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Mitch: Have you been feeling a little off lately or maybe sad for a prolonged amount of time without any obvious cause? I know I feel that sometimes. Could it be depression? And if it is, what are we as guys supposed to do about it?

Depression is one of the most common mental disorders in the U.S. impacting as many as six million men a year. And yet, according to research, men may be more likely to suffer from the severe consequences of depression, like substance abuse and suicide.

This is "Who Cares About Men's Health," where we aim to give you some information, inspiration, and a different interpretation of your health. And today we'll see if we can't shed some light on depression.

I'm Producer Mitch, and I bring a little more than the microphones. And as always, we have Scot, manager of The Scope Radio, and he always brings a healthy dose of BS. Hey, Scot.

Scot: That's right. I'm ready with a healthy dose of healthy BS. I don't know what happened there. My mouth stopped working. All right. Why don't you introduce Troy?

Mitch: And the man who brings the MD, Dr. Troy Madsen.

Troy: Mitch, I'm super excited to talk about depression.

Mitch: I know, right? The most exciting topic. And joining us today is Dr. Scott Langenecker, the clinical neuropsychologist and professor of psychiatry at University of Utah Health.

Dr. Langenecker: Hi.

Mitch: Now, before we get to the professional, I think one of the things that we should probably talk about first is kind of the layperson's understanding of depression, because I think we toss that term around a lot. It's like, "Oh, I'm feeling a little depressed." That seems to come up a lot and I'm not always 100% sure if that's true depression. Scot, when you hear depression, what does it mean to you?

Scot: That's a great question because it comes back to this whole notion of what does it even mean to be happy? I tend to think that my people, if you will, tend to be maybe just a little on the depressed side. Maybe we don't relish in life as much as other people. Maybe we're not as effervescent.

But what is it really? I don't know. Is it a feeling of you just can't go on? Is it a feeling of you can't breathe, like you're dragging your feet in concrete just trying to get things done? Is that depression? So yeah, I'll be curious to find out.

Mitch: Yeah. And what about you, Troy? I wonder if in your practice at the ER and stuff like that, you must have at least a little bit of an understanding of it.

Troy: We do see a lot of patients who come in who are depressed. And certainly, I think all of us have fluctuations in mood and outlook. I think depression in my experience, it's more when it's . . . You get to a point where it's just like this haze, this fog that you're in, and it affects your ability to do your work. It certainly affects your outlook, affects your relationships.

So I see it as certainly a step beyond just a lot of, I think, the fluctuations we might feel in our mood over the course of a day or a week or whatever that might be.

Scot: Or just a little sadness or feeling the blues or something like that.

Troy: Yeah. Exactly. And like you said, Mitch, you might be like, "I just feel depressed today." But yeah, I think it's certainly something beyond that kind of mood changes we might experience.

Mitch: Yeah. And personally, I actually got diagnosed with some depression this last year and have been taking a kind of professional approach to it. But I don't want to bury the lede. I don't want to steal anyone's thunder when talking about depression. So why don't we get to Scott?

Dr. Langenecker, what is depression? And I guess as a follow-up, what is causing that?

Dr. Langenecker: So I want to put it in two big categories to start out with. The first big category is that you all alluded to, that sort of feeling sad for more than just a day, maybe a couple of weeks. So that's one big bucket.

The other big bucket is, "Man, I used to really enjoy hiking or skiing or running or playing basketball, and now it's kind of like blah. It doesn't give me that jazz anymore." And it could be one of those things. It could be one of the other things.

There are another seven symptoms that can be part of it, but those are the two big ones that sort of tip people off. But if you're not looking forward to things coming up in the future, or you look at your schedule for the day and you're like, "This is objectively a good day and I still feel sad," that's probably a tip-off.

Scot: Is it really sadness, though? I mean, how do we even define what sadness is?

Dr. Langenecker: Well, that's a great question because I'm not sure men are allowed to feel sad.

Scot: Oh, okay.

Dr. Langenecker: Can I say that?

Mitch: Only anger.

Troy: Scot, you've never felt it, so you wouldn't know.

Scot: Right. The eternal optimist.

Dr. Langenecker: Sadness isn't a man thing.

Scot: I don't know. Yeah, I think about depression and I don't know that I think about sadness necessarily. Maybe something like overwhelmed with some emotion. Maybe it's overwhelmed with sadness.

