the past, but it is not dictated by the past. Oh yes, and that's just such a a powerful thing is when watching people discriminate the present from the past. That's when I see a lot of opening up, since you're bringing that up something we were chatting about earlier.
Speaker 2:As I was reflecting about our meeting today, I was thinking what are the things that I commonly hear and commonly see? And one thing that I do commonly see has to do with this notion of past decisions and present life and what your future life will be. So a lot of people that I talk with, whether I'm seeing them as a psychiatrist or I'm doing a coaching session with them, they get trapped in these feelings of remorse and regret about either choices they could have made but did not in other words, paths they could have taken but for whatever reason or reason, they didn't or a path they did take and the way that path led their life to become. And they feel stuck in that, as if I can't shift, I can't look at things differently. Frequently, it's because they have these ideas they've developed about. Well, this is where I would be today, or this is how my life would be today, if I had either taken that path or I didn't take this path.
Speaker 2:And I was talking about the fact I was reading a fictional novel called the Midnight Library, where this mid-30s lady finds herself. This won't ruin the book for anyone if they decide to read it. It's a fictional book that has a good premise. This woman finds herself in this midnight library. That has to do with all these choices she could have made. She could have chosen to do something differently and her life would have had this development, and so there were infinite possible lives she could have lived. Interestingly, if you pay attention to this and you read that book, you'll find things aren't always the way she thought they would turn out.
Speaker 2:And that's why I'm using that as an illustration, because I think for all of us, we have to make choice points in the moment in terms of using the information. We have to make the best decision we can at the time. Then, later, when we're disappointed, we have to be careful not to get trapped in the quicksand of those feelings of remorse and regret, instead to say, okay, what did I learn from that choice? What came of that choice? How do I wish things would be differently? And in the moment where I'm living now, what do I need to put into place to develop a path forward? And that is just really critical. I think and that's a lot about what my book is about it's helping. It's a very straightforward, simple tool to help people be able to do just that, to pause the moment and say how do I develop a plan to move in the direction I want to go? What do I need to assess to figure that out? And that's what the book is. What do I need to assess to figure that?
Speaker 1:out, and that's what the book is. It's a guide for that, you know. I think that's so needed. What we found in our depression study was overwhelmingly for the participants problem solving is what resolved a several decade long chronic sense of depression. There you go, and I've been doing a lot of research recently looking at outcomes, and what's super interesting to me is that most of the outcome data that's positive in mental health or in in the treatment world has to do with skills. Yes, it's skills.
Speaker 2:It do with skills.
Speaker 1:Yes, it's skills, it's acquiring skills, it's learning acquisition. That is the I don't want to say the predictor, but it sure has been shown in outcome data that learning acquisition is the most solid uh Indicator Of positive outcomes. And what you're talking about in your in your book, mastering your Storm, is putting a pathway. That's teaching skills, which is again a positive predictor for outcomes. That's really cool.
Speaker 2:It is cool. The piece of it that I really like a great deal is that by teaching skills, you empower people to be able to be in charge of their life in the present and the direction they're going. Yeah, and then, whatever you encounter in that direction you go, you have ways to cope and deal with it through the skills you've acquired. Yeah, yeah, to cope and deal with it through the skills you've acquired.
Speaker 1:Yeah, yeah, and there's that, like you said, I love that, that sense of personal agency, yes, which goes back to one of my favorite things to talk about is that whole sense of self-awareness, that intrapersonal awareness is that when I learn what I, what's going on inside of me, then I know how to bring me to we yes.
Speaker 1:And I may not be met. I mean, I may not be met with what I'm wanting from someone, but if I give what I wanted to give out of, if I did what I wanted to do, the behaviors that I wanted out of me, then I can have a certain sense of accomplishment from that. Yes, I can't control the environment, but, you're, I can have a certain sense of accomplishment from that yes.
Speaker 1:I can't control the environment, but you're setting people up for a sense of agency. And did you say that there were seven different domains that you touch on in your book?
Speaker 2:Well, let me pause here and see which ones I do talk about. I begin the book by talking about why you picked up the book in the first place. If you don't know anything about mindfulness, I have a very straightforward each chapter is about five to seven pages short guide as to how you can look at mindfulness for yourself, because we all have to be grounded in a sense of the present to evaluate where we are in the moment, to be able to move forward. I talk about intention. I believe all of us have intention about things in our life, but we don't always label it or understand that.
