Amanda Kostura, LISW-S from Carve your Own Path, Inc. here in Fairlawn, and Nick Angelis, CRNA discuss alternatives to life-long pharmaceuticals for mental health issues. Pain and depresiion often occur together, so they give practical advice on how to manage complex conditions. Ketamine, TMS, Spravato, various types of psychotherapy, lifestyle changes and prescriptions–oh wait, aren’t we trying to avoid medicine? Turns out some people need it. However, they stress the importance of setting goals and evaluating progress. The hope is to eventually wean from powerful treatments, much like someone with diabetes might need insulin but eventually manage their disease mostly with lifestyle choices.

Transcript:

hello and welcome to the Ascend Health show I’m Nick Angelis I’m the owner of Ascend Health Center and a nurse anesthetist and I’m here with licensed independent social worker Amanda Kostura from carve your own path hey Nick nice to see you again I almost put like the supervisor like since it’s in your title I know it’s hard to say it then I’m like with supervision designation and then people are like what does that mean and I’m like just never mind I’m a social work supervisor yeah just let me know if you need Super what are all these letters I’m like no nobody knows it’s fine you go to another state and it’s going to be totally like they’re like LCSW or LM oh my there’s so much power in Arron you know I mean the military found this out I mean we always joke as nurses that like a nurse will say you know RN BSN and then like a string of other things that just mean you took a class and didn’t enjoy it but now you have some more things to put past your name yeah and even for anesthetist uh I’m not sure if you’re supposed to put the MSN or the CRNA first and they switch it every few years so I know for me I’m like why put mssw like I have to have my masters to have an independent license so like that’s OB like you know for sure so anyways we did a show already but we had a little bit extra time so we thought we’d talk a little bit about depression and what you can do for depression if you don’t feel like taking pills so obviously being a therapist that’s and the thing that we also have in common is so you’re a self-pay therapist and I’m a two practical nurse anesthetist so neither of us are into this whole thing where you like sign up for a lifetime of Mental Health Care like if that sounds tedious and you might as well just take pills and not come see us whatever it’s more of the idea of like okay what can I do that’s time Limited in some cases gets me somewhere and then I can choose when I’m out of survival mode and can figure this out on my own yeah and where you’re not like where you’re giving yourself skills for the future like you’re altering habits you’re altering lifestyle you’re adding supports in you’re making accommodations for yourself right like you’re not just looking we were talking about this on the last one right we’re not just looking for the next Quick Fix we’re not just like oh Planet Fitness has a membership deal so that’s going to be what I’m going to do now for my health oh wait oh look um the meal program sent me or you know like the what am I trying to think like the blue apron or the they sent me a deal in the mail and that’s going to change my life that’ll help me eat healthier right like we’re always just jumping to the next thing and it’s like let’s start small cuz my clients will be like yeah so all right I’m going to start I’m going to meal prep every night and then I’m going to do the and I’m like wo like let’s look at the schedule and say what day out of the week is best to plan your meals and then what is the next day to go shopping and then when is the best time to cut clean prep your food right like we get so we get these big lofty goals that are like that’s what’s going to change my life and make me happy and I’m the person that’s like hold on let’s break that down cuz I want you to be successful right otherwise you’re just going to burn out and part of it too is like right now we’re in the most individualistic Society ever known to man so even there’s a lot of uh I’m on X or Twitter too often and there’s a lot of that like the woman should do all these things and it’s like well if you look two generations back when they’re on their Pioneer dresses or whatever their sister-in-law their sister their Church they had a lot of community help because we just talked about Collective trauma um and that’s how they could do all the things because it wasn’t just them when they were in need somebody stepped in to help them out so this idea that we as singular humans responsible for all these things and the other side of it where we we end up with people saying like I have no responsibility toward anyone it’s like well you didn’t pave the sidewalk that you’re walking on your city did we all have responsibility to each other and it doesn’t have to be this like live or die by yourself type of thing yeah and we do better when we take care of each other right it literally takes a village and I think it’s not about depression at all but you you brought it up like you know we we’re very individualistic but we also have no third SPAC is do you know what a third space is no I don’t it’s a place you can just be okay it’s a place you can just be you don’t have to live there you don’t have to work there you can just be there and you don’t have to