Dr. Langenecker: Yeah. So let's talk about the male interpretation of sadness, which is, "I've got people counting on me and I can't cut it. I can't do what I'm supposed to do and I'm letting them down. I feel this pressure and I can't do what I'm supposed to do as a man, supporting my family, supporting my job at work." So it comes across as that. That's one way.

The other way is irritability and anger, which is like, "Ugh, that person just drives me crazy all the time." And maybe it's true. Maybe they are. Or maybe it's just that you're feeling a bit depressed and anything is going to set you off. Those are kind of the two big ones for men.

Troy: It's interesting that you frame it that way too, because I agree. I think a lot of times we think of sadness like just being really weepy and down in the dumps. But to think of it that way in terms of just feeling more irritable and angry and just a sense of inadequacy, that makes a whole lot more sense in terms of, I think, probably how that sadness manifests in us as men.

Dr. Langenecker: Yeah. I would add there's sort of this classic trope about the middle-age crisis for men and getting a new wife and getting a sports car and buying new golf equipment. There's a premise for that that's sort of rooted in depression, which is, "Man, the things that used to really interest me just don't anymore. I feel kind of flat. I feel not into it anymore." Every time you go into that sort of stereotypical midlife crisis mode for men, is that depression? No. But it is some clues, right?

Troy: And you also mentioned it's not just a day. It's not just one day, "I feel irritable today." Maybe I didn't sleep well last night. You're talking about something sustained over weeks to really diagnose depression.

Dr. Langenecker: Yeah. And I should add one more thing. I know you've all talked about the interface between the brain and the body. Sometimes depression comes out, not just in men, but in women too, it comes out in the body. So people are like, "Oh, my back is just driving me crazy. I can't get comfortable, I can't sleep," or, "Man, my knee is just bothering me lately." And it turns out that there's actually a reason for that.

So some of the neurochemical systems that interface between the body and the brain are sending some of those signals both directions. And so it comes out sometimes as pain.

Troy: Yeah, and I will absolutely second that. A very large percentage of people I see in the ER with chronic abdominal pain, back pain, even chest pain, they're clearly underlying emotional health issues, and a lot of that is depression.

So that's a good point of being aware of maybe some of the physical symptoms we're seeing. Certainly not to blow those off as just writing those off without getting those checked out, but it makes sense that a lot of that does relate to depression or mental health.

Mitch: Wow.

Dr. Langenecker: And if you take that analogy a bit further, and this goes back to my upbringing, when you had pain in the olden days, you would go see a chiropractor, like if you have back pain or leg pain or whatever. And what happens in a chiropractor's office? You get a kind, caring individual. They do some manual adjustments. They spend some time with you. It's a powerful human interaction, and it resets some of those neurochemical signals in addition to some of the psychological support that comes with it.

Mitch: So if it's causing trouble in your mood, your behavior, and also in your body, do we know what causes depression?

Dr. Langenecker: We have clues.

Mitch: But no answers. Just clues? Okay.

Dr. Langenecker: We have clues, but no answers. Yeah. So the easiest way to think about it is our brain is really, really sensitive to things that are dangerous to us. And we grew up evolutionarily in a place where it was really a bad idea to not be afraid of a tiger or of a rattlesnake. And it was really a bad idea to sort of go wandering out in the dark at night. And so our brain has adapted over time so that, for many reasons, we would sleep, but also so that we would have a healthy fear of things that could kill us.

Well, it turns out in the United States today, it's a pretty safe place. Part of the evolutionary makeup that we had, too, is that we had to form small groups to protect each other. And so social connectedness was a super huge important part of being healthy and staying alive.

And then the final thing is if we got sick, we needed a system to keep us separated from other people so that we wouldn't necessarily get them sick as well.

All of these things are great if you're running around in prehistoric times with sabretooth tigers and whatever, but it's not super helpful in our environment now. So we have these super-sensitive in-tune systems for detecting danger and stress and so on, and sometimes our system gets over reactive to these triggers in the world.

Sometimes, however, we have experiences which I would put in the broad category of not being fair. And if I had a nickel for every time I said to a patient, "Hey, what happened to you was not your fault, and it wasn't fair, and let's see what we can do about it," I would be a very wealthy man and I wouldn't be talking to you right now.

Mitch: So you're saying that everyone is maybe hardwired to have these kinds of responses? It's not like you are some sort of different. You're not some anomaly if you experience depression.

Dr. Langenecker: This is where I'm at today, after 25 years of studying this. I think that apart from maybe 3% or 4% of humans, we all have the capability of becoming depressed. And I think that's actually an inherent part of being human. I think it's a good part of being a human. And if you don't have those signals working when things go wrong, people probably won't like you very much.

