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celexa and weight loss
. >hi i'm dr. freda crews and iappreciate you joining me for another addition of time forhope a faith based mental health program and we arecontinuing our discussion this week with dr. richard winter apsychotherapist, counselor and
celexa and weight loss, seminary professor and authorof the book we are continuing to discuss titled when lifegoes dark. i have found dr. winter's book to be one ofthe most comprehensive on the subject of depression that ihave ever seen or read. being
trained in medicine andpsychiatry and as a seminary professor and practicingpsychotherapist and counselor he is able to shed light onthis mysterious mental illness from a body, soul, mind andspirit perspective including current research related toour brains and depression. to learn more stay with us. >richard with our experience,background, training we could go on forever on thissubject because i know in my counseling office there weretwo things that showed up the
most frequently. number onedepression and the other was marital problems. i had otherthings, grief and this and of course the gamete. in factwhen i knew something would come in i would have alreadythought i had heard everything but then something new wouldcome in or come into my office or will come into my office.but depression i think most therapists have to deal withdepressed people. and then of course the suicide issue isalways there with severe depression. there are veryfew people i think that are
severely depressed or what wecall clinically depressed over a long period of time thatdo not allow the suicidal ideations you know to come andgo. and i always encouraged them to make sure they let meknow and i always had people that they agreed that i couldcall to kind of keep an eye on them and listen to them. andyou've got the warning signs in your book by the way and iliked that so much that you outlined those. >well it's so important to notto be afraid to ask people who
are depressed, even if you area friend say to someone you know have you ever thoughtof taking your own life? sometimes people think thatthey're going to put it into the person's mind and thatit's dangerous to ask that question. >oh that was it, that's whatwas said for a very long time don't ever dare ask thembecause you'll make them think about it if they haven't andof course that's not true. and that's one of those myths.
>exactly and i think you knowyou said many people come with depression and it's true anddepression often is sort of the presenting thing butunderneath that there are often deep issues of the heartthat they're dealing with. you know maybe sexual abuse in thepast that is coming out now in depression or marital problemsthat are coming out in depression or addictions. sodepression is in a sense a presenter of many differentproblems and it also exists on its own.
>yes you know i can rememberone of my psych professors saying one thing to rememberis as a general rule when they first come the issue is notthe issue. and that still holds. >i think that's true manypeople come and they test you you know with certain storiesand symptoms but underneath you find a whole lot moreif you're willing to really listen. and of course as acounselor you spend a lot of time just hearing people'sstories and it's a great
privilege and honor for peopleto share their heart with you and to expose many of thethings they are deeply ashamed of. and i think many peopleare very ashamed when they get depressed. >talk therapy is still veryeffective, isn't it? i've had people spend an hour when theyfirst come just talking and when they get done they say ohi feel so much better. and i think well i haven't doneanything but listen, but maybe i was the first person in allof the world ever to sit and
listen to them. >and that's why the listening,the talking and if people do need the medication and thereare other things that we can talk about in a while to helpwith depression. but the listening and the medicationneed to go together. the talking, the opportunity to bein a relationship with someone who really cares about you andwho's willing to delve into the deep issues of the heart. >well let's go back as wepromised where we left off
talking about medication andthe placebo effect or the effectiveness of a placebo. isit a sugar pill or what that is given and they believe thatit is an antidepressant and they believe it helps? now thebrain comes in here so i want to hear some of what you'velearned and what you know about the research that isbeing done with the brain and how that fits into this wholething of placebos being as effective with many manypeople as the medication itself.
