Search for tag: "u6019379"

This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.

Scot: Troy, I got a question for you. Are you ready to delve into Mitch's mind today on the podcast?

Troy: I don't know. I don't know if I'm ready for this, but it sounds like I don't have a choice.

Scot: Mitch, are you ready for this?

Mitch: I guess. You guys, welcome to my mind. Let me show you around.

Scot: I hear it's kind of noisy in there. Is that true?

Mitch: It can be. Yeah, it's quite loud.

Scot: All right. Well, today we're going to talk about medications for some who might have been diagnosed with depression. They're called selective serotonin reuptake inhibitors, otherwise known as SSRIs. And for individuals that have been prescribed these, sometimes finding that right specific medication can be challenging and a frustrating process, but in the end, it can lead to a lot of different benefits. And that is what Producer Mitch has discovered, and that's what we're going to talk about today.

We're going to talk about SSRIs, what they are, how they work, how they could benefit somebody, some of the side effects, and then this medication dialing-in process, what that could be like, at least in Mitch's experience.

This is "Who Cares About Men's Health," where men talk about health and health issues. And we also provide some information, inspiration, and a different interpretation of your health. I bring the BS. My name is Scot. Countering my BS with his MD is Dr. Troy Madsen.

Troy: Hey, Scot. That's me.

Mitch: Producer Mitch is on the show again, and a lot of openness talking about his own experience so others can benefit. So thank you, Mitch, for being so open. We appreciate that.

Mitch: Happy to. Happy to share.

Scot: And also joining us today, our expert, Dr. Scott Langenecker. He's a clinical neuropsychologist from Huntsman Mental Health Institute, and he's going to help us better understand our topic today. How are you doing today, Dr. Langenecker?

Dr. Langenecker: Doing well. Thanks.

Scot: Mitch, why do you want to talk about this topic today? And by the way, no pressure.

Mitch: No, it's cool.

Scot: This is just the point where people decide if they're going to keep listening to a podcast or not.

Mitch: Oh, okay. Sure. Yeah, let me just nail it here. So one of the things that I really . . . the reason I really wanted to talk about this is that I had a lot of emotions and hesitancy and just kind of some mental barriers between me as I was dealing with some pretty severe anxiety, a little bit of depression, and where I am today because I was afraid of what meds would do, right? I had people telling me that they were going to make me a zombie. They were going to change the type of person I am.

And I want to make sure that we can talk about this plainly and say, "Hey, here is what my experience has been. Here's how much better I'm doing because of Lexapro and Wellbutrin."

And then on top of that, the thing that I could . . . When I was first starting to get on medication, there was a journey of finding the right medication, trying a couple of different things, emotional waves, weird eating habits, etc., that my doctor didn't really tell me to expect.

And when you go online, it's kind of hard to find people talking about it. So I want to make sure that we have a chance to at least voice and give someone out there, "If you are starting on medication, this might happen. And it's okay, and there's a light at the end of the tunnel."

Scot: What was your situation like, Mitch, before the medications that led you to want to go on the medication or to even consider it? What was that journey?

Mitch: So I think we've talked a little bit before, but I was experiencing what we now kind of know as a general anxiety disorder of sorts, right? Where I was so anxious about so many things. I was nervous about the future. I was nervous about contracting COVID at the time. I was constantly talking poorly about myself, and I couldn't get myself out of those types of spirals.

And I think I've mentioned before, it was . . . To kind of give how out of sorts my brain was, it was everything like . . . Scot, we've worked together for a very long time. Love you. Think you're super great. If you sent an email that was worded slightly too directly, I would be a mess. I would be a wreck. I would be afraid that I was going to lose my job. My friend doesn't like me anymore, blah, blah, blah. And there was no real basis for that. It was just all up in my head.

And that's what eventually got me into therapy. And we started working through things and doing some behavioral therapy and talk therapy and working through some old traumas and things like that. But it just wasn't quite getting there. I wasn't quite getting the peace of mind I was hoping for.

The work that I was doing in therapy was not quite getting as effective as it could be. And so I was told, "Hey, maybe a medication would be right for you." And so I got it and after a little bit of a rough spot, I can't tell you how much better things are these days.

Troy: And you mentioned, Mitch, a little bit of a rough spot. Maybe something that's worth exploring a little more, and maybe letting people know about that. What exactly do you mean by that, by the rough spot? I assume you're talking right after you went on the medication?

Mitch: Yeah. Right after I got on the medication, there were a couple of weeks where . . . I think the term is titration or titrate. You're trying to find what's the right dosage, what's the right drug, what's whatever, what works best in your brain.

And we tried a couple of different doses. We tried a couple of different medications, but that journey was a little different. I cried into a Wendy's hamburger one day for reasons I cannot explain. Just felt wrong, whatever. And so, yeah, I wanted to kind of talk about those a little.

Troy: Yeah. And I'm sure Scott will talk more about that too, but I think that's not unusual to have that when you do start the medication. It may feel like things are worse before they get better. And it sounds like that's kind of what you went through.

Mitch: Mm-hmm.

Scot: So, Dr. Langenecker, what exactly was Mitch experiencing from a medical standpoint? Can you explain that, or is it unexplainable?

Dr. Langenecker: Yeah, there's a tremendous and potentially emotionally overwhelming controversy/discussion about what these medications actually do, how they work, what's the sort of mechanism at the level of a neuron that actually helps people to process emotions differently.

So what we do know, based upon what they're called, these selective serotonin, norepinephrine, and maybe even dopamine reuptake inhibitors, what they do at a very basic level is they kind of block the vesicle where those neurotransmitters, monoamines, sort of get sucked back up into the neuron in the synapse.

And by blocking the reuptake or the reabsorption of those at the level of the synapse, that means more of it is out in the synapse potentially to play and to facilitate some of the neuronal function.

This is at the level of the synapse. And we're talking about 13 trillion synapses in the human brain. How we extrapolate that to Mitch's sensation of the Wendy's hamburger and the tears, I mean, this is a stretch way beyond my skill set.

Mitch: Sure. Right.

Scot: That's quite a juxtaposition, isn't it? Chemical reactions at the synapse level versus that hamburger in Mitch's hands.

Mitch: Yeah, crying into a Baconator in the back 40 of a Sam's Club I think I was at. Yeah, that's very different. There's a long stretch

Dr. Langenecker: But they're related. They're definitely related. So there are a couple of different schools of thought about what's going on. One school of thought is that there's sort of this lack of serotonin within the synapse and the neuron can't do the work that it needs to do, and so it kind of stumbles around. And if you've got 13 trillion neurons kind of stumbling around, things don't go the way you'd like them to go.

I think people are pretty confident that that interpretation is probably, at its core, faulty. And the easiest way to think about that is when you have a headache, what do you treat it with? You might grab a couple of ibuprofen and your headache might go away. Do we think that you have an ibuprofen deficiency? Probably not. You probably have something else going on, and the ibuprofen is helping that other process to resolve, and then your headache goes away as a result of that.

I don't know if that analogy helps, but that's kind of a way to think about it.

There's a newer line of research that is really kind of mind-blowing, which is that we, as human beings, you probably heard we're like 70% water. And our genetic code is not so much what we are, but we're like a standard upgrade 3D printer that's just changing in real-time every day, every second, every minute. And so our genetic code is kind of just telling our cells which proteins to create and where to put them and how to build, and how to fix, and how to set things up.

And if you think about this at the level of 13 trillion neurons, it really gives you that humility for how little we understand about how our brains actually do what they do. Maybe we could figure out a heart valve. We can get that down, but 13 trillion neurons, that's a tall order.

And so there's some sense that the SSRIs or variants of SSRIs are actually changing the way that the RNA accesses the genetic code, the way it accesses it, how it uses that information, how it actually gets about the business of sort of 3D printing ourselves as we move forward in space.

I know that's a lot of detail, but the basic idea, the basic concept is that there might be some sort of rigidity in the way that the genetic code is accessed. And so it doesn't allow for that dynamic re-updating of the brain that's moving forward in real-time.

Mitch: So we don't exactly know how they work, but we're pretty confident that they do work. Is that what I'm hearing?

Dr. Langenecker: We're pretty confident that for 100 people in a room with depression or generalized anxiety, if I give them an SSRI, I'm pretty confident. I'd take this to Vegas and I'd spend everything I've got that 40 of those people are going to feel a lot better.

Now, if you told me in Vegas, "I want you to pick which 40 of those people are going to feel a lot better," I would not make the bet.

Mitch: Got you. Okay.

Scot: I feel like I got a little bit of insight. I think Mitch nailed it. I feel like on one hand when medications are prescribed, the people prescribing them or the people that created them know exactly what mechanisms are being altered to create the desired outcome. But I feel that that's not necessarily the case. I feel like we've discovered that this particular compound makes people feel better when they don't feel good. Is that accurate?

Dr. Langenecker: It is. And we talked about this before. I'd say over 90% of our breakthroughs in depression in particular have been sort of serendipitous, like we tried treating patients with Parkinson's and tremors with this drug and their mood got better, or we tried slowing down people's seizures for epilepsy with this medication and this got better.

And in almost all of those instances, it didn't actually work at all for what it was intended to do, but we had the system set up where we could observe people and notice that their mood improved and that mood improvement was sustained.