Speaker 2:So, I talk about that. I talk about being able to develop resilience, because I have found all of us have things that we've either done that we have negative feelings about, or we have negative feelings about choices we didn't take. Resilience comes sometimes from having those experiences, and I talk about ways you can develop resilience without having to have a negative experience. So sort of talk about all of that. And I talk about action, accountability, how you set that, and then I say okay, I want you just to take a moment to look at these different areas of your life. So I ask people to look at the physical area of their life. It's a very high-level overview because that could be a huge book in and of itself.
Speaker 1:Right, each of these topics could go. Each topic, yeah.
Speaker 2:And what I do at the very end is, for each chapter I give two or three books that if people want to take deeper dives they can read about that have to do with those specific topics. I talk about your emotional or psychological self, because if your physical self and your emotional self is not on track, you're going to have a lot of difficulties and issues.
Speaker 2:We have a whole career based on dealing with people with their emotional and psychological areas of their lives, us and several other people, areas of their lives, us and several other people. I talk about the spiritual domains of your life, because everyone does have a spiritual domain, and I talk about how you look at that, how you explore it, how you get help for that. I talk about the financial aspects of your life. You must be able to have some way to manage those things. I talk about the relationship aspect, because we all have relationships with other people, and then I talk about the intellectual aspects of your life. So there's about six different areas I talk about In the intellectual aspects. I pull into that. It's the things that we use our brains for that are related to work, but it's also related to things we have intellectual interest and pursuits in.
Speaker 2:I think the happiest people I know are the people who remain curious and continue to learn. I mean, lee, I look at you. You've mastered several different areas of therapy. Then you decided to go back and get a doctorate and master this other area and you did that after you had a very full career. You could have just said you know what I'm done with learning, I've learned what I need to know, but you're a lifelong learner and I think the happiest people and the healthiest people are those who are lifelong learners, so I was sure to comment on that as well. I ask people to look at all these areas and then I ask them to say to themselves which area do I think I need to really focus on the most right now as the area that is interfering with my ability to move forward with the plan. Then I help them with developing a plan how to do that.
Speaker 1:I think that's wonderful because you know your statement about curiosity and lifelong learning. Boy, first of all, thank you for the feedback. That means a lot, especially coming from you, because I feel like you've had such an up-close view to my world and I appreciate that feedback and that observation.
Speaker 2:Well, you know, you've mastered so many different areas of therapy, and relationship is a big part of that. You took your intellectual interest and then you began to realize there's the emotional and the psychological and then the relationship, so you really merged three areas there.
Speaker 1:Thank you, and you know the. The thing that really stands out to me in this is the idea that with we, we don't. This isn't about conquering, mastering your storm is not about conquering something and then setting it in mothballs or cold storage and saying I've conquered it, I'm finished, I am, I'm good in this area and I don't need to ever evaluate it again. Evaluation we I, in other words I. I would hate for someone to see life's growth as a burden. It is an opportunity.
Speaker 1:It's an opportunity to enjoy, to enjoy learning more about, I mean, cause. I appreciate you bringing up that point. I love learning about human behavior and at some point you, you know do we stake a flag in the ground and say I know all there is to know? I hope not, because I hope our field is ever changing, because it is. I mean, I was just going through um psychological bulletin, which is a review journal and, for those of you who don't know what review journals are, it's a journal that reviews, uh, research and writes what's called a meta analysis, which is a whole lot of review to review of a whole lot of different studies and pulling together the themes that they see in all these different studies. And I was going through and reviewing the themes that I see in the outcome data and looking at all of that.
Speaker 1:And there was a, an article published in this this past year in 2023, and we call it psych bull and psychological bulletin that was going through and describing almost in detail not bringing up a Jim's model the CBASP, but describing in detail one of the exercises that is used in CBASP and saying how important differentiation is and how important this emotional understanding of self is. And I'm thinking to myself. You don't realize it, but you're describing all of the reasons why Jim, in the 1970s, developed this program. Yes, and it was all the scientific understandings of why he had intuitively seen something 50 years ago. And I just think about how our field is continuously moving and changing, so of course we're never going to stake that flag.
Speaker 2:Never. It's going to always be changing as we move forward, and I hope it's not burdensome. Oh well, you know, and you talk about growth. I want to comment on that because I also think if every person in their life embraces the concept of, I will be growing throughout my life. You know, Eric Erickson has stages of development that go all the way through to the end of life. I'm still working on some.
Speaker 2:So you know, you just keep working on those and I hope you keep working, because I want you to live a very long life. I'm still working on some, you know, so you know you just keep working on those.
