45: Do I Need an Antidepressant?

Scot: Hey, it's Scot and Troy from "Who Cares About Men's Health." The main interview in this episode was recorded before COVID-19 became a thing in our society, but it's still definitely very relevant information today. It was our interview with Kyle Bradford Jones talking about his journey with his mental health, and the episode was titled, "Do I need an antidepressant?"

Troy, explain to us why this is still relevant right now.

Troy: Well, I think a lot of people have experienced a wide variety of emotions and reactions with everything that's gone on with COVID, and maybe a bit of depression as well. And I think he talks about his experience with experiencing depression, and some of it, I think, was related to a lot of what he was going through in his training and certain life stressors. So I think it's relevant for a lot of us right now.

And maybe some of us are at the point where maybe an antidepressant is a good thing. He talks about that. He talks about his decision and how it doesn't have to be a lifelong thing. It can be a short-term thing. So very relevant, I think, to what a lot of us have gone through.

Scot: I mean, I like hearing my own voice, so . . .

Troy: I know, so I choose not to. It just sounds weird.

Dr. Jones: You mean you don't like hearing his voice?

Troy: I don't like hearing his voice. Exactly.

Scot: But with headphones, you can control it. You can turn me down.

Troy: That's right. I could just turn you off and just say whatever I want to say.

Scot: You're a gem.

The podcast is called "Who Cares About Men's Health." It is a podcast that not only informs but inspires you to take ownership of your health. We talk about the core four here on "Who Cares About Men's Health," which is your physical health, your nutritional health, sleep, we also talk about your mental health, and the plus one more is your genetics. And today, we're going to get into mental health.

My name is Scot. I am the manager of thescoperadio.com, and I care about men's health.

Troy: And I'm Dr. Troy Madsen. I'm an emergency physician at the University of Utah, and I care about men's health.

Dr. Jones: And my name's Kyle Bradford Jones. I'm a family physician at the University of Utah, and I care about men's health.

Scot: Do you need an antidepressant? That is the question our guest was wrestling with, and our hope is, through his story, we all can better understand our own mental health, and if that's the way we need to go, is take an antidepressant.

Dr. Jones, thank you for being on the show today. When did you first realize you were depressed? Because that's a really weird thing. I've thought numerous times, "I might be depressed," but I don't know if I'm depressed. I can look in the mirror and see if I'm fat, but I don't know how to identify if I'm depressed.

Dr. Jones: So depression and anxiety is really hard because it's a normal, healthy emotion, but it can also be a symptom of another illness, or it can be an illness in and of itself, and so sometimes that line is very difficult to figure out.

Now, in my case, I started out with very severe anxiety as I was preparing for medical school, which is very common. There's a lot of pressure you put on yourself and that others put on you to succeed. And it was something that had been slowly building for me for many years.

And then my depression came on about 10 years ago when I was a resident in family medicine. And very similarly, a lot of pressure. You're dealing with a lot of life and death issues. You're working very long hours without sleep, and you oftentimes don't have time to eat or exercise or care for yourself. And so that's very common as a physician, but also for all of us in today's society, as you mentioned with suicide. About one in five of all people have clinical depression.

And so the way I kind of came to being on an antidepressant was it actually started a lot with physical symptoms, which is pretty common. So I had a lot of stomach issues that I had been worked up for multiple times and couldn't find an answer with my doctor. Then I ended up having a panic attack.

Troy: This is during residency?

Dr. Jones: This was before. But the panic attack was . . . for anyone who's experienced it, it's awful. It is terrifying. Your heart is racing, and you're having trouble breathing, and you can't focus on anything, and it feels like you're going to pass out, and you have this sense of impending doom.

Now, the hard part is that could be a lot of different things. And so, when I went to the doctor for that, I was thinking I had some sort of heart problem that was causing these symptoms. And going through everything, he identified, "No. I think this is different. This is more anxiety driven."

And it had gotten to the point where it was negatively impacting my life, and so I needed something more to help me get through. And so that's when I decided to start on an antidepressant, to start with therapy, because it was getting to be too much in my life to handle and to function normally.

Troy: And where were you in your training when you decided you needed to be on an antidepressant?