Troy: So what you're telling us, Scott, is essentially SSRIs are like Tang. Like the space program produced Tang, other research produced SSRIs and we found other uses. That's kind of what I'm hearing here, but it is interesting to hear that.

Dr. Langenecker: Yeah. I mean, there's a darker side to this, and this goes back to the stigma that we've been talking about, which is we kind of had this thought in the back of our mind for a really long time that people were just built a certain way and that they were weaker and that their character was flawed. And we didn't really think about mood and anxiety as like, "Hey, that's probably a medical condition."

And so we didn't put a lot of money into understanding it, and so a lot of our breakthroughs have been just kind of random, lucky breakthroughs from people trying to fix some other problem that we invested money in.

Scot: And I feel like also . . . First of all, I've often said that the human body is just a big chemistry experiment, right? And we're just a centimeter away out of being out of balance from a chemical standpoint.

So here's how I'm interpreting what I'm hearing. When Mitch was given maybe the initial SSRI . . . Because that's a class of drugs. There are a lot of drugs that fall within that category. It did some stuff in that chemistry that was not necessarily in the direction we wanted to go. And we don't know why, but it just kind of didn't work. So we've got to try something else to see if that would be better.

Dr. Langenecker: Well, yes. I mean, the easiest way to think about it is we are . . . Let's just say for purposes of hypotheticals, there's a certain subset of 2,000 neurons of the 13 trillion we have that are just kind of out of whack when somebody is experiencing depression.

What do we do? Well, we give people a tablet. The tablet has the medicine in it, it goes into their GI tract, it gets transferred through their liver, goes through the bloodstream, maybe it goes through the blood-brain barrier in some percentage of what we sent them originally, and then maybe some of that is actually making it to those 2,000 neurons that need a little pep talk.

And along the way, there are all sorts of other cells that are like, "What the heck is this stuff? This stuff is not good for me." And so we're kind of fighting between the systems that really need the medication and the systems that are kind of like, "Well, I didn't really ask for that."

And as an example, I'm sure we've all heard, "Hey, you are what you eat." Well, it turns out that a lot of the microbiota in our lower GI create serotonin. They're involved in this whole party and we've never known that for forever.

And so we're sending these meds down into that same spot in our lower GI and sort of thinking, "Well, nothing bad will happen. It'll work out okay." And so it takes a while for the body to kind of equilibrate in all of these other areas where the meds are going, where we don't really want them to go

Troy: In terms of spinoffs, it's fascinating that so many big blockbuster drugs . . . Because SSRIs are blockbuster drugs. They're one of the most prescribed medications. Another blockbuster drug, Viagra, was also discovered by accident as well. That was discovered when they were investigating heart medication and then all these men were reporting erections.

Dr. Langenecker: Awkward.

Mitch: They found that, yeah.

Troy: They found it, yeah. So often that process of discovery kind of follows that path. But it sounds like SSRIs were similar in terms of that route.

Dr. Langenecker: Yeah. And a lot of the data we have suggesting SSRIs are effective are data from mice. When we put them into a tub of water, they'll swim longer. When we put them into an open maze, they'll go into the scary spots more often.

A lot of these sorts of analogies to what is depression and anxiety are a bit of a stretch. The real proof in the pudding is, and I hear these stories all the time, "I was on vacation, and I forgot my meds at home, and when I came back I was just in a bad space," or, "I accidentally switched the medications and I was off for a couple of weeks and things went downhill." So for those 40 out of 100 people that these medications are helpful for, they're really helpful. It's not just accidental.

Troy: Now, I have to be the skeptic in the room because that's my job here. Because I know there's someone listening who's thinking this and has heard this. There have been some studies and there's been a little bit of press attention in recent years of studies suggesting that SSRIs are no better than placebo.

What are your thoughts on those studies and have you seen those and heard others cite those, or did that ever come up when you talk to people about SSRIs?

Dr. Langenecker: Yeah, I love this question for two reasons. The first reason why I love this question is because it convinces me that human beings are in the business of recovery. So if I give you a sugar pill and you're feeling awful, the natural inclination for a lot of people is just to start feeling better.

And if you think about the analogy I was talking before about a real-time 3D printer, nobody wakes up in the morning and says, "Oh, I feel awful. And I think I want to feel awful for another three months. I think that's probably a good idea."

Everybody wants to feel better. And it turns out we're super creative, we're good problem solvers. And so some subset of people just need a little bit of . . . I use the word permission, encouragement, whatever you want to do, to sort of kick off that healing response.

Is it really a placebo? Probably not. Is it just that little nudge that people need to do what they probably wanted to do or were hoping to do anyway? Absolutely.

Now, added to that, if you follow those placebo responders long enough, you'll actually find out that that placebo continues for a good number of people. But it doesn't for other people. They actually get sick again.

And if you give people SSRIs for a long period of time and you continue to give them SSRIs for a long period of time, many more of those people will stay well over time than the people who initially responded to the placebo.

So the placebo is a good thing. We love it. Most people complain about it. I think it's awesome. I think it convinces me of the magic of being human. But it may not be enough to sustain wellness for some people.

Troy: That's interesting. So essentially what you're saying is a lot of these studies, short-term people receiving the placebo, essentially a sugar pill, it's that hope of improvement that seems to elevate their mood, maybe treat anxiety, the hope of being able to heal. But like you said, the long-term sustained effects, you really just see that with the SSRIs then.

Dr. Langenecker: Absolutely agree. And as Mitch has told us, the SSRIs are a piece of the puzzle. You want to get to the point where you're going to do some work in therapy or in life in general where you're going to make some changes.

I use the example all the time . . . It's a tired example. If you're using the same ingredients to make your chili, it's probably going to taste the same. So even though we might add a little bit of SSRI, we might need to actually change the way we make the chili, change a few other ingredients so that it actually gets us where we want to go and it tastes better.

Scot: Mitch, take us through kind of your process with it. You talked about when you first started a particular SSRI that you had some unexpected, unwelcome responses. What was that process of dialing that in like?

Mitch: It was kind of shocking. When we're talking about brain chili or whatever, the first . . .

Troy: Brain chili.

Dr. Langenecker: I love it. Brain chili.

Mitch: So when it came to my brain chili, we put a little bit of . . . I had already been trying to do the work, I'd already been trying to do one thing or another, and I was doing therapy every week to try to get better, etc., and it just wasn't quite getting where we needed to go. So tried the pill the very first day, and it was within four to five hours stuff started to feel different.

At the start, there was maybe a pretty good feeling, but I started to feel nauseous for a while. I got just dizzy for a bit. That was kind of strange. I was told it would probably pass.

The next day I took the pill, I was suddenly very irritable all day long. I was picking fights with anyone and everyone who wanted to wrong me that day in some small slight or whatever. I've never been one particularly with road rage, but that day I was very, very angry.

Third day, I'm suddenly crying again into my burger at the . . . I'm like, "Why am I eating a burger?" It was just bad.

And I reached out to my doctor and the answer I got back was basically, "It can take some time to get used to these meds. And some weird things can happen when you're trying to get on them."

But it wasn't until that first weekend, and we're talking like a week on the meds, suddenly I didn't feel anything. I didn't feel any weirdness. I didn't feel anything. And I thought maybe the drugs had stopped working or maybe I'd become used to them.

But after talking to my therapist and my doctor, that's kind of what we're hoping that it feels like, right? That you just feel normal, but maybe just a little less reactive, or maybe just a little less likely to go down the dark path, or maybe a little less likely to listen to the angry depression monster on your shoulder or whatever, right? It's a little easier to do all of these things.

But man, oh, man. And that's what I want to talk about a little bit today. That first week I'm on Reddit. I'm like, "I have an upset stomach," or, "Hey, what the hell is going on in this way?" or, "Is anyone else feeling extraordinarily like this on the first week of their pills?" And there weren't a whole lot of resources on that. A lot of people just saying, "Yeah, the first week can be rough." That's the euphemism they use, rough. And it was just like, "Wow, I was not expecting all this."

Troy: So was it just a week for you, Mitch, or did it last longer?

Mitch: A little over a week. I think I was still feeling a little irritable for a little bit afterwards, but yeah, it took me about a week to get used to everything.

Scot: Dr. Langenecker, is that experienced differently by many different people? Is that maybe why Mitch wasn't finding specifics or people don't vocalize specifics or . . .?

Dr. Langenecker: Well, there are a lot of different stories out there. Well, let's start with sort of our baseline. Our baseline is things are not going well in Mitch's brain, right? Mitch is doing all sorts of stuff to try and fix that. He's going to therapy. He's doing stuff on his own. He's making all sorts of changes, not quite there. And now we introduce a medication.

And as I alluded to before, this medication goes through the GI tract, right? It goes through the cardiovascular system. It interacts with your microbiota. It interacts with your autonomic nervous system.

And eventually, after a couple of weeks . . . And, Mitch, your response is a little on the early side. But after a couple of weeks, it actually gets the desired change in those neuronal targets pretty far away from where the liver is unpacking that stuff.

And along the way, all of these other systems are thinking, "Whoa, wait a second. Didn't ask for this. What is this stuff doing? What is this stuff doing to the system?" And so some of the side effects, some people actually feel more agitated at first, which is a little counterintuitive. Some people get that dizziness. Some people get the nausea and indigestion.

And the way we report in drug trials is, "Seventeen percent of the people experience dizziness and 13% had impotence and 2% had indigestion." It's not a user-friendly framework for somebody saying, "Hey, why is this happening to me?"