Speaker 1:And I hope you keep working because I want you to live a very long life.
Speaker 2:But you know, we just work on all these things as we grow. I think if people can embrace the idea that growth may feel uncomfortable at times and that's okay, that's a part of life, and if they can embrace the idea of I may feel a little unstable when I'm growing or I'm changing or there's other areas of my life that I may need to reach out and get some sort of help. You know, you and I were talking about the concept of intensive outpatient program, which is a form of outpatient therapy. You all do it here at Restoration right here in Fort Worth, Texas, and do an amazing job I'm involved with-.
Speaker 1:In Dallas as well.
Speaker 2:Yes, and in Dallas too, I'm involved with Connections Wellness Group, which has intensive outpatient programming more north of here and more south of here. We're up in the Plano McKinney area, then we're more south down Arlington, mansfield, and we even have some programs in Tennessee. But the intensive outpatient programming is a really good way for people to go and address some things that are going on in their life, whether it's with relationships, their emotions, their psychological well-being. They're able to develop coping skills. They're able to get some support, because we all need that support at times and by doing this they can grow, they can make positive changes and it's a form of therapy. And people who do intensive outpatient programming may not even need to be on medications. I'm coming all the way back around to medications that you brought at the beginning. People on medications can benefit from that, obviously, but many people who just need more intensive therapy can really benefit from intensive outpatient programming.
Speaker 1:That's true.
Speaker 2:So you were talking earlier about mental health and people asking about really serious mental health issues and other types of issues. I think we have to think of mental health like everything else. It's a continuum. That's right. Everyone in their life will have some mental health concerns they're going to need to address.
Speaker 1:That's right.
Speaker 2:Grief is one, Loss is one. These are important matters. When we talk about the continuum, though, we talk about the common experiences everyone has. Then we talk about some of the things that are illnesses that are not as common. You'd mentioned bipolar disorder. It's a small percentage of the population, but it's very genetic. It's very biological, such as schizophrenia. That is as well. 1% of the population Very small percentage impacted. I think.
Speaker 2:The thing about mental health we think about, though, is there's wonderful and robust data and treatment for the common experiences we all have, such as grief and loss, all the way to the more serious implications, such as people who are out of touch with reality or with, as in bipolar disorder. They are impacted in a way that they're not sleeping, they're not eating, and they need to stay on routine medications just to help them function well. That being said, some of the most brilliant people I know have bipolar disorder, and when they take their medications and stay on them, they're incredibly functional, and so I think that's the good news I want to say about mental health. We've learned so much, but it's a field we're going to keep growing and learning about more as time goes on. It makes it exciting, for us Exactly.
Speaker 1:I love that you use that term excited because it's exciting, because one of the things that I've seen in treating people with bipolar is that working to get the medication right for that individual or the treatment correct for that individual is that I would hear a lot of, not a lot. I would hear a number of individuals say it way. I went from living in technicolor, dealing with that true sense of mania, to I went to living in the gray, and the gray was so just depressing that it would send me into a depression. And one thing that we know to be true is that bipolar depression is so much deeper, it's so incredibly painful, that it's like they would just the controlling that sense of mania would send them into a bipolar depression which is just harsh.
Speaker 2:There are people with bipolar 2 disorder who may not be fully manic and they ask the question often is how do I know I'm bipolar? Here's a really good yardstick. If you've been treated with two or three different medications for depression and you're doing therapy and you can't seem to get better, ask your doctor if there's a possibility you could have a variant of bipolar disorder. That's often a good yardstick.
Speaker 1:That's great, that's great. Disorder that's often a good yardstick. That's great, that's great. Well, I just want to say thank you again for coming and talking with us and sharing all of your wisdom and insight with our listeners, and your book your book is is available in at Amazon and everywhere that sells books. Yes, and there's a Kindle version coming up.
Speaker 2:Yes, there is a Kindle version and a paperback version at this time Awesome.
Speaker 1:Well, thanks again.
Speaker 2:Well, thank you for having me, it's been fun talking as always, as always.
Speaker 3:All right. Thank you. If you found value in our discussion and wish to uncover more about the fascinating world of mental wellness, don't forget to subscribe to the podcast. Stay tuned for our upcoming episodes, where Dr Long will continue to delve into empowering therapies and strategies for mental wellness. Your journey to understanding and embracing mental health is just beginning and we're excited to have you with us every step of the way. Until next time, keep exploring, keep growing and remember to celebrate restored freedom as you uncover it.
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