like patronize and spend money and engage in capitalism right right there’s not very many familyfriendly places that you can just take your children with you right so like the parents that are trying to get have it all and do it all without any Community Support like where do they go where can they be right the library the park maybe but we don’t have a lot of those spaces that are there for Collective support it might just be the library now cuz even like a Starbucks if you try to work at one now you’re like oh this is uncomfortable this is no longer meant for me to Lounge in yes yeah and buy two lattes an hour to like make up for it or whatever but even just those those two examples of like the man trying to like pull himself up by his boot straps and be like I don’t need any help I’ll figure it out I’ll cut I’ll do my own meal prep I’ll do my own gym like whatever it is to get out of this depression myself that’s very isolating which adds to your depression if you think about the new parent that’s now home with their newborn all day every day and they don’t have support from Community they don’t have anyone saying you’re going to be okay we can do this together I’ll support you that’s very isolating which adds to depression right for sure yeah well I think part of it too as mental health professionals is to make our clinics third spaces CU I always tell people yeah just put your feet up treat this like your own home in fact often we’ll have patients just come wander in if they’re like look I’m really feeling really bad I don’t think I’m bad enough to go to the hospital but I’m not good enough to stay home like I’ve told them just come hang out with us for a little bit till you feel better I mean it really only works if they live within 10 minutes honestly right but it’s still an option and and you’re right because there’s so few other places where you can just be whoever you are without some sort of mask cuz even in depression there’s uh the cost of that mask meaning that it takes literal energy to put on this facade of I am a normal person or even if you’re neurodivergent often it’s the same thing that you can decide am I going to be normal today or am I going to be productive unfortunately I can’t do both yes my neuro Divergence s did not think all the way through of doing two episodes with Nick and putting this mask on and then going to have a board meeting in a half hour but it’s fine we’ll find the spoons and we’ll get it done we’ll get it done it’ll be fine so the other thing I want to talk about for depression is uh and this is more for my clinic of Ascend Health Center so one of the meds we have is Spravato. Insurance will pay for it it’s half of the ketamine molecule it’s a nasal spray so it’s not an oral medication you take every day and there’s this new indication for monotherapy which means that you don’t have to be on an anti depressant at the same time uh you do have to have failed two anti-depressants first which is reasonable because you end up staying at our clinic for two hours each session it’s not something we prescribe for you to take home and who’s willing to do that unless they’ve tried a couple things and it’s failed so I think that’s perfectly reasonable um but it’s nice that for someone who’s sort of given up on meds where they just have terrible side effects or you know there’s kind of this bell curve with patients where most people you give them a medicine they feel better it’s the end of the story but I feel that a lot of anti-depressants that kind of cut the tails off of it so you don’t feel really badly depressed but you also don’t feel Joy and I feel it’s kind of cheating like you’re not really living if you’re just kind of existing right I mean we saw that with the opioid crisis a few years ago as a nurse and athetist I was like nope this isn’t working they do not have pain but they are also on their couch 24/7 like I don’t think we won this battle guys right so it’s kind of similar mhm absolutely oh gosh the opiate epidemic go back there yeah so if someone doesn’t want to take medicine what do you tell them and again some of this is you have to do a lot of things in combination depression is a very complex disease sometimes it’s inflammation sometimes it’s just serotonin there’s multiple ways you can get depressed multiple ways to get out of being depressed so what’s kind of like your go-to along with the usual things of taking space for yourself whether it’s third space second space first space and you know obviously talking to a therapist when you need it or whatnot yeah and that’s it’s so complex Nick you know like it’s such a simple question when you ask it but it’s so complex because you might come to your like a therapist for an assessment and say hey I’m depressed and I tried anti-depressants and I didn’t like them you know with my doctor my primary care or whatever I’m not just going to be like oh yeah you have depression let’s treat that there’s a lot of things we have to rule out right like so somebody might have gone their whole life being diagnosed with depression by their primary care or being told that’s what it was or maybe anxiety but maybe they have undiagnosed ADHD maybe they have some other underlying condition medical mental health it’s all medical health is Health your brain is an organ too um your nervous system is there um but first we have to rule out right what else could this be whether it’s