>yes well there are a lot ofissues in that question but i mean i think we know that theantidepressants that we use today, and there are manydifferent types as you mentioned earlier, and we'realways looking for ones that have the least side effectsand have the most powerful effect in relievingdepression or anxiety. >i just want to interrupt youright there and you brought it out in your book that allmedication doesn't fit everybody. generally it's atrial and error isn't it till
it can be matched; the med andthe person can be matched. >our understanding ofantidepressants and of the brain mechanisms of depressionare pretty primitive still compared with many otherillnesses and many other organs of the body. we knowless about how the brain works than about the kidney or theheart or the lungs because you can't get in there to lookat it, a living brain. until recently of course we'velearned a lot more with different types of brainscans. so yes each person
needs to find theantidepressant that works best for them in the best dose forthem so they have to work carefully with the doctor orthe psychiatrist to get that and the least side effects andthat may take time. and people need to be on antidepressantsfor many months, it's not just a few weeks, this is along-term thing. and then they need to come off them slowlyand carefully when they do stop using them. and somepeople who have chronic recurring depression may needto take them for a lifetime.
especially people who havebipolar disorder, what we used to call manic-depression. >yes and you did say lithiumis still the standard. >for bipolar disorderand there are many other medications too that i usedfor that. the anticonvulsants are sometimes used; thingsthat we used for epilepsy are sometimes helpful. >i think depakote is beingused quite a bit isn't it? anti-seizure medications.
>and then going back to theissue of placebo what i was trying to say was thatantidepressants have been shown as far as we know todayand research may change our view of this in the future,they work for severe depression but we're reallyuncertain how well they work with mild andmoderate depression. >so would thatexplain the placebo? >well i think the placebo,some people are very suggestible, you know evenwith pain when you give people
pills that don't have any painkiller in them for pain they actually relieve the painbecause people believe that they are taking somethingthat's useful and that will relieve it. so you know whatwe're saying i guess in this is that we shouldn'tbe too quick to rush to antidepressants for thetreatment of depression. we should be trying many othermeans for helping people with depression. especially i thinkexercise and a good diet. >i always required my patientsto get on an exercise program,
walking. >this affects the brain whatwe're talking about the different ways that affectthe brain. and meditation and breathing exercises andrelaxation and good nutrition, healthy diet, taking fish oil. >not too much caffeine. >not too much caffeine exactlybecause that can exacerbate anxiety. not too much alcohol,all of these things i think are ways in which we can pushback against the effects of
the fall and our individualvulnerability to depression. so that medication comes in assort of when the other things don't work and when thetalking doesn't work. when someone is still deep indepression and they may need that. and then sometimes whenantidepressants don't work people may need what we callelectroconvulsive therapy, ect. >yes and that scares people,that word very often scares people severely. >it sounds like somebarbaric medieval torture.
>yes. >it is in fact an effectiveway and it's done in a very careful way. the person isunconscious, they have a short anesthetic, they have a musclerelaxant so their muscles are all beautifully relaxed. andthen the brain is shocked with an electrical impulse thateffectively gives it a seizure. and they found, theway they found this was people with epilepsy many years agowho also had depression after an epileptic seizure veryoften, their depression would
go away for a while. so theythought well if we give them a seizure maybe that will getrid of depression. so then now people will have maybe six oreight treatments over several weeks and with resistantdepression that is resistant to antidepressants it can be avery effective treatment. it went out of favor for a whilebecause people were using it much too much and for thewrong reasons and now with careful controls it's comeback in again as a useful treatment for depression,serious depression.