To add to that, we're introducing a change in a system that isn't working so well. And so when you introduce change in a system that's not working so well, other things can pop up.

I know that's kind of an oversimplified explanation, but as we've alluded to before, I'm not a physician. I'm a researcher studying this from a different sort of angle.

Scot: Mitch, was it just the singular medication and then you just had to kind of go through the week or 10-day process, or did you try some different medications?

Mitch: So lucked out with the first one. For my generalized anxiety, Lexapro, spot on. We did tweak the dosage a little bit after a couple of weeks. After I got used to it, they moved me up to a higher dosage so I'd have more of the effects. And that was a pretty decent . . . There wasn't a huge shift when they went from . . . Going from zero to whatever my first milligram dose was rough. Going from the second to the third was not a big deal.

However, a couple of months later when I was still having issues with depression and I talked to my PCP, he suggested I get on Wellbutrin, and it was the same thing again. It took about a week, two weeks, or so until I started feeling normal again. I was having all sorts of weird symptoms again, or side effects, and then back to normal.

Troy: Did you swap meds or did you just add the Wellbutrin?

Mitch: We added on top. There's a whole bunch of ingredients in my brain chili.

Troy: A lot of special sauce.

Mitch: A lot of special sauce.

Troy: I like it.

Scot: So how are you feeling about that, Mitch? I mean, we talk about the stigma of being on medication and how you were kind of raised that it's a moral failing or there's something wrong with you. You're not just on one pill. You're on a couple of pills now, so how are you handling that?

Mitch: It was a little weird when I had to get my mental health advent calendar thing, where I got my little pill organizer and had to fill it every week and make sure I have my dosages right. There was something that made me feel like I was a sick person, right? I was an unwell person.

But what really shifted and changed for me, and really kind of made me get over a lot of that stigma that was so deep in me, was actually the work I was doing with my therapist. And like Scott just mentioned, yeah, some stuff came up when we got my anxiety meds all figured out. We found a lot of . . . there were traumatic events in my past. There was all of this stuff that I was unable to even allow myself to think about or work through.

And suddenly, by turning down the volume just a little bit of the noise in my head, to just soften some of the more reactive parts of my brain just a little bit, I could actually work through some of those. And it allowed us to make some really great breakthroughs that have significantly helped my self-esteem, significantly helped my understanding of who I am and where I am in the world, etc.

One of the things that keeps getting talked about is that I might not have to be on these all the time. Maybe. We'll see. It's kind of a "if we remove this ingredient, is it going to change the way that your brain works?" But it has allowed for a lot of growth.

Troy: And I'm curious about that, what you just mentioned, Mitch. Scott, maybe you can speak to that. When people start an SSRI, how long should they expect to be on it? Should they say, "This is something I'm going to be on for the rest of my life," or are there a number of people who eventually transition off an SSRI? What's your experience with that?

Dr. Langenecker: Yeah, the current recommendations are if you start an SSRI and you experience benefit, you probably will be on that, or should be . . . "Should" is such a strange word to use when we're talking about depression and anxiety. But it's best practice to be on that for at least two years.

And to what Mitch described here, I think the reason why we've learned that it has to be that long is not necessarily all because of the effect of the medication. It's just this reality.

If you're going to make changes in your life that can potentially minimize or mitigate or reduce some of the emotional upheaval, some of the noise in the brain that Mitch was talking about, it's going to take a bit. It's going to take a bit for you to sort of get those changes into a habit, into a structure.

And then it's going to take a little bit longer for the people who love you and maybe the people who think they love you, but love you less than they should, to accept those changes. And during that time, you might need that little boost.

And so that's kind of the rule of thumb. It's a bit of a helper along the way, but those changes . . . Changes are hard. Changes are hard to make and they're hard to sustain. And so two years is a good number. There are some folks who go to 20 or 30. But most everybody should expect about two years.

Troy: But it seems like one of the themes that is coming up here, just in what you said and what Mitch has talked about as well, is it's not just about the SSRI. It's not just about the pill. It's about therapy and making additional changes. And then, like you said, maybe then you get to a point where those changes are enough, where eventually you might transition off the SSRI, but that's just one piece of the puzzle.

Dr. Langenecker: Yeah. One way I like to think about it is you want to get to a period of homeostasis where you feel pretty good about yourself, about the world around you, about the people you're interacting with. And that takes a bit.

And sometimes when you take the medication and you start to feel a little bit better and you start talking with a therapist about it, you sort of identify some of the relationships and some of the people that are triggers for you. And then you start to work through, "Well, do I have to be triggered by this person? Do I have to interact with this person? What part of it is that person? What part of it is me? What part of it is the relationship?"

So much of the work is really reimagining your relationship with yourself and with other people. The medication gives you a little bit of space to do that thinking without so much emotion.

Scot: Mitch, talking about your experience, you hoped that maybe you could help other people since there seems to be a lack of that information. Is there something else about your experience with the SSRIs that you wanted to make sure that you got out into the world?

Mitch: Just that it has helped a lot of people, the medication has, and it's helped people like me. And with how I'm feeling now and the progress I'm making today, I would deal with that week or two of feeling kind of crappy over and over again. I would always have made that choice.

Scot: Might have been nice to know that it could have been as bad as it was, maybe.

Mitch: Yeah. It would've been nice to . . .

Scot: Or how long it's going to last, so you know, "All right. Just a few more days." Kind of like when you quit smoking, for example.

Mitch: Yeah, absolutely. I did not know when I quit smoking that my shifts in nicotine levels were going to cause such an emotional response. But in that case, there are people out there, addiction specialists and things like that, that have talked about very openly on Reddit and places like that about, "Hey, you might have some weird feelings after you quit nicotine."

But same thing. If you're changing something with your brain, it might take some time, but if you are one of those 40 people that it could really help, if you're someone like me, it is 100% worth it to go through that rough patch.

Scot: Just night and day for you? Like, your life is noticeably better?

Mitch: Very much so. It's mostly in my ability to do the work, mostly in my ability to work with my therapist and actually try the things that I'm thinking about of speaking to myself more positively, or stopping and listening better in my communication with my relationships, and things like that.

It used to be I was so high-strung, so anxious, so whatever that I couldn't. I couldn't focus. I couldn't give myself a breath or a break. Everything was at code red all the time. And I can't make any improvement on that system if it's that sensitive.

And so by turning it down a little bit, I've been actually able to work on things and self-esteem and anger issues and hyper-fixations on things. I've been able to actually work on those and get better at them. And I wasn't able to before. I just could not. And so it's allowed me to improve my life.

Scot: I feel, Troy, like there's a parallel between some of the other topics we've talked about on the podcast. Sometimes you need to . . . We've talked about testosterone therapy. Maybe you need that because your energy is slow and you can't exercise, right? It's not the thing that's going to make you better. It's the thing that is then going to allow you to do the things that will make you feel better. Whether that's eat better or exercise or be able to do the mental work as well.

I would imagine that's pretty important, isn't it, Dr. Langenecker, for people to realize it's not just a pill? That's just the beginning point that allows you to do the things that are really going to get you to a place where maybe you've never been before.

Dr. Langenecker: Yeah. I mean, we talked about this sort of thing before. Self-improvement, if we want to use that old phrase, or building resilience, or recovery, whatever framework you want to think about it, it's a journey. And medication for many people . . . I said 40 out of 100. If I said, "Hey, you 100 people, I want 40 of you to take Prozac," or, "I want all of you to take Prozac," 40 would get better.

And then if I said, "Oh, man, 60 of you didn't get better with Prozac. I want you all to try Wellbutrin." And then 20 of those 60 are going to do better with Wellbutrin.

And then the 40 who didn't get better with Prozac and Wellbutrin, "Hey, let's try transcranial magnetic stimulation." And another 13 of those folks get better. We sort of just chip away at it here.

So the basic idea is sometimes you need just a little bit of something something to get you started, and then you're moving along the right path.

And for depression and anxiety, you're feeling good about the path. You're feeling like it's a good journey to be on.

I want to sort of put a public service announcement bit in here, sort of two basic things. One is most people, when they start taking these medications, the dose is too low. And the reason why the dose is too low is because PCPs have . . . I mean, they've learned. Maybe they don't talk about it like they didn't talk about with you, Mitch, but they've learned that people are really uncomfortable with the side effects.

And so they're pragmatists. They're like, "Okay, let's get a medication started. Let's try and keep the side effects low so that the person actually continues to take the medication." And that's kind of the default stance.

And then what happens is sometimes people don't go to that second step or the third step, and so they're really kind of under-treated.

And so anybody out there, if you've tried a medication for depression, an SSRI or SNRI, and you're like, "Oh, that really didn't work for me," most of you didn't get a high enough dose or didn't take it long enough.

That doesn't mean that it's going to work for everybody. I think I've made it clear these meds aren't going to work for everybody. But oh, for goodness's sake, give yourself enough of a shot to see whether it'll help you.

And that's a safe question to ask your doc. "Hey, I've been taking this for a couple of weeks. Is this the right dose? Do we need to go up? Is this the therapeutic dose?" I know that may be an uncomfortable question to ask, but it's a really important question.

Scot: Well, Troy, that wasn't too bad. Mitch's mind wasn't as bad as I expected it to be.