Mitch: You're unlikeable if you can't get depressed? Is that what you're saying?

Dr. Langenecker: You're unlikeable if you don't care about things and don't care about other people. And it turns out if you take that capacity to care and you combine it with bad experiences, a lot of times that's going to end up being maybe not depression, but some sadness, a couple of days of sadness.

So you asked me the question, "What is the cause of depression?" And that's the segue. The segue is a couple of days of sad to more than a couple of days of sad. I use this term professionally. It's perseveration of negative mood. What the heck is that? It means that the negative mood doesn't leave, no matter how hard you try and shake it.

So it brings me back to Charlie Brown with the rain cloud over his head following him around. That is a beautiful example. And I know that Charles Schulz experienced depression because nobody else would draw that unless they experienced depression.

Mitch: And that's interesting that you said that because that was kind of my sign that something was up. In the past, I could maybe go for a jog after I learned to enjoy running, or I could watch a movie and I could pull myself out of a funk if I did these particular activities, eating food I enjoyed, etc. Suddenly, nothing seemed to pull me out of it. And it didn't matter how hard I worked or how many self-help programs I tried or how many books I read, I just could not get out of it. And that's when I knew I had to talk to someone. And eventually, I had to get some medication for it.

Dr. Langenecker: Yeah, that feedback system, right? We have a feedback system from our brain to our body. And you sort of think in depression, that system gets jammed up. It isn't working the way it's supposed to.

I don't know about any of you, I joined the conversation about running late, but I don't like to run. I hate running, but I love how running makes me feel. And if all of the sudden I didn't feel that way after running, it wouldn't take long for me to say, "You know what? I don't want to run anymore." And that's what depression does.

So we mentioned it before. Depression is this sneaky [beep] that takes away the joy from things and then convinces you that that's a good idea. Like, "Oh, no. I shouldn't seek out joy anymore. That's a great idea. I should just sit in my bed."

Troy: And how good are we at actually recognizing that in ourselves? How often do you find people like Mitch who recognize it, get help, versus how often is it others who are really pointing that out, saying, "Hey, you used to really enjoy this. You don't do it anymore. What's up?" I'm curious how that really works.

Dr. Langenecker: It's interesting. I don't mean this in a negative way, but we as humans have a lot going on, right? There's a lot of stuff going on in our heads, lots of stuff going on in our lives. And sometimes we just miss it. We miss it in ourselves. We miss it in other people. And that's not bad on anybody else. That's just the complexity of being a human being.

But sometimes it's absolutely the case that you miss it yourself. Absolutely the case that somebody else is like, "Hey, I notice that you're a bit off. What's going on?" And then of course as a man, our first response is, "Whoa. No, no, no. We're not going there."

Scot: "No, no. Everything's fine."

Dr. Langenecker: "I just rubbed some dirt on it. It's fine."

Mitch: Right. Can we say sneaky [beep], Scot, or is that what . . .

Scot: I don't know.

Mitch: All right.

Scot: Why sneaky [beep]? Why is depression a sneaky [beep]?

Mitch: That's what I was going to say.

Scot: What is the fact that has . . . What's the definition of [beep]?

Dr. Langenecker: Yeah. Unpleasant fellow. Let's use "the sneaky unpleasant fellow."

Scot: Oh, yeah.

Mitch: Okay. I love that.

Scot: I thought it meant something else, I guess. Okay.

Dr. Langenecker: So, in technical speak, we talk about cognitive distortions, like how depression changes the way you view the world. You view the world in more black and white terms, like, "Things are all good or they're all bad," or, "People are out to get me," or, "Things are never going to work out for me." And those cognitive distortions don't really work for a podcast or for actually talking to patients, like real humans. And so I've come to think of depression as this sneaky inner voice.

So you might remember back in the day, long ago in cartoons where they had the devil on your shoulder and the angel on your shoulder. This is kind of the devil on your shoulder saying, "Yeah, things are terrible. They're always going to be terrible. And that person is not going to help you, even if you ask them for help."

And so those cognitive thoughts are happening in the same exact system that does all of your problem-solving. And it doesn't take long to figure out, "Oh, so the same exact system that's doing the problem-solving is also distorting my perceptions of the world." That's the trap. That's the sneakiness of depression.

Scot: It's like a little saboteur.