physical there could be external factors that are contributing to it like if you go to work every day and you are just being bogged down by like an abusive coworker or boss right like you just have to think about all those contextual things that are coming into it before we’re like ology you have major depressive disorder you know right here’s your stamp so a lot of it is like validating for people well man like if I had to experience what you’re experiencing all day every day I’d kind of be depressed too right like so sometimes it’s those kind of conversations and maybe figuring out if people have access to it like how we can shift things in your life if it makes sense for you if it is a true depression I’m never going to tell someone not to take medication if they choose to decide that they don’t want to do that then we have lots of other options so of course we’re going to do like let’s encourage you to do some Behavior modifications let’s encourage you to do one small task and then we’ll build upon it right like habit stacking so if you’re having a really really really hard time remembering to I don’t know take a supplement that you think will help you or um go out for a walk in the morning it’s like habit stacking like we were just talking about I think before the show got started or maybe at the beginning cuz time and might have been that adht talk that we did when we talked about the Habit stacking yeah so like instead of trying to like I’m depressed what can I do to magically fix all of it it’s breaking it down into small steps and creating those habits um I love animals so if my people have animals I always encourage them to spend more time with them especially if they have dogs um it’s a good practice to love and receive love honestly yeah and there’s it’s there’s a lot of research behind the human animal Bond and how beneficial it is for your not only mental health but your physical health like it reduces cortisol levels um it regulates your blood pressure and your heart rate um gives you better feelings of like um positive mood and decreased depression and anxiety and when you have a dog whining that they need to go outside you can’t just lay in bed like I mean I guess you could but then you have to also clean up the messes right so like it’s Behavior activation too cuz it’s motivating you to get outside um how is your puppy doing by the way oh yeah it’s a five-month old puppy so he’s great no he’s awesome he’s like the best puppy we’ve ever had oh good um his name was kale it was a whole little litter of vegetable babies there was like green bean and I don’t know the whole litter was born at the rescue so that’s great that’s when love he just wants to snuggle up on me in love so um but also like when we’re in that freeze response really cuz we have what fight flight freeze and then there’s some other ones but we’re not going to get into that today for the general public but depression really is kind of a freeze response so we need some kind of activation because typically like you’ll probably relate to I don’t want to go but I know I need to right so like once you get to the thing like there’s been times like I’m feeling funky I’m feeling depressed I’m feeling unmotivated I don’t want to go to that hangout I scheduled with my friends but once I’m there I’m good and I feel better and I’m getting dopamine and even the most impressive TMS ketam infusion all that stuff that we do at Ascend a lot of it still won’t get you to want to go the difference is that once you do go you’re be like oh yeah this was a good idea so which I think is important because if you’re giving someone so powerful that just obliterates the way they were then it’s almost like when we would give patients GE Dawn and it’s like you’re not depressed well okay you’re barely surviving but so sorry no you’re no that makes sense for sure yeah and then um you know people obviously like we control of your diet what do you have control over your diet I don’t know depends like what type of food you’re able to access right so um that’s like an equity issue there but definitely diet nutrition plays into your health um and then we talk about things like having that support system in place yes you can come talk to a therapist and tell us all your deep dark secrets and we’re here for it and we want to know the tea and um you need accountability Partners like you need people in your life that you trust enough to say I can’t get out of my own damn head today and they’ll be like hey it’s okay we’re going to be all right do you want me to come over and hang out on the couch with you and just vegetate like you need somebody that you can say I’m not okay to right and then not feel alone not feel isolated but then able to get that support and in our gig economy you really need someone that you don’t have to pay to do things for you right honestly cuz like I took a $65 uh Uber trip to the airport the other day to go this bravado conference I was like huh I mean I did have people who were willing at that point I was like no this is going to be too much time out of your day I’ll just pay for it or whatever but there’s just something about the fact that like in our in today’s economy we’re all so singular and we had to pay for every single little thing that it’s really important to sometimes uh get something and give something without any strings attached both of them are really important kind of going back