Dr. Jones: So when I first started it, I was actually in undergrad, but throughout that, and medical school, and residency, and now as a practicing physician, I'm still on medication. Had to go through a number of different ones to find the right fit and make sure I was getting the help that I needed.

I've been through multiple different therapists, which is pretty common because finding a therapist that you work with, it's almost like dating. You have to find that right fit. And so, thankfully, right now, I have a good therapist that I trust, but it's taken a long time to kind of get there and get the full effect from that.

Scot: From my nonmedical point of view, antidepressant, I always perceive that to be like the last thing you try. You try different things first, try some exercise, some mindfulness stuff, then maybe therapy, and then maybe . . . Was that the journey that you took, or did you kind of go right . . . From a medical standpoint, is my perception correct or not?

Dr. Jones: Yes and no. In my case, I needed to go more right to the antidepressant just because of how severe my symptoms were.

Scot: Your panic attacks?

Dr. Jones: Yeah.

Scot: You were having them pretty severely and pretty frequently?

Dr. Jones: Yeah. But in general, when taking care of depression or anxiety, those things you mentioned with diet, exercise . . .

Scot: Sleep.

Dr. Jones: Sleep. Absolutely. Those are huge, and those are absolutely necessary to really get things under control and to be able to function well.

Scot: It sounded like you didn't have those things under control. Did you get those things under control first and then the antidepressant, or was it the antidepressant so then you could get those other things under control again?

Dr. Jones: It was more of the antidepressant first. And sometimes that does happen where you are so depressed or so anxious, you can't get to the other things, or you can't function well enough to exercise regularly, for example, and so you need kind of that kick to be able to overcome that and get to the next step.

Troy: I think one of the challenges we face certainly as men, but I think particularly as physicians, is some of the stigma associated with being on an antidepressant that unfortunately exists. Is that something you've faced or something you've had to deal with?

Dr. Jones: Again, yes and no. It's definitely something I felt. And even now, I've written about my experiences and whatnot, but there's still a little bit of that in the back of my mind, like, "Well, what are people going to think about me when I talk about this?"

But at the same time, it was never as big a deal to me as it is for a lot of other people and for a lot of other men. In our culture, being on an antidepressant, suffering from any mental illness is oftentimes seen as like a moral failure. "I should be able to get over this on my own without medication." And oftentimes, that's not the case.

And that's kind of where the question of, "Well, where's the line between the emotion of depression and anxiety versus the diagnosis?" That's where your doctor comes in. If you feel like you are struggling, go see your doctor and see what they think. There are some different tools they can use to kind of work through it.

But I think, honestly, one of the biggest things that tips it off for me is if this is affecting your relationships, whether it's a significant other, or kids, or friends, or workplace, or whatever it is, when it kind of crosses that line, it becomes a significant impediment to healthy relationships with other people.

Troy: Is that sort of the guide you would give people? Scot talked a little bit about how do you make this decision as to when you should be on medication? As a physician, if you're seeing someone who's saying, "Hey, it's affecting my relationship with my spouse, with my kids, with my family," is that when you say, "Hey, we should probably try some medication"?

Dr. Jones: That's certainly a big one and probably one of the biggest in my mind. There are other things that go along with it. One of the most common symptoms that goes along with depression is called anhedonia, or basically you no longer enjoy the things you used to enjoy.

So, for example, I really like movies. And so, when I have been in the depths and worst parts of my depression, I could watch any sort of movie, doesn't matter, it's not enjoyable to me. I can't get into it. I can't concentrate on it. And that's really another one of the biggest hallmarks.

But there are also other symptoms. So sometimes you sleep too much, sometimes you sleep too little, but in general, sleep isn't as good as it should be.

Another interesting thing that goes along with it is guilt. And part of that is the stigma, but it's more that you feel guilty that you can't function normally, and as though, "Boy, something's really wrong, but I just can't overcome this." There were times where I felt extreme guilt because of how it affected my relationships or how it affected my work life or personal life.

Scot: Did you like lack of energy to want to do your job, just not really even caring anymore, would rather just go home and not do much of anything? Were all those kind of some symptoms that we're talking about?

Dr. Jones: Absolutely.