Dr. Langenecker: It is absolutely a saboteur. And then to add insult to injury, in depression, I will feel ashamed that my brain is doing this to me on top of that.

Scot: Actually, it's like that game. What's that game, Mitch, that brought up the term sus? "It seems sus."

Mitch: Oh, "Among Us."

Scot: "Among Us." Yeah. It's like the little evil person in "Among Us" that pretends to be your friend, pretends to be looking out for you, but really behind the scenes, not doing cool things.

Dr. Langenecker: Yeah. So we come back to the question of "What is depression?" Depression is your own brain convincing you that things that are good for you aren't good for you.

Mitch: That resonates so much with me. I was actually talking to my therapist the other day. I've been in a bit of a depressive episode. And when I was chit-chatting, it was just like . . . He's like, "You know what you need to do to get better." And I'm like, "I know. I need to start eating better, I need to get out, I need to do the things that I enjoy more, remind myself I enjoy them. I need to be talking to people."

And he's like, "Even if you don't like doing it right now, that's just your depression telling you, 'No. Don't work out. No, don't go talk to these people because they hate you,' or whatever. Just power through it. Ignore them. It might be unpleasant, but you've got to start doing those types of things if you're going to get out of the depression cycle."

And I think that's kind of what I want to ask next. What do you do? How do you fight back against this saboteur of depression?

Dr. Langenecker: I'm glad you brought that up, Mitch, because there's another piece to this. So you take this maleness of "I don't need help," and then you take this sort of cultural belief that we're doing the Horatio Alger thing and just pulling ourselves up by our bootstraps. And then you take this idea of positive psychology, which is literally rub some dirt on it or rub the dirt off of it. I don't know what it might be. And for somebody who's experiencing depression, that's basically telling them, "You're an idiot. You can't figure it out. You should have figured it out a long time ago. Why are you such a moron?"

And I'm using really strong language here because that's the saboteur. The saboteur can take really well-meaning, "Hey, maybe you could try this," or often, "You should do this," and it comes across as, "I'm incompetent, and I'm making a big deal out of this, and I should just get over it."

So part of the work with a therapist, honestly and truly, is getting folks to realize that they deserve better and to believe that they deserve better and to do things in the world to actually experience the better. That's how we beat the saboteur.

Mitch: That's interesting, because on another episode we kind of talked a little bit about the first couple of mental health workers I worked with. I was suffering from depression and that was the very same thing I felt. When that first person was like, "Oh, yeah, have you tried gratitude journaling?" the first thing I thought was, "I've tried it. It's obviously not working for me, doc. You've got to help me here. I'm not going to open up the journal again. Things are obviously terrible."

And I think looking back on that, he was probably giving decent advice and good advice. I just was not in the mood to hear it.

Dr. Langenecker: And that's why I use the analogy of a journey with some really comfortable shoes because it's not just the what, it's the when. And there's a phenomenon in depression, the waxing and waiting of depression, where as a therapist, I wait for windows of opportunity. I don't force windows of opportunity. And that has taken years to hone that skill, because if I force it at the wrong time, I'm going to be breaching some of that trust that I worked so hard to build with my client.

Mitch: So to kind of wrap up this discussion on depression, Scott, it sounds like depression is when you are feeling out of sorts or sad for more than one day, things that you used to enjoy aren't giving you that spark of joy that they used to. At what point should someone . . . what is a sign, a red flag that they should probably go talk to someone or they should probably seek some sort of treatment in one way or another? And what can they expect on those first steps of their mental health journey?

Dr. Langenecker: So to come back to that point, having the sadness or lack of joy for . . . Technically, we use the term two weeks or more as sort of the breakpoint. That is not a magical number. That is just a number that we've come up with over time. It could be more than five days, it could be more than three weeks, but just sort of this idea that something is off.

And then if it starts to mess with your sense of who you are as a person and what you deserve in the world, that's the point at which you say, "You know what? I don't have to fight alone. There are really talented people who are out there ready to help me."

Mitch: I love it. And what can they kind of expect on their first couple of steps into getting help?

Dr. Langenecker: I think the main thing is don't rush it, like we were talking about before. Don't feel like you have to rush this thing. We get into this mindset of, "Oh, I can take my car in for a tune-up." A brain tune-up is much more complicated than a car tune-up. It might take a couple of months. It might take longer. Be comfortable with the idea that you are investing in you. You are investing in you deserving a better life.

Mitch: Scott, thank you so much for joining us, and thank you for caring about men's health.

Dr. Langenecker: Thank you.