>now how does that fit in orwhatever with the deep brain stimulation thatyou talk about? >i mentioned that briefly thatthere have been some studies in recent years again ofpeople with very severe depression which doesn'trespond to anything. any talking treatment, anymedication and they've found that putting a tiny electrodeinto the brain to the particular part of the brainjust sort of behind the forehead here and stimulatingthat can relieve this very
severe depression. now thereare only a relatively small number of people but some havehad very dramatic improvements which really demonstratesthere is an underlying physiological biologicalmechanism in some forms of severe depression. >well it's time for a breakand we'll be right back. >why don't we as has been saidjust jump a creek and go into the newest meds that you areusing and finding effective. >what comes to mind isecclesiastes that there's
nothing new under the sun.and what are apparently new medications are actually,there's really only one new one and we'll talk about thatin a second. but there's a new technology that is beingapplied and that is if you take an antidepressant andyou look at it under the microscope the molecules haveright and left handed forms so they are called isomers andthey're about evenly mixed. but one isomer is the activeone and the other isomer is inactive so say prozac, half aprozac does nothing but give
you side effects. now whatthey've done is they've gone in, they've taken out thatactive isomer. it's not as complicated with the fda toget approval because they've already got an approval. thenthey give it a new name and they market it. and of coursethey own it then for years because you can only getbrand. and it turns out that by in large they are bettermedications. you can use a smaller dose and you have abetter side effect profile. the more familiar ones areprestic which is the active
isomer of effexor. lexapro isthe active isomer of celexa. focalin is the active isomerof ritalin. vyvanse which is used for add is very popularand i'm very pleased with that is the active isomerof adderall xr. >so you can actually use thevyvanse with depression? >actually you can. it'sinteresting because what goes around comes around and in theolden days of psychiatry it was very common when peoplewere in the hospital to bump their mood a little bit with astimulant. especially if they
were in bed and not movingand couldn't do anything or elderly who were verydepressed we gave them a little boost. and then thatfell out of vogue and now it's coming around again. and soit's just temporary though and so you really have totreat the mood with the antidepressant but you can geta little bit of a mood lift out of a mood stimulant. >i remember too many peoplethat were being treated and on medication gained weight.
>actually there's only one andmaybe two, the wellbutrin has no weight gain with it andthat's a norad allergic helper, a pure norad'sallergic helper that's out there. but unfortunately itsmain side effect is anxiety and agitation and so we don'tuse it by itself very much. we use it in conjunction with thessris. ssris are notorious for two things. some of them likepaxil are bad about weight gain but the others you can'tlose weight on. so you might stabilize but if you try togo into a weight loss program
you're not goingto lose weight. >thanks so much for sharingyour knowledge with us. >welcome back to time forhope dr. winter and i are discussing a problem, a mentalhealth problem or disorder that we could go on for weeksand weeks and weeks and not exhaust so bear with us as wetry to get out some of the outstanding things that itwill be good for you to know about the subject ofdepression. so i'm going to turn back to dr. winter andwe're going to try to pick up
and move on with ourdiscussion on depression. and richard i want to go back alittle bit and thinking about depression would you tell mereal quick, you went through it, you've been through it,i've been through periods of depression, could you quicklysay, you're saying when the world turns dark, so what's aperson feeling and you know what's their outlook like andwhat's going on with them emotionally, psychologically,even spiritually, cognitively, whatever during aperiod of depression?
>during a period i think ofwhat we're talking about is severe depression, clinicaldepression because we mentioned earlier many peoplemay have times of being down. but when i think, when lifeloses all its color, you know when you don't find pleasurein anything anymore, when you can't laugh. some people can'teven cry when they feel this way. and when that goes onover more than a two-week period almost every day that'sa significant thing. if it just happens for a few daysthen we wouldn't call that
clinical depression. but whenit's extended over a time and then when often there is anappetite disturbance, people can't eat, they're off theirfood or they're eating too much for comfort. they may besleeping too much or sleeping too little. they wake veryearly in the morning at two or three ruminating about allthe problems, they get more anxious, often more irritable.they may be crying a lot and then they may begin to thinkthoughts of suicide. they may feel god is far away, prayeris useless and the bible is
meaningless as we said earlier. >and it also really very oftenhappens about the scriptures, related to the scriptures iswhen they do pick up their bibles the verses they findare moving against them or confirming their guiltfeelings which can be a pseudo-guilt or a false guilt.so they kind of push away from the bible because it seems tocondemn them rather than help them. >exactly right, yes. so guiltand sometimes false guilt, i
mean people can be depressedbecause they are really guilty but often when people areseriously depressed they feel guilty without any real cause.so you're right the bible seems to condemn them. itfeels like god is a fierce condemning person. >and the lord that might beone of the purposes he allows us to go through if there isreal guilt that he wants us to deal with in it also. he doesnot always and most of the time does not deliver usfrom pain and suffering.