Troy: It was all right.

Scot: It's a happy place now, which is fantastic. Or happier.

Mitch: Happy. Oh, yeah, sure. Whatever.

Troy: Yeah. We took a swim in the brain chili, and we came out okay.

Dr. Langenecker: We're finding a way to fewer . . . Less chili powder.

Troy: Exactly.

Mitch: Less chili powder. A little spicy.

Scot: I hope that this was helpful to somebody listening. If you have been experiencing symptoms that perhaps an SSRI could help, or if you've been on an SSRI and you have experienced those side effects, maybe didn't get the benefits, I think Dr. Langenecker gave us some great advice to ask questions about the dosage, the time you're on it. Maybe you need to try a different type of SSRI medication to get it dialed in. And then just be ready to do the work.

Mitch, I just love hearing your story about how much better you feel and how things are going. So thank you for sharing that.

Mitch: Happy to. I hope someone out there is going through something similar and give yourself a chance, right? Give yourself a chance to be better.

Dr. Langenecker: And you deserve to feel better. We've talked about it before. It doesn't have to be this hard. If you're struggling, give it a shot. We're here to help.

Troy: Mitch, too, I think just the fact that you're willing to talk about it, it's a big part of just removing the stigma. I think that's a big barrier for a lot of people. Just knowing that there are a lot of people taking medications and you just need that extra help sometimes. And so it's great you're willing to share that.

Mitch: Yeah. No problem.

Scot: Dr. Langenecker, thank you for being on the show. Mitch, thanks for sharing, and thank you for caring about men's health.

Dr. Langenecker: Thanks, everybody.

Contact: hello@thescoperadio.com
Listener Line: 601-55-SCOPE
The Scope Radio: https://thescoperadio.com
Who Cares About Men’s Health?: https://whocaresmenshealth.com
Facebook: https://www.facebook.com/whocaresmenshealth

This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.

Mitch: Anxiety. What is it? Why do we have it? And how do we kind of cope with it? This is "Who Cares About Men's Health," where we try to give you some information, inspiration, and a different interpretation of your health.

I'm Producer Mitch, and today I'm joined with Scot. He brings the BS to our show.

Scot: Glad to be here. Can't wait to talk about anxiety.

Mitch: Right? How exciting.

Scot: Can I sing it every time I say it? I'd love to.

Mitch: Anxiety? Okay, yeah. We'll see if you commit. And to bring a bit of the MD to the rest of our BS is Dr. Troy Madsen. Hey, Troy.

Troy: Hey, Mitch. Good to be here.

Mitch: And joining us today to talk, he's back, it is Dr. Scott Langenecker. Hey, Dr. Scott.

Dr. Langenecker: Howdy.

Mitch: So before we dive too far into what anxiety is, how we deal with it, etc., I wanted to ask the rest of the team here. Scot, when was the last time you felt anxious?

Scot: Not that long ago.

Mitch: Oh, really?

Scot: Yeah. The last time I felt anxious was during my graduate studies. Working on my final project, I had to make a couple of presentations for that. I get a little anxious. I find myself getting anxious as I approach deadlines.

Mitch: Sure.

Scot: I am curious to find out . . . I've heard there's a difference between just normal . . . I just labeled it, right? And I shouldn't have done that. Just kind of anxiety out of events like that versus maybe more severe anxiety. There'd be times where I would notice I was getting a little short of breath and I just have to go, "All right. Calm down. Take a couple of deep breaths and you'd be good." I had never really experienced that level of anxiety before. Otherwise, it was just kind of butterflies in the stomach.

Mitch: Like having to talk your body down?

Scot: Yeah. A little bit.

Mitch: Okay. Interesting.

Scot: And to a past episode, that I remembered box breathing, right? That our brain and body are so tied together. Calm one down, it'll help the other. So yeah, that's my story with anxiety.

Mitch: Oh, cool. Okay. And what about you, Troy? I mean, you're in a really intense job. It's a little bit more than a podcaster. Do you get anxiety a lot?

Troy: I try not to. And it's one of those things you have to check yourself sometimes because if you are feeling anxious at work, it can be very distracting and detrimental.

But I will tell you the shift I worked just a couple of days ago, there was a point I had several patients I was trying to see, and then they just kept bringing more patients back. And it was kind of a moment where I just had to catch myself like, "Okay. Take a few deep breaths. Just go one at a time. See the patients. No rush."

It was kind of that feeling of being anxious and also feeling a little bit overwhelmed, which is funny to say after doing this job for however many years I've done it. So yeah, I definitely felt a bit of anxiety at that moment, for sure.

Mitch: That's interesting because those are both situations where it kind of makes sense, right? There's a threat, there's a stressor, there's something.

One of the things that I've been dealing with for the last year working with mental health, and one of the reasons I really wanted to do an episode and bring Scott back on to talk through this with us, is I apparently have some generalized anxiety where it's just like I'm always just a little anxious. And it has been a long journey to be able to just quiet those feelings down a little bit.

And so just to give us a little bit more perspective about what is anxiety and how do we work with it, etc., Scott, why don't we start there? What is it? What is anxiety? Because you hear people say, "Oh, I'm feeling anxious today." Is that really anxiety, or is that just a catchall term for "I'm a little nervous about something"?

Dr. Langenecker: Yeah, it's a great question. I think I'd like to start out with this concept of pain. So why do we tell kids when they're young not to put their hand on the stove? Why do we have pain receptors in our hands? It actually keeps us from harming ourselves.

And so anxiety at its core is a danger warning system in your brain. And it turns out it's a pretty old system. It developed a long time ago. Many animals have anxiety. We humans have anxiety. It's not really a fine-tuned system, and so it's pretty easy for it to go a little bit awry.

Mitch: Okay. And when you say old, it's pre-caveman? We're talking way down the line in the evolutionary line, or what?

Dr. Langenecker: It depends who you ask. But if you ask somebody who likes to be contrary, they will say an amoeba can have anxiety because it can move toward or away something based upon the danger of that object to the amoeba.

Mitch: Wow.

Dr. Langenecker: Now, obviously, that's a bit of hyperbole. We like to think of anxiety as having a little bit more sophistication than that. But that's sort of at the far end of the spectrum on what we think of anxiety, is moving toward or away things that may be dangerous to us.

Troy: That's what we need, Scott. The next book is going to be "The Emotional Life of the Amoeba: Dissecting Their Emotions and Treating Them."

Mitch: Is anxiety an emotion, or is it a biological response?

Dr. Langenecker: I would opt for a biological system or a biological response that can lead to a host of emotions.

Mitch: It's not an emotion. Your body is actually afraid or telling you, "Hey, there's danger here"?

Dr. Langenecker: Yeah. Most often, when we think of anxiety, we think of it going along with the emotion of fear, but there are other emotions that can come with it, like excitement, or anger, or disappointment, disgust. It doesn't have to be that specific.

Mitch: Before we started the interview, you mentioned that you like to think about anxiety as the tiger of the mind. Do you want to explain that a little bit to me? That sounds very exciting and interesting.

Dr. Langenecker: Sure. This is the way that I make anxiety real for patients of all ages. But it's really helpful for talking with kids too, because kids have lots of fears. Some of them are useful, some of them not so useful. As we move into adulthood, we get better at managing them, by and large. Not always.

So when I think of tigers of the mind, I think of "What is the evolutionary purpose of anxiety?" And the evolutionary purpose of anxiety was literally to keep us from eating that poison mushroom, from going out in the dark and being eaten by tigers. And so, anxiety was a good thing, right? It made us cautious. It made us think rather than feel.

And those people who were more cautious and did the thinking rather than the acting impulsively are the ones who passed their genes onto their kids. So anxiety has been preserved, and I would say even strengthened as we've evolved.

Mitch: If it is this kind of evolutionary thing, almost everyone has a little bit of anxiety, it's a biological system that allows us to respond to dangers, at what point does that become, say, an anxiety disorder? And what kinds of anxiety disorders are out there?

Dr. Langenecker: So that's a whole thick book, but the basic idea is we have anxiety. The best way I've heard it described is anxiety is about a loss of control. So control about safety, control about your social status, it could be control over a number of things.

So social anxiety is one, right? That's potentially a loss of status. That goes back to Scot's anxiety around his performance in exams and projects and so on. "If I don't do well, I may not gain the social status that I'd like, or I might lose some social status."

When Troy was talking about it, it might actually be related to danger. "If I don't find a way to manage the anxiety there, there might be some danger to me."

And then we have fears, phobias of various things.

The generalized anxiety that you referred to before, Mitch, is kind of . . . I'm going to use the word unsettled.

Mitch: Sure.

Dr. Langenecker: Things don't seem to be settled often and your brain is constantly looking for why. Why are things not feeling settled? And so it becomes generalized and you're just looking. You're looking for the monster under the bed, even when the bed is not there. That's what your brain is doing to you when you have more of a generalized anxiety.

That's just a couple. There are more complicated ones around trauma and obsessions. And I think just in the interest of time, let's get past those for now.

Mitch: For sure. It's interesting to hear that because one of the things that I've been working on with my therapist was the idea that my generalized anxiety may be connected to some childhood trauma. It might be connected to some instability in my life for a long period of time when I was jumping from job to job doing freelance stuff, etc., whatever.

