Personal Growth

Name, Frame, & Brave Depression: Science-Backed Strategies to Treat Mild and Stubborn Depression & Recover Your Joy with Dr. Len Lantz

Episode Notes

Have you or someone you love struggled with depression?

If so, you're not alone. Rates of depression have increased in the past few years, and my guest today is here to give us hopeful, helpful, science-backed wisdom on how to name, frame, and brave a path out of depression. From identifying the subtle signs of mild depression to addressing more severe and persistent symptoms, our conversation will equip you with practical tools and strategies to tackle depression. Whether you're personally struggling or supporting a loved one, this episode will help you find clarity and direction.

My guest today, Dr. Len Lantz, is one of America's top psychiatrists and a clinical assistant professor in psychiatry at the University of Washington School of Medicine. He is the editor of the www.psychiatryresource.com, and he maintains a clinical practice at Big Sky Psychiatry in Helena, Montana.

Content Warning: This episode briefly touches on the topic of suicide. We want you to feel safe and cared for while listening, so please take care, or if you need to skip this one, consider asking a friend to listen on your behalf.

Here’s what we cover:

  1. Why mental health diagnoses are hard to get right
  2. Current statistics on increasing rates of depression
  3. Signs and symptoms of depression
  4. Debunking stigmas about depression in faith-based communities
  5. Research-backed interventions for mild depression
  6. Proven medical options for treating severe or stubborn depression
  7. How to support a loved one struggling with depression

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Additional Resources:

Related Episodes:

  • Episode 103: Name, Frame, and Brave Gossip
  • Episode 104: Overcoming the Fear of Vulnerability—Strategies to Stop Feeling Alone and Build Meaningful Connections
  • Episode 105: 4 Lies We Tell, the Mental Health Benefits of Honesty, & How to Stop Lying In Your Relationships
  • Episode 106: Transform Limiting Beliefs, Embrace Critical Thinking, & Navigate Holistic Health with Dr. Josh Axe
  • Episode 33: People Pleasing & Developing Your Own Inner Compass: Thoughts on Depression, Mental Health & the Church, and Finding Hope in Dark Places

Music by Andy Luiten

Sound editing by Kelly Kramarik

© 2024 Alison Cook. ALL RIGHTS RESERVED. Please do not copy or share the contents of this webpage without permission from the author.

While Dr. Cook is a counselor, the content of this podcast and any of the products provided by Dr. Cook are not specific counseling advice nor are they a substitute for individual counseling. The content and products provided on this podcast are for informational purposes only.


Alison Cook: Hey everyone, and welcome back to this week's episode of The Best of You Podcast. I'm so glad you're here today and I'm thrilled to bring you this conversation all about naming, framing, and braving depression. This is such an important topic.

As you'll hear from my guest in today's episode, depression has increased in numbers over the past decade, and it's really prevalent, especially among women. My guest today is so helpful and so practical and so hopeful in helping us to name depression in our lives, frame it and then take brave steps toward finding more joy and more health and more wholeness in our lives.

My guest today, Dr. Len Lantz, is one of America's top psychiatrists and a clinical assistant professor in psychiatry at the University of Washington School of Medicine. He is the editor of The Psychiatry Resource, and he maintains a clinical practice at Big Sky Psychiatry in Helena, Montana.

I actually met Len way back in the day when we were both undergraduates at Dartmouth college. Len and I lost touch after college, but reconnected when he got his hands on a copy of my first book with Kimberly Miller, Boundaries For Your Soul. And he realized as he was reading it, that he knew me that we had gone to college together. 

We reconnected and I learned about his work treating depression and his book called unJoy: Hope and Help for 7 Million Christians with Depression. It's a fantastic resource for anyone who struggles with depression or if you know someone, a loved one, a family member, a neighbor who struggles with depression.

Len brings together the best in science and psychiatry and current research on depression with a faith-based perspective. This book is such a helpful resource and I'm so thrilled to bring you this conversation today with Dr. Len Lantz.


Alison Cook: So the last time we saw each other, I think, Len, we lived in the same dorms, like the same cluster of dorms at Dartmouth. Weren't you in the Choates?

Len: I want to say I was in the Choates for maybe a year. And then I was in the international house for my junior and senior year.

Alison Cook: How did you end up in the international house?

Len: My freshman roommate is from India and he loved the international house, and you're allowed to be in the international house if you're from the U S. I felt a lot like an international student being on the East coast, because I'm from South Dakota, and I think that it felt like a big cultural shift for me to be on the East coast and to be at a place like Dartmouth. I really connected well with the international students. We all felt like we were in the same boat. I was actually their RA for a year.

Alison Cook: That's amazing. I was from Wyoming, born and raised in Wyoming, and it absolutely felt like going to a different country and even, maybe even more so back then, I don't know, because there, it's not like there was the internet, we really were in a different world. I remember very quickly feeling like I was a fish out of water.

Len: Absolutely.

Alison Cook: Did you end up feeling like, in hindsight, you had a good experience at Dartmouth overall?

Len: So the things that were very meaningful for me at Dartmouth was connecting with other Christians

Alison Cook: Yeah.

Len: It was transformative in my spiritual life. I went from, this is what I want to do, God, please bless it, please make it happen, to moving into my own faith. Not the faith of my parents, but my own faith where then I'm asking God, what do you want from me? What do you want me to do? As opposed to, this is what I want to do. Please bless it.