Scot: And then we tell ourselves we're lazy. "Oh, I guess I'm just lazy. I just don't have . . ."

Dr. Jones: Yeah. And it's things where you think, "Well, everybody . . ." Not everybody likes their job, and you think, "Well, okay, so this is normal." But when you can't really function, you lose that energy. You lose the ability to accomplish what you need to. That's another really big sign.

Scot: Looking for distractions so you don't have to do things?

Dr. Jones: Exactly.

Scot: Boy.

Dr. Jones: Any sort of excuse.

Scot: It's a little scary for me. This is way scary.

At the top of the show, we talked about depression and, of course, suicide is what the ultimate . . . it could lead to. Did you ever feel yourself in danger? Because that's something else I'm trying to get my head around. I might think, "Well, I might be a little bit depressed, but I don't have suicidal thoughts, so everything is cool."

Dr. Jones: Sure. And that does not always go along with depression or severe anxiety. Oftentimes it does, kind of to your point, but not always. And with me, I felt what we'd call passive suicide, where it was like, "Well, I think I'd rather be dead than dealing with this," but I didn't have a plan. I wasn't intentionally going to act on it, which is more called active suicidal ideation or suicidal thoughts. And so, thankfully, I never got fully to that point, but did get kind of partially in that direction.

Troy: One thing that may prevent people from going on antidepressants is the concern about side effects. Is that something that you've experienced or something that you find that people worry a lot about when you're talking to them about taking this next step?

Dr. Jones: Absolutely. And with any medication, obviously, but with antidepressants there's the ability or the likelihood that it can affect your GI tract. You get an upset stomach. You can get diarrhea and nausea. That, in general, tends to be short-lived, maybe a couple of weeks, and so a lot of people can kind of work through that and it's not a huge deal.

But going forward, you can have some sexual side effects, and so that's a big concern, especially among men, of, "Is this going to affect the relationship with my partner?" And that's something where . . . obviously, that can be a very big deal and impact our mood and our depressive symptoms. But it is one of those things also where it is a minority of people that that affects, and oftentimes it's not anything that's very severe to the point where it will negatively impact your relationships.

Troy: And something I'll sometimes counsel patients on as well, if you start an antidepressant, even during those first couple of weeks, you could experience increased thoughts of suicide. And I always say, "Make sure you're aware of that. Make sure you're in touch with your physician." So, like you said, there's sort of this period where you have to get used to the medication and be aware that these things can happen.

Dr. Jones: Absolutely. And especially the first weeks to one to two months, you don't necessarily see the positive impact of the medication. So you might experience the side effects, but you don't necessarily feel any better mood-wise. And so that's another thing to really keep in mind. Some patients, if you don't educate them on this, they'll go take it for three days and they're like, "Well, I didn't feel any better, so I stopped taking it." But it takes a little bit longer than that to really take effect.

Scot: Let's talk about your before and after. So after you kind of sorted it out and were on the medication for a while, how did your life change?

Dr. Jones: It's amazing. In a lot of ways, it's night and day. Now, as a physician, I'm on two medications for my depression and anxiety, and I mentioned I'm seeing a therapist right now, and I'm functioning great. I'm successful in my personal life and professional life. I'm able to accomplish what I need to.

Again, going back to how it affects your personal relationships, the relationship with my wife, and kids, and friends, and coworkers is absolutely better than it was before being on medication.

Scot: And you found that energy, and desire, and passion to do those things that you care about?

Dr. Jones: Absolutely. You get all of that drive back.

Troy: And that's a great point, too. Being on an antidepressant isn't just about trying to get through the day-to-day. You went on an antidepressant before you started medical school. You continued to make changes and adjustments, and you performed at a very high level. I mean, you went through medical school. You went through residency. You're a very successful physician. So it's really about, as you're talking about, being your best self and not necessarily just like, "Hey, I'm down in the dumps. I just need some to get through until tomorrow."

Dr. Jones: Absolutely. And so it's not just to bring you to that point of, "Okay, I can get through this," but you're right, to really kind of optimize your life.