It seems there has been a big increase in the number of children being diagnosed with sensory disorders. One reason may be that kids with sensory issues actually have other diagnoses, such as ADHD, anxiety, PTSD from abuse, and autism, just to name a few examples. Other times, some kids may just be sensitive to some things but not others and don't actually meet the full criteria. It has only recently been added to the psychiatry diagnosis textbook, the DSM-5.

Sensory processing disorders are basically where kids are sensitive to sounds, textures, or other stimuli to the point where it is beyond normal childhood behavior and causing a disruption in the child's life and also in the life of the family. Any of the five senses, taste, touch, smell, sight, and sound can be affected. Often children with sensory issues also have poor fine motor skills or have a hard time with social cues and interactions. They have a hard time regulating their emotions.

One study shows that sensory processing disorders affect 5% to 15% of school-aged children. Another study showed that there may be a biological cause with abnormalities in the white matter of a child's brain that could explain sensory issues.

Some children are hypersensitive to things and may think everything is too loud or too bright. They are the ones who are covering their ears often or have a low pain threshold or are super picky with eating certain textures. They have a hard time focusing and controlling their emotions, and they don't like to be touched. Other children are hyposensitive and they crave input, trying to get more sensory input. They're more likely to have a high pain threshold, put things in their mouths, hug too tightly, invade other people's personal space, or rock and sway.

One big issue is that there is still so much to be learned about sensory processing disorders. Your pediatrician can suspect your child has a sensory processing disorder but cannot actually make the diagnosis. Again, there are so many other brain issues that can present with similar symptoms so it takes a developmental or a behavioral specialist or even a neuropsychologist to get an official diagnosis. Your pediatrician will refer your child to someone who can help do a full and complete evaluation to get the correct diagnosis. The mainstay of treatment for sensory processing disorders is occupational therapy. Occupational therapists can help kids and parents learn ways to manage their sensory needs.

If you have concerns that your child may have a sensory issue, please talk to your child's pediatrician and ask them for a referral to a specialist who can get them the right diagnosis and treatment.

Dr. Jones: If you knew that you had a gene that caused illness in your children, what are your choices? New research into editing genes in human embryos gives us some new choices and new dilemmas. This is Dr. Kirtly Jones from obstetrics and gynecology at University of Utah Health and this is The Scope.

Announcer: Covering all aspects of women's health, this is The Seven Domains of Women's Health with Dr. Kirtly Jones on The Scope.

Dr. Jones: Mutations in the genes we carry cause thousands of diseases. Some of the diseases are manageable and some are deadly. If we knew we had those genes and didn't want our biologic children to suffer those problems, what might be the choices?

Of course, you could toss the genetic dice and just hope that the next baby didn't have the disease. A lot of people do this. They can't afford other options, although the care of what might be a critically ill child has its own costs. Maybe they feel that the options of creating a child aren't in their hands. Maybe the disease they carry isn't life ending but is life limiting. They have to manage with this disease and they figure that the children will as well.

Okay, the next choice might be that you choose not to have biological children. Some people make that choice because the possible outcome of a child with a severe disease is too heartbreaking for them. They may adopt children or remain childless.

Another choice might be to use donor egg or donor sperm depending on whether the dad or the mom has the mutation and make a baby that way. Donor sperm are relatively inexpensive, donor eggs are not. Some people want their own biological children and may search for another path.

Genetic testing of early fetuses in the womb by collecting cells from around the fetus has allowed pregnant women and their partners to know if the fetus carries the abnormal gene. The couple can decide if they want to terminate the pregnancy. This was the only option until about 15 years ago for a couple to try to select a healthy pregnancy. Clearly, it can be heartbreaking for couples to terminate a wanted pregnancy but if they already had a child die from the disease, that option might be preferable.

About 15 years ago, pre-implantation genetic diagnosis became widely available in the U.S. Couples with a known genetic disease can have in vitro fertilization and their early zygotes, very early embryos, can be tested and only the healthy embryos placed in the uterus to hopefully implant and grow. The abnormal embryos can be discarded. In healthy fertile couples with genetic diseases, this technique can be very successful.

Now, this week a multinational group led by a team at Oregon Health Sciences University reported the first successful techniques in editing out a mutation in sperm from a man with genetic heart disease. They were careful and successful in creating what appears to be genetically normal embryos. Although the embryos weren't implanted and were discarded after testing, their new technique opens up new doors and asks some questions.