to that whole dog analogy of like just that human ability like I’m doing this and I’m not getting anything for it and that’s perfectly fine it’s a much healthier way to live and if you feel like you need to have like a give and take in a relationship we can live in a barter system like okay you take me to the airport today and I’ll pick up your kids from school next week right like well that’s true too so if uh if it’s very clearly defined there’s also something very wholesome about that right like I see Dr. McElrath and she says like no eat that pizza and say to yourself This is a bad food and I’m going to eat it and I’m going to enjoy it and that’s so much better than like it’s a vegetable I deserve it I was good I was better whatever other weird things cuz our brain will rationalize anything we tell it to rationalize like that’s what it that’s that’s how it do but your body and your body will believe everything you say right so then all of your other systems in your body start to participate with that belief that you’ve created there’s a famous study I wrote about in a book so uh they gave these participants shakes and one person they told this is a diet Shake it’s good for you and they told someone else oh this is a decadent dessert shake and when it was a decadent dessert shake like the body produced gin like all of the things that the stomach itself produced in response to what’s in the food changed based on what the brain told it it was receiving so all those systems that we think are completely separate from the brain it’s like okay I released pepsin because this is a protein here’s the enzyme I release because of the carbohydrate nope it’s still controlled by what your brain thinks is happening yep and I’m trying kind of like we’re my my kid’s three right so I’m doing all these like basic lessons right so like you know he sees something on a show or reading a book and he’s like Mommy what’s that right so like we’re reading a book and it’s like talking about the parts of your body and it’s like that’s your brain and I’m like okay buddy what does your brain do and he’s like it thinks and I’m like yeah what else and like it I’m like it communicates to your body things that it needs to do right so like if you think about that at like the most basic level this is why we don’t want you isolated we don’t want you stuck in those negative thoughts because your body is going to believe everything that you’re telling yourself so just say I’m not good enough I’m a piece of crap I’m not worth anything I shouldn’t well whatever those things are your body is like all right well we’re just going to adjust our functioning and that’s where kind of chronic Health chronic disease comes from right so um although you might be annoyed with your therapist for like wanting them wanting to do reframing your thoughts or affirm like uh self-affirmations it really does matter because what you tell yourself yeah so tame the Beast is a series on YouTube that’s really good for pain when I first started in 2019 we did a lot of chronic pain infusions with ketamine, Decadron tool like every single Med that’s nonopioid that you can use and then over the years I was like the fewer medications I can give and the more I can get people to like buy into them controlling their pain bio feedback like the better off we are and obviously it’s like the less they have to see my face which maybe it’s not the appropriate way to do it but for all almost all my patients I’m always like what’s the least amount of work that we need to do to get you the the best yeah because I feel that that’s what we all think internally when we go to the doctor like how can I see you as as little as I need to yeah so it is important and chronic like I was mentioning earlier before we started chronic health and chronic pain absolutely co-occur with depression anxiety things like that right like when you’re in pain and it hurts to just do your daily tasks then that can be really depressing um I remember years ago when I was still working um as a behavioral health consultant in primary care offices I would see a lot of those chronic health patients and chronic pain and I suffer from chronic pain myself which most people are like what you’re so young you look able-bodied um and it’s invisible it’s called an invisible illness and so when I would help people understand and try to like there that’s where that therapeutic self-disclosure would come in sometimes CU I’m like there’s a barrier like you’re older than me or you just you don’t see how I can help you so let me try to bring it a little closer and i’ be like you know I’ve had the I’ve had some chronic pain too and this is what’s helpful for me and I try to be like breath work and mindfulness and the things that really can work they’re like lady my body’s in chronic pain what do you mean I’m going to sit here and do breath work that’s not going to do anything right but then for the people that were like all right I’m willing to try anything they’re like wow hold on this weird tapping thing you taught me I don’t feel pain now for a little while right like where did that pain just dissipate to or I was doing Lisa’s sound bow therapy and a certain sound wave I don’t know frequency whatever you call it moved through my body and as it was moving through my body I felt no pain and then it moved through and there was my pain again right so like be open-minded to trying new