Another thing I think is important for men to know is that oftentimes we think, "Well, if I start an antidepressant, I'm going to be on that for the rest of my life." And the majority of people who are on an antidepressant only need it for a year or two, and can get off of it and can move forward with their lives without it.

In my case, obviously, I'm still on medication. It's been about 17 years that I've been on some form of medication, but for most people, they don't need to take it that long.

Troy: Yeah. And that's a great point and something worth emphasizing. I'm glad you brought that up because I think people may feel like, "Oh, I'm going to become dependent on this medication. I'm going to become addicted to it," or whatever thoughts they may have, or, "I just cannot get off it." But as you're mentioning, it's not unusual, and probably more common, that people are on it for short period of time, couple of years, and then transition off.

Scot: So we talked about a lot of symptoms or a lot of reasons why somebody might want to go to a doctor and talk to them about their mental health. It's not just because you might be having suicidal thoughts. It might be simply, as we've discussed on this podcast before, you don't feel as though you can go out and accomplish the things that you want to accomplish, that you can't live that life that you want to live, that your relationships are suffering as a result.

Dr. Jones, advice for men who may be feeling some of these similar things, or have heard something in this conversation that resonates with them? Give us a map to how to proceed.

Dr. Jones: So really, the first thing is recognizing that stigma that exists, but it doesn't need to. This isn't any different from having another medical condition. There's not a stigma against having cancer. We get the treatment. We do what we need to. And this is the same thing. It's not a moral failing. It really is a medical disease. And so I think that's really the first step, is to understand and recognize that.

And if you are experiencing some of these things, it is important to talk to your doctor, to seek out a therapist. I recommend therapy for everybody, no matter what your mental state is. I think that's an important thing.

Scot: So my first visit is with my primary care physician, or I make an appointment with somebody at a clinic?

Dr. Jones: Yes, absolutely. So you can start with your primary care physician and go from there.

Scot: All right. And then perhaps a psychiatrist. What else would somebody might expect on this journey, or what would they need to do?

Dr. Jones: So oftentimes the primary care physician can direct all of this and you won't need a psychiatrist. Sometimes if you're not responding to medications or it seems to be more severe, then we'll need help with psychiatry or more specialists.

Also, therapy is going to be recommended, and that's important. Like I said, that can be a little hard to find the right fit, but it is an important thing and tends to be more life-changing and impactful long-term than medication can be sometimes.

Scot: Great story. Thank you for sharing that. Do you still hesitate sometimes to share it?

Dr. Jones: I do. Even when I've written about it, when I talk to people about it, they don't know how to respond, partially because of that stigma, and so then it makes it more awkward and whatnot. But the reason I'm more open about it is to try to knock that down, to help people understand this is okay to talk about, this is okay to be open about.

Troy: It's such a hard thing for us as physicians, too. We don't want to talk about it, but yet we have some of the highest rates of suicide, and depression, and substance abuse of any profession. So I'm glad you're talking about it. As a man, as a physician, it's something we need to know about and be aware that there should not be stigma with this. We should get the help we need.

Scot: And let me throw out, just even beyond the physicians, I grew up in a ranch environment. This is not something that you would talk about in a ranch environment. I think a lot of small rural communities . . . definitely where you live will impact how other people might view this, or how you even think about it, because those have all been embedded in you throughout your whole life.

Troy: Exactly.

Dr. Jones: Absolutely.

Scot: Dr. Jones, thank you very much. I'm glad that you're seeing success. Thanks for sharing your story, and thanks for caring about men's health.

Dr. Jones: Absolutely. Thank you.

Troy: Yeah. Thank you.

Scot: Paging Dr. Troy Madsen to Scope Studio for "ER or Not." All right. This segment is called "ER or Not." I throw out a scenario, you decide whether or not it would be something you would go to the ER for or not, and then Dr. Troy Madsen will give you the actual answer and you can see how good of an ER doc you would be.

So today's "ER or Not" hits a little close to home for Producer Mitch because he was out doing a training run and he rolled his ankle pretty badly. Can you put weight on it?

Mitch: As of today, I can put weight on it. But yes, I rolled it. I felt a little bit of a crunch. I texted you guys immediately to be like, "Hey, what am I supposed to do? Do I go to the ER or not?" Literally that was the exact first thing I thought of.