Wow, this reminds me of typing term papers 50 years ago on a typewriter. When you made a mistake on the page, you could use white out, but it looked bad. You had to start all over. Then came the electric typewriter which let you correct little errors but not big ones. Then magic happened, computers created word processing. You could cut and paste with a click. It would even tell you when you'd made a mistake. It completely transformed written document creation. That in mind, how did this Oregon team do it?

They used a gene editing technique kind of like word processing called CRISPR-Cas 9. A lot has been written about this genetic technique. You can watch it on YouTube, there are TED Talks. It was invented or perhaps we should say discovered by two women scientists, one from the U.S. and one from France.

The Oregon team put a little cool twist on this technique. They took the sperm from the man with a known mutation that causes heart failure, they added the sperm to donor eggs. After injecting the sperm into the egg, they added a molecule created in the lab to specifically cut out this abnormal gene from the sperm DNA. And the really cool part, the egg with the normal gene had natural gene repair mechanism that replaced the gene from the sperm that been cut out, with a copy of the normal gene from the egg. They even in the paper called it not "gene editing" but "gene repair."

The zygotes that were created with this technology were then tested and the majority of them were normal by genetic testing. Now, this was a very special kind of genetic problem. It came from the man and was carried in the sperm. The cutting and pasting happened very early after the sperm was added to the egg, waiting later after fertilization doesn't work as well. And other research teams using this technique in already fertilized eggs didn't find it worked as well. We don't know if this would work if the egg was carrying the mutation and that would be much harder to do as eggs are hard to get.

So why would a couple use this technique when it's perfected rather than other options we've already mentioned? Some people have philosophical or religious concerns about discarding embryos. This new technique isn't perfect and some abnormal embryos will still be created, so discarding embryos will still happen.

Should we do this just because we can? Maybe. Pre-implantation genetic diagnosis, the technique we can do now to replace only normal embryos is complicated but it works very well. You do need a bunch of embryos to make sure you have enough for some to be normal. Gene editing might allow for greater chance of getting normal embryos, if you don't make very many eggs.

Of course many people worry about a slippery slope of creating people with specific genes for certain traits, height, smarts, eye color. But the same kinds of arguments were put forth when any genetic testing of fetuses or embryos was first attempted. So this technology is not ready for general clinical use at this time. It's amazing that they could cut out the abnormal gene from the sperm and the eggs' DNA repair could create a new healthy gene. If the technology gets better, and it will, it'll be available somewhere in the world and some people will use it. So stay tuned and thanks for joining us on The Scope.

Announcer: Want The Scope delivered straight to your inbox? Enter your email address at thescoperadio.com and click "Sign Me Up!" for updates of our latest episodes. The Scope Radio is a production of University of Utah Health Sciences.

Interviewer: Ten percent of people living in Utah are at a higher risk for seasonal affective disorder. We're talking today with Dr. Jason Hunziker. First of all, why are we, living in Utah, at a higher risk?

Dr. Hunziker: There are a lot of theories as to why people who live in the northern latitudes are at higher risk of this type of depression. One of those theories is the fact that there just is not as much daylight in the north as there is closer to the Equator. So the further we get away from the Equator, the shorter the days become, the darker it becomes, and so people get more depressed.

Interviewer: And so, then it's true that sunlight actually makes you happy.

Dr. Hunziker: That's correct. People who live closer to the Equator have less chance of this type of depression.

Interviewer: Are there other risks then, being in Utah, besides not enough sun?

Dr. Hunziker: There are, and people who are at risk that live in Utah are people who are young, they're a lot more at risk. Women tend to be at a higher risk than men, at an almost ten times more likely to get this type of depression than men.

The other thing that occurs in Utah, that doesn't occur in other places, is our inversion. So time away from the sun, even on a bright day, we don't get that because the inversion's there to block the sun. People who live around tall buildings that block the sun tend to get more depressed. If your job is indoors, in the basement with no windows, during the winter you're really at risk.

Interviewer: And especially since we have Daylight Savings here in America, you get out of work at 5:00 and it's already dark.

Dr. Hunziker: That's right.

Interviewer: And so you don't really ever . . .

Dr. Hunziker: That's right.

Interviewer: And then you wake up at, you know, 6:00, 7:00 and it's still dark, and so you never really see the sun.

Dr. Hunziker: That's correct, and it can't just be the light in your office that makes the difference, it has to be the same wavelength as the sun to make a difference, which is why people use light boxes because that does help with most people who have this type of seasonal disorder.