But he explained it to me and generalized it, my particular case, that just I'm super-duper sensitive, right? My whole system is constantly searching for "What is danger?" And it is starting to create danger where there is none. And it would be everything from like Scot would end an email with a period rather than a smiley face. And I would just be like, "Oh, Scot hates me. He's going to fire me. What am I going to do?"

Scot: Wow.

Mitch: No, it's real.

Dr. Langenecker: Periods should be banned from sentences.

Mitch: And so it was that kind of stuff. And it's been really interesting viewing it from that side. It's not, "Hey, you're not crazy. You're just . . . Because of one reason or another, your system is hyper-wired and very responsive to these things." It's trying to protect yourself. And that gave me kind of a different, I guess, appreciation for what I was experiencing.

Dr. Langenecker: One way to think about it is our DNA is super complex and it's designed to create variability. And so if you think of trying to find the sweet spot for anxiety, our DNA is actually going a little bit high sometimes and a little bit low sometimes. And unfortunately, you and I actually end up a little bit high on that scale. And the non-therapist therapist advice here is the biggest part of managing it is actually just calling it what it is, like, "I'm high on the scale."

Mitch: And that has been, for me at least, one of the biggest changes because I'm finally able to be like, "No, you're not scared. Your body is over overcompensating. This is where you're at. Calm down." The higher brain can talk me down a little bit, which I appreciate.

Dr. Langenecker: And the trick then is if your system is super sensitive . . . If we just think about tests, there are false positives, false negatives, true positives, and true negatives. If your system is super sensitive, you're going to end up with a lot more false positives, which means you're going to feel anxious when there actually is absolutely no reason why you should feel anxious.

Mitch: Yeah. There was a day or two in therapy where I just was like, "I feel really anxious." And he's like, "You just spent the last 15, 20 minutes telling me how good your life is going. What are you anxious about?" And I'm like, "I don't know. Something is going to happen." There's a rubber band theory out there where it stretches and stretches and stretches and things are going good, things are going good, just snap it back.

So yeah, it's interesting to hear that.

Dr. Langenecker: And these are the parts of the brain that we understand the least well. There's the very simplistic way of thinking about the amygdala is looking out for threats in the environment, and it triggers a fear response. But there's a whole bunch of cortex that's actually linked in with the amygdala that's making all sorts of complex calculations about, "What's the likelihood of this event being truly dangerous? And how often has this happened before? Am I in the same environment that this happened before?"

And when we think about anxiety for humans, we have the capability of adding all of these layers to it. And that's where I think we end up with things like generalized anxiety. There's a cerebral element to it as well.

Scot: Can I try my hand at an analogy? It sounds like if somebody has generalized anxiety, their threshold for setting off the alarm system that would normally help keep somebody safe is really low, which is what you've said. And then it also seems like that then when the alarm is going off, your body is almost going, "But there's an alarm going off. There must be a problem." It's this loop almost.

Dr. Langenecker: Yes.

Scot: Would that be accurate at all?

Dr. Langenecker: Yeah. I think you're spot on the money. And then there's another element to it as well, which is sometimes you as the person are like, "Hey, the alarm hasn't gone off in a while. Is it working? Maybe I should set it off to see if it works."

Mitch: Oh, man. And it would cause me to be suspicious of people sometimes, kind of like, "Hmm, there should be a danger here. Maybe this person is my danger." Yeah, it's fascinating.

Troy: This reminds me of the smoke detector in our bedroom. I looked up at it the other day and the smoke detector is there, but it's pulled out so the batteries are pulled out. So it doesn't work. And I said, "Well, why are we doing this? The smoke detector needs to have the batteries in." So I put the batteries in.

I shower the next morning and the smoke detector goes off. I'm like, "Oh, that's right. That's why I pull the batteries out. Every time we shower, the steam comes out of the bathroom next to the bedroom and lets off the smoke detector."

So it sounds like you're saying anxiety disorder is a little bit like that, where its threshold is just too low and it senses danger from things that don't present danger.

Dr. Langenecker: Yeah. That's absolutely right. Now, I'm making light of it because we're on a podcast and we're trying to make light of it. But there's a darker side to it as well, which is people who have experienced adversity and trauma. Their brain is actually changing and adapting to that. And it's not that clever, funny analogy anymore.

That's why I use the analogy of tigers of the mind, because tigers are sneaky and tigers are dangerous. And there's a bit of mindfulness we can do with anxiety, but there's also a bit of, "Hey, this is a real thing. You went through some real trauma and your brain has changed because of it. And so then what are we going to do next?"

Mitch: So I guess going down that line, what are some of the signs that someone might notice in themselves that they might have not just the run-of-the-mill responsive anxiety, but maybe something that could use some professional help?

Dr. Langenecker: The big grab bag category we use is "Does it affect your functioning in your life?"

So, for example, if I have social anxiety and, therefore, I can no longer go on a podcast because I'm afraid people are going to send me hate mail, that's where it moves into, "Oh, boy, that's leading to some dysfunction."

If it makes me uncomfortable and I do it anyway, that's sort of in a gray category.

If I have a fear of fire in my house since I'm constantly checking the smoke alarms and making sure that the oven is off and it takes me an hour or two a day to go through those loops 17 times in the morning, 5 times at lunch, and 5 times before I go to bed, that's moving into a dysfunctional area.

So when we talk about anxiety and dysfunction, we say, "Well, does it change the way you pursue your goals? Does it prevent you from pursuing your goals?" And when it does, then it's time to get some help.

Scot: Somebody who's more sensitive or who has had trauma that's experiencing this type of anxiety, that sounds exhausting. So beyond just it impacting the goals that you're trying to achieve, does it just mentally wear you out, tire you down to a bad place?

Dr. Langenecker: Yeah, it can. So one of the things that I focus on a lot in my therapy with patients is, "Is it affecting your sleep? Is it affecting your energy level? And is it affecting your mental focus?"

So you can run into this situation where people are sleeping, but they're not sleeping well and they feel like . . . They go through an entire day, every day thinking, "I just need to take a nap." And there are actually some biological reasons for this. If we trigger the stress response over and over and over again, that stress response actually loses some of its elasticity. It loses some of its ability to recover over time.

So let me give you an example. We're going back to tigers again. I find myself, unfortunately, in a jungle and there's a tiger there, and there's a huge surge of cortisol that comes through my system to help me, probably unsuccessfully, fight against this tiger.

That cortisol surge is to actually assist me in getting more strength, more agility, to heal faster, but it's supposed to last maybe 20, 30 minutes. But what happens if that gets triggered with the tigers in your mind 50, 100, 150 times a day? That response after a while is going to get a little bit worn out.

And I know that's not a technical description, but yeah, you can end up being pretty worn out from that constant stress.

Mitch: I was. I was getting really tired, really fast and it was leading to inability to sleep, inability to work out. I just was exhausted all the time.

Dr. Langenecker: Yeah. And it ends up being a bit of a trigger for depression, actually.

Mitch: Yep.

Dr. Langenecker: Folks with anxiety are at twice the risk for depression, probably because of that very mechanism of getting hyped up so often and then getting worn out.

Troy: Certainly there the underlying issues, but how much of this, though, is situational where you do face those threats, and legitimate threats? And obviously, the easy analogy for me is just a point to my work. It is a high-stress job with high levels of anxiety just with dealing with unpredictability, both in terms of the kind of things you take care of and just the number of issues you have to deal with.

How much of that becomes a trigger for people? Or would you say that anyone, regardless of their job situation, if they're getting to that point where they're just feeling overwhelmed and exhausted by anxiety, that it truly is a sign of an underlying anxiety disorder?

Dr. Langenecker: Yeah, you've moved into an uncomfortable area here, Troy, which is I honestly don't know how you do it. I honestly don't know how ER docs and first responders and military personnel do it, and yet many do and do for a long period of time and do so successfully.

There are many people where that's just not something that they should be doing. Their body isn't designed to handle stress in that way. But I don't have an answer for why some people seem to be able to manage high levels of anxiety reasonably well.

Troy: When you talk to people in those situations, in high-stress jobs or environments, do you ever simply counsel them to say, "Hey, maybe this is more of a response to what you're facing. Maybe try something different before we recommend medication"? Is that an approach or do you usually say, "Well, clearly, this is disabling. Let's try medication and see if this helps you to work reasonably well in that high-stress environment"?

Dr. Langenecker: I think most people weed themselves out in the process of pursuing these types of careers, but there are times where that's my actual counsel to folks.

So let me give you a couple of examples. We've run a couple of projects with firefighters, and what they'll say to me is, "It's a young man's job, or a young woman's job," which is your ability to physically and mentally be agile in responding to stress just changes over time, and they find themselves less able to do that with as much plasticity as they move into middle age.

And the counsel is often exactly that. "You've had a good run of it, you've done amazing work for your community, and your body is just not able to do that work anymore, and your brain is not able to do that work anymore, so maybe let's find something else for you." And sometimes that's enough.

Mitch: For people that maybe their lives are being impacted by the level of anxiety, maybe not even to a full disorder, but if it's impacting their life at all, how do we cope with it? Is it medication? Is it talk therapy? How do we help people that are experiencing those types of things?

Dr. Langenecker: So this is the really uncomfortable part of this discussion for me, in that for most people, anxiety is not something . . . It's not like an infection, right? You don't treat it and then it goes away. It's more kind of along the lines of diabetes, which is once you have it, you probably have it for life. And then the question is how do you manage it?