Scot: So rolled ankle, ER or not? What do you say, Troy?

Troy: So my answer is you really don't need to go to the ER. You can go to an urgent care. But the question is do you even need to go to an urgent care? And I think that's the question Mitch was asking, is, "Do I need to get an X-ray of it? Is it broken?" The obvious stuff is . . . occasionally we see people where it's obviously broken, it's deformed, the ankle is twisted off to one side, or you see the bone come out through the skin. That's a rare situation. I think that's kind of a no-brainer.

Scot: Is that what you're seeing, Mitch? Are you seeing bones sticking out right now?

Troy: Is there bone coming out? I did not ask you that question last night, Mitch.

Mitch: No. There's no bone sticking out. I think at that point I would have made Jonathan get me up to the hospital. But it's swollen up pretty bad.

Troy: So it's swollen. So the questions I asked Mitch were . . . Mitch, maybe you can tell me. What were the things I asked you on the text?

Mitch: You asked me if I could bear weight on it. Is it tender on the bones that stick out on either side of the ankle? Was there anything else?

Troy: That was it. It's quite simple. So if you can walk on it . . . which you could, so you said, "I can bear weight on it, and I'm walking on it right now. It hurts a lot, but I can at least bear weight." And then those large bones on both sides called the malleoli . . . there's the medial and the lateral malleolus. If you feel your ankle, those are just the two big bones that stick out on each side. You felt on there . . .

Scot: Those little bumpy, lumpy things?

Troy: Yeah, those big bumps on your ankle.

Scot: Okay. Got it.

Troy: So Mitch felt along there and said, "Well, maybe it hurts, but not really. It's not really that tender." So, in that case, you probably don't need an X-ray. And this is based on a study that was done out of Canada that we've had multiple studies on. We use this all the time to decide, "Do you need an X-ray?" It's called the Ottawa ankle rules. So if you touch on the bones on your ankle . . . and it's really on the back part of that big bone on both sides of your ankle. If you touch along the back part of that bone on each side and it's not tender, and you can walk on it, you don't need an X-ray.

There are exceptions. People who are older, if you're more prone to fractures because of osteoporosis, whatever, that would change things, but someone like Mitch, our advice was, "Keep your ankle up. Use some ice on it. Get an ACE wrap, something to put some compression on it, and it should get better. It's going to take a while. It's going to hurt. It's going to swell up, but you probably don't need an X-ray. No need to rush to the urgent care even."

Mitch: So if I've been icing it and I've been elevating it, how long is the recovery on one of these things? When do I need to start worrying and maybe need to go get help?

Troy: That's tough. So the recovery on an ankle sprain . . . I don't know. If it's still hurting after a week, you may want to go see a sports medicine physician. They would get an X-ray there if it's still really having a lot of pain and swelling, and you're not bearing weight on it. But then longer term, you may be looking at physical therapy, things like that to try and re-strengthen an ankle, stabilize it. In some cases, you can have more than a sprain where you actually tear the ligament. Some cases it requires surgery down the road.

So, again, all reasons that . . . you don't need to rush to the ER, but that doesn't mean there's not something wrong and it doesn't mean that you're not in for potentially a long recovery with this sort of thing.

Mitch: Great.

Troy: Probably not the news you wanted, Mitch. Sorry. I hate to tell you that.

Mitch: I know. And that was kind of it, as I'm leaning back.

Troy: I hate ankle sprains.

Mitch: I'm leaning back with Jonathan. I'm leaning on him. I'm just like, "I have a 5K."

Troy: I know. It's so frustrating.

Scot: Obstacles that don't kill you just make you stronger.

Mitch: Or permanently maim you. Yeah. Whatever.

Scot: All right. Time for "Odds and Ends" on the show. That is where we talk about some ongoing threads and wrap up anything that might need wrapping up. Today, just a couple items and they both have to do with Mitch's 5K that we're going to do, the "Who Cares About Mitch's Health" 5K, which has now been moved to June 20th. Is that correct, June 20th?

Mitch: Yep. June 20th, that Saturday.