Interviewer: So knowing that people in Utah are at higher risk for depression, tell me from a doctor's perspective exactly how dangerous that is.

Dr. Hunziker: Yeah. So depression can be extremely dangerous, and suicides rates, particularly in Utah, are quite high. And if depression of any type goes unchecked, it can lead to people thinking about ending their life, which is extremely important. So any time you're experiencing a depressed mood, it should be evaluated, at least by your primary care doctor to see if something else needs to be done.

Interviewer: So with depression being so serious, does it often get confused for somebody just being moody, then, because people get moody and they get upset, but when does that become depression? When does it become dangerous?

Dr. Hunziker: The way you can tell is if this lasts every day for at least two weeks, where you're feeling so terrible that you don't want to get out of bed, where you feel like you have to sleep all of the time. You have absolutely no energy, or interest, or desire to do anything with anyone. You notice that you're eating a ton, particularly carbohydrates. With this population that gets seasonal affective disorder, carbohydrates tend to be the big thing that they do. And then, of course, if you start having any thoughts about hurting yourself at any time, that's when it really needs to be addressed.

So in summary, I think that for those of us living in Utah, we are at higher risk, so we need to pay attention to those signs of depression. Particularly women, particularly young people, particularly people who work in environments where they're not around sunlight need to pay attention to this. If you notice that you're having any changes in your mood, please seek help.

updated: December 16, 2022
originally published: December 16, 2015

Dr. Jones: About 10% of US adults experience mental illness such as depression or anxiety every year. How to overcome that stigma? This is Kyle Bradford Jones, family physician at University of Utah, coming up next on The Scope.

Announcer: Health information from expects, supported by research. From University of Utah Health, this is TheScopeRadio.com.

Dr. Jones: So lots of people, particularly adults in the US, suffer from depression or anxiety but have difficulty overcoming the stigma of having that. A lot of people think, "Hey, am I crazy if I'm depressed? I can buck up. I can do this on my own." The culture in the United States tends to revolve around being the cowboy, "I am independent. I can do this on my own. I do not need your help," but depression and anxiety is more than that. This is something that is a real illness that you cannot simply overcome on your own.

There are a couple of things to keep in mind. This is more than just being sad. That's kind of the first thought that most people have. Depression can be an emotion, it can be a symptom of something else, or it can be a diagnosis. The emotion is feeling sad. It is having a bad hair day. It's going through something tough. That's completely normal. It can also be a symptom of something else, such as thyroid disease or something like that.

But the diagnosis of depression, you feel a little bit more sad, you feel guilt, you have trouble concentrating, you have less energy. You no longer take pleasure in things that are normally fun and entertaining for you, and it leads to decreased function. And so having that thought of, "Hey, I can overcome this on my own," is actually going to be detrimental if you have the diagnosis of clinical depression.

So what things can you do? First of all, go see your physician. This is something I can start with your primary care physician. Talk to them about what you are experiencing. They can give you some guidance on how severe it is, if it is the diagnosis versus if it's an emotion, a symptom, they can offer some different things for you.

A lot of people think that therapy is just talking to someone and that's it. But that's not the purpose of it. So certainly that helps a little bit, but there are therapeutic methods that have been proven to give you better coping skills, to help you better deal with the things that you're experiencing.

Now, the best way to deal with depression is a combination of therapy and medication. A lot of people are worried, "Hey, if I go on medication, I'm going to be on this for the rest of my life. It shows that I am crazy and I'm going to feel like a zombie. It's going to completely take away my ability to feel." It's actually the opposite on all those accounts.

The vast majority of people who are on medication for depression or anxiety take it for about 6 to 12 months, and then they're okay without it after that. It's actually not something that's going to make you feel like a zombie and keep you from feeling. It actually quiets the depression and anxiety so that you can get back to your normal self, to your normal feelings, your normal activities. Less than 50% of adult men get treatment for their depression or anxiety. Obviously, that's a big deal.

Now, how do we get rid of this stigma? The first step is understanding it, understanding that this is a medical condition. It's caused by a decrease of chemicals in your brain. This is not a moral weakness. Oftentimes this can be brought on by a stressful life event and it can just be a short-term thing. Like we said, you don't need to have treatment long-term for most people. Also, understanding that as a society we just need to talk about it more. It's okay.

There are actually a significant amount of people that struggle with this from time to time and that's okay. Treatment helps because if you don't get it treated, it actually worsens your relationships, it worsens other health problems that you have and overall can simply make things worse. So seeking treatment and seeking the appropriate diagnosis can really make a big difference.