And by manage it, there are things that you can do in your life: exercise, mindfulness, sleep hygiene, diet even, things that can help. But for many or for some, we have to go one step further and pursue medication. And that makes, I think, everybody including myself uncomfortable, which is, "Do I have to take these medications for the rest of my life?"

It's an uncomfortable conversation, and so that's why I like to use the analogy of diabetes, which is the medications are there to help balance out your system. You would never say to a diabetic, "Hey, let's try not using the insulin this week. Let's see what happens." We wouldn't do that. That would be a bad idea. And so, for some folks, their anxiety is just at a level right now where medication is a good idea.

Mitch: So I actually started taking some anti-anxiety meds last year, and it took a little bit to get used to them, but it is night and day for me. It feels like the system has calmed down. It feels like I can actually do some of the mindfulness kind of activities and cognitive behavioral, self-talk type stuff. And it's gotten significantly better, but it did take me a while to find a guy, a mental health person. And then on top of that, to just straight up say, "Hey, I think I have anxiety, and I think this is impacting my life."

So I think just to wrap things up a little bit, is there anything that you would want to tell maybe a guy out there who's like, "Maybe I have anxiety. I don't know"?

For me, sometimes it feels like, especially with my upbringing and everything, mental health is a mystery and a foreign language, and the people in it are not me. That's the ideology that comes behind it. What would you tell the someone out there that maybe would be curious and what they should do to address the issues?

Dr. Langenecker: So let's start with the myths right up front. These medications with titration, with maybe some switching and augmentation, they'll help about 60% of folks who have anxiety live better, more fulfilling lives. Will they make anxiety go away? No. But maybe it takes the edge off a bit. So that's the first thing.

The second thing is it does take a bit of time to figure out the best mix for you. Sometimes that's months. Hopefully not years.

The third thing I would point out is that people . . . there's a bit of machismo here, which is, "I can do it on my own. I don't need medications." And I get that. I hear people when they say that and I just ask myself a simple question, which is, "Does it need to be that hard?" And the answer is no. It doesn't need to be that hard. You can take a shortcut.

And the shortcut here is actually helping your brain to do what it wants to do anyway, which is to give you the goods, which is to make your life fulfilling and meaningful and allow you to connect to other people. And if anxiety is getting in the way, medications are worth a shot. They're worth a shot to try out.

Troy: I know a lot of people are hesitant to take medications just because of potential side effects and issues. Do you find that that's a big issue when you're talking to people about these things? And how do you work through that?

Dr. Langenecker: Oh, yeah. We forgot about that one. So the word on the street is that some of these medications might lead to sexual impotence. And yes, that can happen for a small subset of people. If that happens to you and it's cutting into your enjoyment of your life, you can cross that bridge when you get there. You can try different medications. You can stop taking medications.

Again, it doesn't have to be that hard. Try it out and see if it actually can work for you. And for many, many people, their quality of life will improve not just a little bit, but substantially.

Mitch: So if someone is, say, struggling with anxiety at any level, where do they go first if they are looking for help? Is it your PCP? Is it a mental health specialist?

Dr. Langenecker: This is where I'm going to get into a little bit of trouble, but I'm going to the data. So the data suggest that if you go to your PCP, most of the time, a PCP is going to be helpful. They're going to try and prescribe a med for you. But they're more risk-averse in that they might under-dose in an attempt to avoid some side effects, which basically means that you're trying something, but not really trying something. And so the data just show that that's the most common thing that happens if you go to your PCP.

Fortunately, there are lots of online resources to sort of verify whether or not you might be under-dosed. I know Troy is probably going to slap my wrist and say, "You shouldn't go to Google MD. You should use it as a resource to augment what you know. You should not use it as the sole source."

Troy: Yeah, Google MD kills me. Please. The number of times I hear about things people read on Google that brought them to the ER, it's just . . .

Mitch: "I've done my research."

Troy: "I've done my research. This is what Google said." Okay. Here we go.

Dr. Langenecker: But the basic idea is going to see a psychiatrist even for something we might consider minor like anxiety is fine. If you're wanting to try it, it's okay to try it in a context where you're going to get an expert to help you.

Mitch: Scott, thank you so much for answering all of the questions that we had about anxiety. Hopefully, for someone out there, that'll help them. It doesn't have to be that hard. And myself, I cannot tell you how much better I feel after getting some treatment. So thank you so much for talking to us, and thanks for caring about your health.

Dr. Langenecker: You bet.

Contact: hello@thescoperadio.com
Listener Line: 601-55-SCOPE
The Scope Radio: https://thescoperadio.com
Who Cares About Men’s Health?: https://whocaresmenshealth.com
Facebook: https://www.facebook.com/whocaresmenshealth

This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.

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.

This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.

Mitch: Now, mental health is something more people than ever are struggling with according to a bunch of different articles. And I can tell you from personal experience that it's just as important as your physical health. And that's why we made it one of our Core Fore.

But as guys, as people who may not have been raised with the most positive approach to mental health, it can seem a bit overwhelming to get started. And finding the right mental health specialists can be everything.

Today, let's see if we can't learn how to find the right mental health specialist for you. This is "Who Cares about Men's Health," where we aim to give you some motivation, inspiration, and maybe a different interpretation of health.

I'm Producer Mitch, and I bring a little bit more than the mics, I'd like to think. And as always, we have Scot Singpiel, manager of The Scope Radio and one of the best BSers that I know.

Scot: I can't wait to start shoving some feelings down. I'm really excited for that.

Mitch: Perfect, I'm excited for that. And bringing the MD and maybe a touch of validity to the show, it's ER physician Dr. Troy Madsen.

Troy: I don't know about the validity. Maybe the MD. Thanks though, Mitch.

Mitch: And joining us today is Dr. Scott Langenecker. He is a clinical neuropsychologist and professor of psychiatry at University of Utah Health.

Now, before we get into the kind of nitty-gritty, I just want to do a quick check. Scot and Troy, let's start with Scot, what would you say your relationship with mental health is? I mean, it's the Core Four. We talk about it a lot. Have you ever taken the steps to actually talk to someone?

Scot: What's my relationship with mental health? It's kind of like the person that's across the street that you think you know and maybe you wave at them just in case you do.

Mitch: There's a casual nod every now and then, yeah?

Scot: Yeah, I don't like to get to intimate or too close with it. No, I'm kidding. I don't know. That's a tough question to answer, Mitch. It's something that I consider. It's something that I've become more aware of. I think just realizing and acknowledging sometimes when I'm stressed, or when I'm anxious, or when I'm not feeling well. What was the question again?

Troy: Have you ever talked to anyone?

Mitch: Yeah, have you ever actually had help?

Scot: Yeah, I did. A lot of workplaces have those programs where you can have an appointment. And there was a particular time in my life where things were really, really difficult and I just wanted some insight and maybe some tools to help me work through it. So I had two or three meetings with a professional in that respect.

Mitch: And how was it? Was it good? Did it feel weird to be there?

Scot: I'm looking forward to this topic because while it was good, I don't know that I necessarily felt that I had a connection with that individual. And if I was to continue that, I think I would want to try to find somebody that I had more of a connection with. So I'm really looking forward to finding out more about that today.

Mitch: Perfect. And how about you, Troy?

Troy: Mitch, mental health is something I absolutely think about. Sometimes I worry that I think about it too much, and I'm like, "Am I overthinking mental health?" Is that kind of a paradox? I don't know.

Self-diagnosis is something I often struggle with. And I've said before I sometimes take the approach where I either diagnose myself physical ailments with cancer, or I just tell myself, "Don't worry about it. Don't think about it." So sometimes, maybe I do that with mental health as well. But I absolutely think about it.

In terms of speaking with people, I think it's been more of an informal thing for me. I've had a number of conversations recently with several of my colleagues that have been really productive and very helpful as a lot of us have struggled with wellness and mental health, I think coming out of the pandemic in particular, but maybe just general job stressors and those sorts of things.

So it's kind of a relationship. Maybe I'd describe it as an on-again, off-again relationship. Maybe that's the best way to put it.

Mitch: Casual. It's complicated. Yeah.

Troy: It's complicated. Yeah.

Mitch: So with me, I think I've had probably the most interaction with a mental health professional myself. When I was growing up, mental health was definitely kind of treated as a sign of weakness, right? This idea that if you have "big emotions," then it's some sort of moral failing, and to buck up, "This is how men are," etc.

But during COVID and during the last couple years of my life, I knew something was kind of off and something was really wrong. I was feeling stressed, anxious, couldn't sleep. Work was really tough. Feeling good about things was bad. Relationships took a nosedive. And it got to the point where I felt I finally needed to talk to someone, and it was really tough.

I'll kind of fill in as the conversation goes, but it took me a while to find someone that I could talk to with my situation and actually get a connection that could help me. I actually went through three or four mental health specialists until I found the person that I did.

And the reason I even came up with this idea for this episode is I wish I had known that it's okay to find the right person, to try a couple. It's not you. You're not the one that's screwed up. But that's kind of why I wanted to make sure we talked about this.

So I've been with my current therapist for over a year now, and we're making tons of great work. I wouldn't have been able to do that had I not found the right person.

So let's turn to the professional a little bit to talk about this process and a little bit about maybe some strategies and kind of how we can approach this. Scott, Dr. Langenecker.