Scot: All right. A 3.1-mile run. You can do it your way, though. If you want to run, walk, ride your bike just to show support for Mitch, who's gone from couch to 5K in nine weeks, although because of COVID, it's going to be a little bit more than nine weeks. It'll be interesting to see how this pans out now that he's sprained his ankle and the recovery process goes.

Mitch: If it's "our way," I might have to just hopple.

Troy: You could do it on one of those little knee scooters. Just push yourself. Just get a good downhill route.

Scot: All right. So, anyway, that's coming up. And between now and then, we're going to be putting some running tips out on our Facebook page from our great experts at the University of Utah Runner's Clinic.

So if you're just starting out with running, you can start your training now and then hear some of these tips about your form and some different things that might answer some pretty common questions that beginner runners have. So even if you haven't started training yet, you still can for the "Who Cares About Mitch's Health" 5K.

Also, at facebook.com, you can download your bib. The bibs are done, Troy. How about that?

Troy: Yeah. So excited. Nice.

Scot: Here's what we want you to do. We want you to download your bib, print it out, put it on yourself, and then just take a photo to show us that you're all in for when the 5K happens, and then post that on our Facebook page. So, Troy, go download that bib. I want you to put it on, and take a photo, and put it on our Facebook page, all right?

Troy: I'm going to do it. It's going to be cool.

Scot: Awesome. I will do it, too. Anybody that wants to support Mitch and participate . . .

Troy: Scot, I'm going to put one on my dog, too, because she's running with me. So Charlotte cares about Mitch's health too.

Scot: I love it. Time for "Just Going to Leave This Here." Could have something to do with health, might be a random thought. Troy, why don't you kick it off?

Troy: Scot, I'm just going to leave this here. I finally got off snowshoes. And this is a big thing for me because I've been running on snowshoes all winter, and where I am, up in Summit Park, it has been this eternal snow. But it was just so wonderful finally yesterday to get out and do a long run without snowshoes on. I saw a couple of moose just hanging out there. Was with my dog. Had a good hard run, lots of hills, and no snowshoes. So that's good news. Spring is here, almost summer.

Scot: Just going to leave this here. Texting nowadays, you see a lot of people . . . and I've become this way, too, and I don't know why exactly, if it has to do with I've just got to find the latest out about what's going on with the COVID thing, but I'm constantly in my phone now when I'm walking.

And it just occurred to me that, at some point, I think we're going to start evolving as a human species with feelers on our heads so we can look down at our phone and then if we get close to bumping into something, our feelers will touch those, and then we'll avoid the thing if we keep doing this. So get ready, Troy, for the evolution.

Here's another idea. Here's a million-dollar idea if somebody wants to make this. How about smart shoes that have curb feelers on them? So they will alert you via your phone or they'll start beeping if you are approaching something dangerous, whether it's walking into a tree or a stairwell that you might fall down. That way, we never have to look up from our phones again because our shoes will be doing the watching for us. What do you think?

Troy: Scot, I've got something you can do right now, and you may have seen this photo. It is the viral photo of this guy wearing those water noodles sticking off of his head several feet in each direction in a grocery store, and that was his way of social distancing, of telling people, "Don't get too close to me."

So you can just start to wear that now and that's going to bump into something as you're looking at your phone. That can be your sensor. I can make one for you right now. I want you to wear it because I know this is a big deal for you apparently. So social distancing and it'll protect you from bumping into stuff.

Scot: I think I'll just make an effort to not do it anymore because I'm too vain to wear this hat that you're talking about.

Troy: Okay.

Scot: All right. Time to say the things that people say at the end of podcasts because we are at the end of ours. It seems like every podcast ends this way. I mean, it seems to be a proven formula. Let's do it the same way here.

First of all, thank you very much for listening. If you would subscribe, that would be great. Then, every week, this show can be in your pod feed and you can get all the great topics we talk about and the inspiration to care about your health and to continue caring about your health.

If you want to reach out, Troy is going to tell you how to do that.

Troy: So you can contact us at hello@thescoperadio.com. Our Facebook page, facebook.com/whocaresmenshealth. Website is whocaresmenshealth.com. We love getting feedback, love to hear what you think about the show, any suggestions for guests or topics. Thanks for listening, and thanks for caring about men's health.