In summary, if you feel like you may be suffering from depression or anxiety, you are not crazy. Seek therapy. Go see your physician. Don't be afraid of it, because denying it only further ruins everything else going on in your life.

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Interviewer: People with eating disorders experience severe disturbance in their eating patterns. It's important to remember that eating disorders are mental illnesses and the physical effects are the symptoms. That's coming up next on The Scope.

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Interviewer: Three percent of Americans suffer from binge eating disorder. We're talking with Dr. Jason Hunziker, a psychiatrist at the University of Utah. Dr. Hunziker, what mental conditions can cause an eating disorder?

Dr. Jason Hunziker: There are lots of mental illnesses that are associated with eating disruption or eating disorder for different reasons. An example would be somebody with schizophrenia gets very paranoid often, so they won't eat their food because they're afraid it's been poisoned. We have other people who are so anxious about allergies in food that they just won't eat, so they have a specific phobia about certain foods. Some recent studies have shown that people with bipolar disorder and/or depression also struggle with eating disorder of a different type in which they binge eat.

Interviewer: First of all, what is binge eating?

Dr. Jason Hunziker: Binge eating is when you're going along fine and you eat normal foods, then you have an episode in which you just can't get enough food. You binge on whatever's in front of you. Most often it's not stuff that's good for you.

Interviewer: Always.

Dr. Jason Hunziker: You eat lots of it. Then, you eat to the point that you almost feel like you're going to burst. That leads to some people then going in and purging and getting rid of the food that they just ate.

Interviewer: So, it's different than, say, on a Saturday night I'm in front of a movie and I'm eating everything that's in my kitchen. That's different. It's those people that do that but then feel guilty, and then they throw up afterwards. Is that correct?

Dr. Jason Hunziker: That's correct. Usually, with binge eating there is a number of times you need to participate in that event before it even gets classified as a binge eating disorder. That has to be several times a week or month. Then, you qualify for a binge eating disorder.

Interviewer: What exactly causes someone mentally to think okay, I need to throw up? Because when I eat too much and I'm full I just wait for the food to settle down.

Dr. Jason Hunziker: Not everybody does throw up when they have the binge eating. What they'll do, though, is they use that food as some way to help comfort them for whatever's going on in their life. Often, as I said, it is associated with depression. When people are sad and they're down they...

Interviewer: They eat.

Dr. Jason Hunziker: ...feel like eating. And, the same with bipolar disorder - when you're sad and you're down, you eat. That somehow gives them some comfort, while at the same time it induces shame, and guilt, and other aspects of well, now I'm gaining weight, and now I'm not thin. It's a vicious cycle for them.

Interviewer: We obviously know that we classify binge eating as an eating disorder which is a mental illness. What other physical health conditions can it cause?

Dr. Jason Hunziker: It depends on how long this goes. Clearly, binge eating is going to increase your weight. As your weight increases we know that affects all aspects of your body including your lungs, and your heart, and then the cardiovascular system and other physiologic effects that it can bring on. Type-2 diabetes in this country now is really expanding because of the obesity problem, and this would be another way to contribute to that problem.

Interviewer: That's interesting. There are all these sorts of more severe diseases that can come from just binge eating.

Dr. Jason Hunziker: That's correct.

Interviewer: Obviously, you know that's going to happen. You want to treat it. Is it something that you physically and emotionally are maybe aware of, or do you need somebody to tell you I think there's a problem you need to go see a specialist?

Dr. Jason Hunziker: I think that some people are aware and some aren't. I think if it's associated with your mood disorder that would be a time to get into your doctor and get on some medication for your depression, which often will help take care of those binge eating episodes. Sometimes the medication itself will help take care of that compulsion or drive to eat which some people just have. They just feel compelled to do it and they can't feel good unless they do it. Then, they feel bad after they do it. It's a really vicious cycle. The medicine often will help with that.
There are good therapies that can help with eating disorder as well. It's really important to understand the underlying cause, and if it's caused by another illness to make sure that you treat that illness so that you can then treat the binge eating.

Interviewer: Any final thoughts on binge eating?

Dr. Jason Hunziker: I think that the important thing to do is for the patients and/or their families to recognize that the binge eating is a disruption to them, and that they get into talk to their doctor as soon as possible about what could be done to help them...

Interviewer: Because it can be treated.

Dr. Jason Hunziker: ...because it can be treated.

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