Dr. Langenecker: Yeah, call me Scott.

Mitch: Call you Scott?

Dr. Langenecker: Call me Scott.

Mitch: We've got two Scotts.

Dr. Langenecker: I know that's confusing. We've got Scott squared here.

Mitch: Maybe I'll call you Dr. Scott, I guess.

Dr. Langenecker: That's a groaner. That's a groaner when you're talking about mental health, but we'll work with it.

Mitch: Gotcha. So what kind of person needs mental health help? I guess that's kind of where I wanted to start. Who can mental health assistance help the most?

Dr. Langenecker: That's a fabulous question. I think about it this way: What's the most complicated system you have in your body? The obvious answer is your brain. If your brain is not working the way you want it to, that's the time to find somebody to talk it out and figure it out and see if you can optimize what's going on.

It's not always about things are terrible. I feel awful. Sometimes it's,"I just feel off," or, "That didn't go the way I wanted it to," or, "I got angry there and I really don't like it when I get angry." There could be all sorts of reasons why it might be a good idea just to chat with somebody and check it out.

Mitch: Is there something that men kind of deal with more than, say, anyone else that maybe that's a sign you should probably go talk to someone?

Dr. Langenecker: Well, the big one for most men is anger, and even acknowledging that sometimes anger gets the best of you. It may be that you've got it under control. It maybe that it doesn't really affect anybody else except for you. But if you walk around, and you get home from work at night, and you just feel off or irritable or angry, that's kind of a good sign that maybe it's a good idea to talk to somebody.

Mitch: So let's go to that next step. You need to talk to somebody. And I've heard that exact phrase far too many times. "Go talk to somebody. Go find a professional." What am I looking for? Are there different types of specialists? Is there some place that I should start? Who is that "somebody" in that statement?

Scot: I mean, that's a great question because there are licensed clinical social workers, there are psychologists, there are psychiatrists. There are probably 16 other titles as well.

Mitch: I was actually sent to my primary care physician first. And I was like, "What? Why would I talk to them about this?"

Dr. Langenecker: Yeah, most people are actually sent to a religious person first, which can be a little bit complicated.

Mitch: What?

Dr. Langenecker: Yeah, the most common person that somebody talks to first would be a pastor or a priest or a bishop. And that can be helpful. But if you think about the first question you asked, "How do I know that things aren't really going the way I want them to?" if the answer to that is, "I don't feel like things are in my control," or, "I feel like there's too much weight on my shoulders," or, "I feel like I can't quite keep all the pieces together," that's a good example of when to say, "Hey, let's maybe talk this out with somebody else."

And then the next step is really to say, "Well, what is it that I think is going on? Is it my emotions? Is it my sleep? Is it my sex drive? Is it my body falling apart as I'm getting older?" That might sort of dictate where you go.

And what am I looking for? Do I want somebody who's just going to listen to me as a real human and care about me? That's pretty powerful all by itself. Or do I have some work to do? Maybe I've got this thing where I come home and I'm angry, and I drink and maybe I drink a little bit too much, and that causes trouble in my relationships or maybe it messes up my sleep. If I've got to do some work, if I've got to make some changes, then the kind of professional I'm going to look for is going to be different. Does that make any sense?

Troy: I was going to say that makes so much sense. And I love, Scott, how you said, "It's one of those things where the mind is the most complex system in the body." The brain is the most complex system, and I look at some of the advice that I hear people's family members giving them about the heart or the digestive system, and it is not good advice.

And then you think we need these supportive people. We need them in our lives, but oftentimes, we're going to them with very complex mental issues and really internalizing that advice when we probably need something more than that and a much higher level of expertise.

Mitch: It makes me think of my cousin and her mother. She was having heart palpitations and she was like, "Mom, I have heart palpitations." "Oh, I have those. They're the flutters. Don't worry about them."

Troy: Exactly.

Mitch: I'm just like, "Maybe you should go talk to a specialist, not just somebody."

Troy: Exactly.

Dr. Langenecker: Yeah, let's get that bit out of the way right away, because the first thing that you're going to get from people who care about you is, "I want to come to a solution for you." And how that's going to be heard in your mind might be, "I don't really care about your problem. Let's talk about something else."

Mitch: Yeah. That struck a chord.

Troy: Yeah. I mean, certainly as men as we talk to other men, I know that that is often a complaint about men, hearing people talking about issues that are of importance to them. We certainly are solution-focused. We want to find answers. And I am as guilty of that as anyone. But again, like you said, that may not or probably is not the best approach.

Dr. Langenecker: Yeah, that's going to come across as, "You're making me uncomfortable right now. Please talk about something else."

Troy: Yeah, like, "Let's put a bow on this. Let's move on. Let's talk about something else."

Dr. Langenecker: "Let's go play basketball."

Mitch: "Cool. Yeah."

Troy: Yeah. Exactly. "Cool. Okay."

Mitch: So your loved one is good for a lot of things. That's important. Those relationships are important, but maybe not the most helpful person to go to with some of these issues.

Dr. Langenecker: Well, it may be that the relationship with a loved one may be the thing that you're struggling with. Your loved one may be struggling, or you may be struggling and your loved one doesn't want to hear about it, or they don't know how to how to support you. That's a good time to go seek out a mental health professional.

Mitch: All right. Let's go to that next term then -- mental health professional. What am I looking for? If I type in "mental health professional," am I going to get what I need, or do I need to go in with a little bit more know how?

Dr. Langenecker: Well, to be completely frankly honest, this is a daunting thing for me, and I've actually been doing this for 25 years. So I do want to be completely honest with your listeners.

Your example, Mitch, is a perfect one, which is sometimes it takes a bit to find the right person. And so when you start out, you might be entering something into Google. "I've got anger issues, and I want to find somebody to talk to." And that may send you to a place that you don't ultimately ended up going, but it may send you to somebody who can actually give you some advice on where you need to go next.

So one of the things that I say in the first meeting when I meet with any patient is I say, "You know what? I'm a 51-year-old white male from rural Wisconsin. That may or may not jive with who you are and what you think of the world. And we're going to talk for a bit and hopefully you feel comfortable working with me. But if you don't, I want you to feel comfortable saying, 'Hey, Scott. I need to talk to somebody else. Can you help me find someone else?'" And then I do.

That's where we get to some movement, get to the place where you actually find somebody who you can jam with and jive with and feel comfortable with and do some meaningful work.

Troy: And you don't take offense at that, if someone is just like, "Hey, this is not working. I've got to find someone else"?

Mitch: It's not you. It's me.

Dr. Langenecker: Yeah, to be completely honest, as a therapist, I feel it too, if things aren't quite going. I'm working my tail off to try and make it work, but if it's not, and you're just being polite and saying, "Hey, let's work on this thing today," and it's kind of nails on the chalkboard, let's not do that. Tell me so we can find somebody who will work with you and you get a good experience out of it.

Troy: So I wish I could do that as a healthcare professional. "This isn't working. I'm going to go find someone else to take care."

Scot: "I'm going to go find another arm to fix."

Troy: I'm just joking.

Scot: Hey, Mitch, I've got a question for you. So what was the process for you? What was going through your mind as you were meeting with different professionals and you were trying to find that right fit? How did you know? What were the considerations?

Mitch: So I first went through the company work assistance program, and I'm just like, "Hey, I'm feeling off. I think I need to talk to someone." They're like, "Well, we'll connect you with someone." And they first asked me, "Do I have a preferred gender of specialists?" I'm like, "I don't know. No. I don't think so." And so the process, I think, was a little lacking as to . . . I just was given who I was assigned.

And what was interesting is I came in, I was at a really kind of downplays, I was suffering with severe anxiety, severe depression. I was trying to decide whether or not to get on medication for it. I was in a really dark place. And so I'm suddenly just on a Skype call with some random soft-spoken individual and there was something that felt off very early in the conversation with this person.

And what was interesting is that I think it's partially myself, but there's something that's . . . I just assumed that maybe mental health work was not for me, right? The fact that I wasn't jiving with this person, the fact that I felt the vibe was just wrong. I'm like, "Hey, I'm feeling really depressed, and I can't seem to get rid of it." And it's like, "Well, have you tried a gratitude journal?" And I'm like, "Okay. Cool. Yeah, I have. I think there might be something else that I would like to try." "Well, why don't we try that first? I think that's always a great place to start."

Nothing against the guy, but for me, that was just like, "Dude, I've read the self-help books. I've done this stuff. Please listen to what I'm trying to say." And rather than just saying, "Hey, this isn't working for me," I was very sheepish and I was like, "Okay. Yeah, sure. I'll trust the process. I'll trust the person."

And so it took me three or four weeks with this person. And finally deciding, "No, this isn't going to work for me. This isn't the person."

I actually had to talk to a friend who happens to be a mental health specialist for her to remind me, "You don't need to stick with it. You can keep trying people out until you find the person that works for you."

Troy: I was going to say, Mitch, hearing about that, it sounds a whole lot like dating. And I guess with that in mind, Scott, my question for you is how long do you give it? Do you have to go on a second date?

Scot: How many times?

Troy: Can you just walk out on the first date? Can you get 15 minutes into and just be like, "This is not working. I'm not wasting my time"?

Dr. Langenecker: That's a great analogy. And let me take that analogy one step further. "This date is not working, but do you have any close friends that are hot?"

Mitch: Yeah.