things because our brain again is wired for survival so it’s going to tell you like don’t bother doing that thing it’s not going to work uh that’s not going to work either we’ve tried that nothing matter right like you’re so just be open-minded and just go with it what is the Mel Robbins book like the 5sec rule or something like if you have an idea and you’re like I want to go for a walk like just get off the couch go put your shoes on like don’t even allow yourself to think through it because you will inevitably talk yourself out of it cuz brain is like oh no survival um if we get up and walk right now like that’s too much exertion we don’t want to do that right like keep you safe but it can keep you too and it’s a good way to trust your gut so I’m a little cynical where I’m like a lot of this like follow your heart follow your emotions like it just feels good for the moment you just followed some dopamine rush but that’s one example it’s like well no as you learn to listen to yourself then you’re better prepared to answer questions cuz a lot of times I will tell patients like no you need to suck it up in try psychiatric medicine so maybe not quite as therapeutic at you with the idea like no we want you to get off of everything but start this let’s see if we can get the ball rolling and then let’s find a way to wean it cuz unless we have some sort of endgame then I’m signing up for a lifetime of uh an appointment at least every 3 months at a sent Health Center like what’s our end game here but in some cases like well everything you tried was related to serotonin we need to try something with glutamate whether it’s like the drug Auvelity or ketamine infusion or Spravato or something electrical like transcranial magnetic stimulation but the idea of like well let’s not try the same thing because but we can at least reach is low hanging fruit like tried okay now we can start talking about your thyroids sending up with a functional medicine doctor something’s more expensive or more detailed things but we can at least try with some of the easy things uh CU I think I feel that’s what holistic means like a holistic way to treat depression doesn’t mean here’s an herb see you in two weeks don’t eat any chemicals it’s like we’ve got this huge we know that this is a complex disease so we need a huge variety of ways to treat it and each one of these ways we need to take it to completion not like oh I tried that once and there’s very few things like I took a walk it was 2023 the leaves were falling maybe October didn’t work here I am still depressed so it’s a sort of like well how long do you need to try something before you can say that was a failure and part of it too is like well what was the side effect of that failure like you to buy running shoes a few weeks earlier like that’s okay keep doing that thing as opposed to like I nausea for a month like okay let’s not try that again we the pros and cons for sure yeah so we have about a minute and a half left before we have to leave to go to your board meeting yeah so what else do you want to say while we’re here and all so we’re talking about depression there’s other things other than meds I’m saying sometimes just try the med as long as you’re with a provider who has an idea of like okay here’s how we’ll get you off of it in case it wastes your time and a lot of it is financial I mean I talk about finances a lot because I feel everything in health should be viewed the same way as you do anything else in life like there’s something so empowering about oh this will make me feel better Noe not worth the money MH I feel that’s kind of kind to yourself instead of the like I’m in survival mode like throw the kitchen sink at me or whatever yeah and I think this is probably something I’ve said on a previous show but I love like listen to your body um a lot of us have been taught you know our parents did the best most of them sometimes um but a lot of times they were like teaching us not to trust our bodies and not to listen to our bodies right like no you need to stop eating that’s enough or no you don’t right so like a lot of times it’s like re almost reparenting themselves my clients of like it’s okay I can trust my body so a lot of times when you’re in those function or when you’re heading there right like we’re heading to the really deep depression Punk you’ll have an idea like oh I should call someone or oh I need to move my body I need to walk or I need whatever it is and don’t ignore that go do that thing right absolutely and sometimes there are spiritual issues too like you know being raised as a pastor’s kid a lot of it is like okay God will fix this or I need to pray to God but there’s still plenty of room for your own Insight God wants a real relationship not just some sort of robot who’s like oh must pray must do this so no matter how you’re raised or whatever belief system uh there’s so much room for like what is your own intuition you know what wisdom have you gained from your faith practices what wisdom have you gained from the way you’ve lived your life and you need to start to trust that wisdom for sure absolutely what wisdom have you gained from the collective that you’re supporting yourself with absolutely well thanks for coming on for a second show then I’m here for it we got to do this again soon absolutely and thank you all for watching as well

[Music]

you are watching WCTV Wadsworth Community television