>exactly, we see that so muchand the psalms don't we and david's laments caused by allsorts of different things. sometimes by his own sin thathe needed to repent of and sometimes by persecutionfrom enemies, from difficult circumstances, being out inthe desert maybe without food or whatever. he went through alot of difficulties but he was able to just pour out hisheart to god and that's the beauty of the psalms is that ithink they encourage us to not be ashamed to tell god exactlywhat we're feeling and to be
able to tell another personand that's the value of counseling is being able totell another person. and to try and make sense of theconfusion that we often have of why am i depressed. asdavid says why am i cast down oh my soul? >he was talking. i've alwayspointed my clients to the psalms when they couldn't readanything else they can find comfort very oftenin the psalms. >and i think the old testamentsaints were far better than
the new testament saints intheir earthiness and talking about and telling god whatwas going on with them. >well so much of the oldtestament is stories isn't it of people's lives? and peoplelike naomi and ruth, that story i love. just ordinarypeople that god worked with and comforted them intheir grief and sorrow and depression. the new testamentthere is a lot more sort of didactic teaching in theteaching of paul isn't there? and the gospelstories of course.
>of course. now let's backupand try to close out with the medication. we could go on fora long time with that. but when the medication works, howdoes it work in the brain? what's going on so thatmedication can be effective in relieving a severe depression? >well as far as we know itworks on the neurotransmitters or the chemicals that aretransmitting impulses between the nerve endings and thebrain. often in depression it seems that they are depleted,they're lowered so that in
taking an antidepressantyou're raising the level of neurotransmitters to help theconduction. it also seems and we're discovering this morerecently that antidepressants encourage the regeneration andeven the new generation of nerve cells in different partsof the brain. and they damp down the over active partsof the brain and help to stimulate the under activeparts of the brain that we can see on brain scans thatdemonstrate this in depression. >and that is new knowledgefor us because for so long
remember it was believed thatwhen the cells died, they're dead and there are no new onescome to replace them. but the brain scans and aspect imagingand so forth are revealing that's not true. >and what's amazing is thatthe brain scans are also enabling us to see that notonly do the antidepressants help and how they might help,they're also helping us to see that talk therapy, thepsychotherapy, the counseling also changes the structure andthe function of the brain.
that you can actually seechanges happening in the way the brain is acting aspeople are moving through psychotherapy and counseling. >you know that really laysout a great ministry for the church doesn't it? when youthink about that the lord made us communicable and socialpeople and we don't like being alone. that's within our verynature. so to be able to be with people, people thatunderstand, people that will listen rather than alwayshaving the answers and for
sure we don't need peoplewhen we're depressed that are judgmental. we want to steeraway from those kinds of people. >well people when they'redepressed quite often isolate themselves which of courseis not the best thing. so to encourage them to be keepingon in relationships and being part of a community, beingpart of the body of christ which is there in orderto help them as a sort of alternate family to help themto grow and to change and to
get out of the dark places oflife. we need other people. >we need other people andespecially during a season of depression. that's one of thebest, if you want to talk medication or one of the bestmedicines is understanding, loving, gentle, kind,compassionate friends and family members and so forth. >and if friends and family andcommunity and the church was functioning as it should weprobably would need less psychotherapistsand counselors.
>very good thought. don't goaway i have a prayer request to share with you and a noteof encouragement. and we're going to continue thisdiscussion and should close it out next week and we're goingto close it out with hope. we're going to close it outwith ways that you can come out of the darkness into thelight if you're experiencing depression. so make sure thatyou join us again next week as we close out our discussion,dr. winter and i about his book and about the subject ofdepression and his book when
life goes dark finding hope,and we're going to give out that hope, in the midst ofdepression. and then i have a prayer request. >and we haven't even gottenaround to discussing happiness as dr. winter does in his bookso we'll try to do that next week. and then a note. >and i'm glad you added thatbecause we have a wonderful staff here and i couldn't dowhat i do without the staff that the lord has given me.so don't forget join us again
next week and we're going tocover some territory and get you to a place of hope ifyou're dealing with depression. >to order our resources,follow instructions on screen.
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