Troy: Can I go with your roommate?

Dr. Langenecker: I mean, that's kind of what it's like. The person that you're talking to, you may not jive with, but they're probably in the best position to point you to the next stop. So one, maybe two visits. If you're not feeling it then, then it's time to move on.

Let's be honest. We're all human beings. When somebody says, "Hey, you know what? It's you," we can be hurt by that. And so somebody might say, "I've got to take a minute to think about what you just said before I can be effective in giving you good advice." I hope for a day when that doesn't happen, but I think that's where we are right now.

Scot: I want to jump in with a quick question for you, Scott. I was listening to Mitch's story and just thinking what that would be like to go in and start revealing some of these very personal feelings, right? For some people, maybe that's going to happen on the first time. But for a lot of people, it's going to take time with an individual before you can really start getting at it. Is there any research or anything that shows how many times you have to go before you start developing a trust?

Dr. Langenecker: It's really tricky to answer that question. So some people feel comfortable with a person, and it's like opening the floodgates. It all comes out.

And then sometimes as a therapist, you're like, "Oh, man. We're just scratching the surface. We're scratching the surface." We're on the third session and I'm like, "There's something else here." And as a therapist, then you kind of just try and bring the warmth and bring in the energy and just say, "Hey, it seems like there might be something else on your mind."

And the funny joke we have as therapists is if it comes up in the last two minutes of a session, it's probably super important.

Scot: I have people in my life, that's their strategy. It's the "one more thing" strategy, I like to call it, where the one more thing is the thing.

Dr. Langenecker: "And by the way, my house is burning."

Mitch: Well, it's interesting that you said that because it took me three or four people and I actually started to talk to friends. And that was a really weird place myself, to be like, "Hey, do you go to therapy? Do you have someone that you could recommend?"

And it eventually got to the point where I had been working with some mental health specialists up at The U for another project, and I was talking to the person I was working with and she was just like, "I have the perfect person for you. Reach out, see if they have any openings, whatever." I got in.

If we're going to keep saying that it's like dating, there was just an instant connection. There's something about being able to find a mental health person that approaches your problems in the way that you need, who can talk to you the way that you need to be talked to. There's something about being able to just like . . . I curse like a sailor, and just to be able to curse freely and not feel inhibited by that and have the same energy brought right back and just . . . I don't know. There was something that very quickly I was able to really . . .

We talked about Kung Fu movies. There was just something instantly about this person and this connection, and all of a sudden he's making references to TV series as how they can be applied to my life. And I'm like, "I've seen that series. I love that series. Yes." And that's when the mental health work actually started.

Dr. Langenecker: As you're talking Mitch, it just makes me think of . . . Imagine you're going on a journey to a place you've never been before and you have to go on this journey with a blind date. This is kind of how hard it is. And so if you're not feeling that chemistry right away, it's probably time to find a different blind date.

Troy: And would you recommend you go into that search kind of with that mindset, like, "Hey, I've got to go on a long road"? Let's say it's a 24-hour train ride or something. Is that the kind of person you're looking for, the person you want to take that train ride with? Someone you enjoy that much that you would enjoy spending that much time with them?

Scot: I don't know what kind of problems Troy has, but 24 hours is your idea of long?

Mitch: That's long. That's terrible.

Scot: I thing we're talking like a summer backpack across Central America, perhaps?

Dr. Langenecker: Yeah, I was thinking more like a trip to the Lonely Mountain with Bilbo.

Mitch: Sure. Yeah.

Troy: Okay.

Mitch: You need a Samwise.

Troy: Twenty-four hours is the starting point.

Dr. Langenecker: Yeah. I mean, it could be. It could be 24 hours. Just to share a bit of my own experiences with mental health, I've been in sessions for other people who have needed support. I've obviously been on the other side providing the support. I've gotten support myself. Sometimes it's literally like I need to talk to somebody about this problem, it's going to take about 30 minutes, and that's it. And that sounds like such a male thing to say.

But sometimes it takes more. Sometimes it takes quite a bit more. And so you don't necessarily know. But it's fair to say, "If I got I trapped in a capsule on the mission to Mars with this person, could we make it? Could we do it?"

Troy: And not just do it, but enjoy the conversation, I guess.

Dr. Langenecker: Well, maybe.

Troy: Maybe.

Dr. Langenecker: This is hard work. So it's kind of like cleaning a bathroom. You know you've got to do it. You know if you don't do it, you're going to get germs all over, and it's going to be gross, and you're going to get sick. But it's not like somebody says, "I want to do this today."

Troy: One thing Mitch mentioned, too, kind of looking at this process, he started with the Employee Assistance Program. Do you find those programs are helpful? Is that a good starting point if someone is just like, "I don't know where to go. I don't know where to start"? Or do you recommend a different route?

Dr. Langenecker: That's such an important question. In our culture, right now, in the space we live in, most people don't seek help because they're afraid that it will affect their job. And so going to an EAP, that's the hardest thing in the world. If you feel comfortable with that, great. I mean, those folks are there to help you, and they're good at it, and they're in touch with being confidential about things. But if that's going to be a hesitation or a hitch for you, then let your fingers do the talking. Go to Google or talk to somebody who might know somebody.

Troy: Yeah, I think from a personal standpoint, it's a good point you make and it's interesting to hear that. I feel like if I went there, they would know my job title, they would know what I do for work. I would just worry that there would be so many assumptions based on that, and I would almost feel obligated to play that role. For me, personally, be the doctor role. "I'm the guy who sucks it up, and I deal with it, and I'm going to get through this." My doctor persona.

So I wondered if that's the best route just because maybe you are in more of that work mindset and that work role that you play, and if that would carry into those sessions.

Scot: I'm getting the feeling that you think that the person would know your job title. I don't know that that's the case.

Troy: I would think so. Maybe they don't. Yeah, I don't know.

Dr. Langenecker: Let's explore this from the headspace, the headspace of the person who's looking for some help. There might be some shame. There might be some shame about, "Oh, gosh, I've got to ask for help." First of all, men don't ask for help. And second of all, we do it while playing basketball, not in some cushy office. So that could be a really hard thing to start out with.

I just try and clear the air, right? Clear the air and be like, "Let's go to a place where you feel comfortable walking into the building, and that shame thing isn't going off in the back of your head."

Troy: Yeah, and maybe that's the EAP program, maybe it's not. Maybe it's somewhere else.

Dr. Langenecker: Yeah, it's not a one-stop shop and it's not a one size fits all.

I was sharing with Mitch before when we were chatting, finding a good therapist is kind of like finding a good pair of shoes. You've kind of got to know what you're looking for. Do I want running shoes? Do I want hiking shoes? Do I want dress shoes? But they've got to be super comfortable. You've got to be comfortable working with a therapist.

And the reason why I like using the analogy of shoes is once you put them on, you're going to go somewhere. If you're going to be successful, you're going to make some moves. You're going to make some changes.

Troy: See, that's a great analogy. There's nothing worse than a long walk or hike or run with a little rock in your shoe. And you think, "Oh, I can deal with this." But just that little thing in there just becomes intolerable. So I would imagine same with these relationships. If things just are not quite right, it's just not going to work.

Dr. Langenecker: Yeah, we've all been on that walk with that pebble in our shoe or we don't have the right kind of shoes, and we're not enjoying the scenery. We're thinking about the blister we're about to have.

Mitch: That reminds me of the time I wore cowboy boots on the Vegas strip. And that was the worst decision I have ever made. I think I could not walk the next day. My feet were so broken.

Troy: Let me guess that was probably the first time you'd ever worn cowboy boots.

Mitch: Absolutely. I bought them for the Vegas trip.

Troy: That's what people wear in Vegas. They wear cowboy boots.

Dr. Langenecker: I bet you they looked good, though.

Mitch: Oh, they were banging. But no, after walking up and down the strip all night, the next morning I was limping to a Walgreens to get some flip-flops.

Troy: That sounds so horrible.

Mitch: It was.

Dr. Langenecker: If I could carry the analogy further, there are some times where a person just needs somebody to talk to and they just need a super comfortable pair of loafers. They're not going anywhere. They just want somebody to hear them as a human and to feel the connection.

Scot: Scott, talk about for somebody that maybe does not have EAP assistance or doesn't have very good insurance, what are their options?

Dr. Langenecker: Yeah, that's a great question. So here in Utah, at the Huntsman Mental Health Institute, we have something called the Warm Line. And I hope it's every bit as warm as it sounds. You can call them and say, "Hey, this is the thing that's going on with me right now. Do you have any advice for me on where I could go next?" They're there 24/7.

And it could be like we were talking about before. It could be like, "I've got this blister on my foot." It's probably not a blister on your foot, but that's just sort of me giving you space to say if you think it's a minor thing, it may be, or it may be something bigger. Just call the Warm Line and they can help you out.

Mitch: Scott, thank you for being here so much. If there was one piece of advice when it comes to finding the right specialist, if someone is curious, if they're feeling the things you're saying, something is off, you need to talk to someone, what is the one piece of advice you'd give our listeners?

Dr. Langenecker: My best advice is don't delay. In your mind, especially for men, it's like, "Oh, I can deal with that later." I know you've covered this in other health topics on this podcast, which is, "Sure, it can wait, but it doesn't have to." Things can get better, and they can get better sooner.

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

Dr. Langenecker: Thank you.