And then I was still dating my high school sweetheart, whom I married–Krista. She was going to college about four hours away at Bard in New York. I was gone for a lot of the weekends where she was there. And that kind of changed my experience a little bit because we had that relationship that we were trying to nurture. 

And then I changed my major, because I felt that God was calling me into medicine, which is a story in and of itself, but it was a huge leap of faith for me to change majors and then to plan to go into medicine. That changed everything for me academically, because I had to shift majors and classes. And Dartmouth was hard. It was harder for me than medical school. I am very grateful for it. And it was a challenging part of my life.

Alison Cook: That makes sense. It's so interesting listening to you because, I'm going to guess, Wyoming and South Dakota were neighbors, more culturally Christian in a sense, and definitely more people identify as Christian. And I had the same experience where my faith came alive at Dartmouth and it's fascinating because, people think, oh, if you go off to these secular Ivy league schools, you're going to lose your faith. You and I had the opposite experience. There was a really vital Christian presence at Dartmouth. It was very formative for me spiritually as well.

Len: Absolutely. It’s a place where you are exploring it for you. You're not doing it with your family.

Alison Cook: Yes. And not because there's some cultural norm behind it either. You really have to think about it. That's one of the things, we landed in Boston, my husband and I, these last 20 years, and I'll say gosh, the Christians you meet here are amazing because you're not going to be a Christian really in the Northeast because it's culturally what the norm is. You're going to have put some thought into it on some level.

Len: Absolutely. And you're going to have to seek out Christian communities. 

Alison Cook: Yeah. Okay. So I want to get into it a little bit. So you didn't get into college thinking, I'm going to be a doctor; that changed in college. You decided you felt called to go into medical school. Did you know at that point you were going to go into psychiatry?

Len: Oh no, not at all. In fact, I thought I was going to go into family practice and that's because one of the former U. S. Surgeon Generals, C. Everett Koop, was at Dartmouth and he did a lot of talking about family practice and the importance of medicine and primary care. And I thought, when I was thinking about medicine, I was like, okay I'm going to be a family practice doctor.

And then when I got into medical school, we had this opportunity to experience a lot of different medical specialties. I was thinking about family practice, but I loved surgery and I loved pediatrics or thought I was going to love pediatrics, but then I got into it, and I realized that a lot of, at least on the outpatient side of pediatrics, a lot of it is treating kids who are aged two and younger, so they can't communicate really well. 

And it's usually well-child visits. So you're like pinning these little kids down and they're really upset. And you're looking in their ears and looking in their mouth and their eyes. And I I felt like a bully; I'm like pinning down these kids who can't talk to me.

But what I loved was when the teenagers would come in and they were usually only coming in for sports physicals or whatever. And they were anxious and aloof and maybe a little irritable. And what I really loved was breaking the ice, getting past their armor a bit. And then they would open up and talk and talk. They wouldn't want to stop talking. 

And I thought, this is awesome. What if I could do this all the time? And then I thought more about psychiatry and child psychiatry. And the more I looked into it, the more I realized how much of a need there is, how much there is a national shortage for psychiatry, and in particular, child psychiatry or pediatric psychiatry. When I realized the need, that spoke to my heart, punched me in the gut where, wow, I'm not gonna be yet another doctor in a city or community or state or whatever–I can make a big impact

Alison Cook: Oh, yeah.

Len: So that's what really drew me to psychiatry. And I see a ton of kids still, and I see a lot of adults. But it's been a great experience. And then the other thing that I really like about psychiatry is that it is challenging to do well.

Alison Cook: Yeah.

Len: Every day is different and every person is different and everybody's story is different and I find that so valuable that it's easy for me to go to work and actually hear about people's story, and it's not hard on me per se. I think God designed me to be able to hear the hard stories. 

Alison Cook: Yeah, that's amazing, Len. With psychiatry, it's not like there's a lab or a blood test you can take to get a diagnosis for depression or anxiety, necessarily. You correct me. There's probably some, maybe brain scanning. And so you're having to listen really hard and really well to people's self-report, which is notoriously kind of murky.

It's hard for us to know how to communicate what we're feeling. And you have to sift through all that. So you have to have some serious skills at listening and discerning; I'm trying to think through what you're hearing and how it matches up against a potential need for a diagnosis or a medication.

Len: Yeah. I think of myself a bit as a detective. I want to get to know this person really well. And I want them to trust me. I believe I'm trustworthy, but I want them to trust me so they can share the hard stuff and then I listen really carefully and then be thorough and come back to things again and again to make sure that I'm not missing something.

Because in medicine and in psychiatry, in terms of diagnoses or whatever, it's important to be able to diagnose, what do you have? But it's also important to be thorough to say, what do you not have? I enjoy that. I find it very energizing.

Alison Cook: That's incredible. Some psychiatrists do some therapy, talk therapy in addition to prescribing. Do you have a component of that in your practice?

Len: I would say I incorporate it. I'm actually trained in a lot of different psychotherapy modalities, and I've done a lot of psychotherapy and family therapy, and I really love it. I love it a lot. I incorporate a lot of different therapeutic modalities, whether it's interpersonal psychotherapy or cognitive behavioral therapy and some acceptance and commitment therapy.

However, unfortunately the need right now is so great that I'm trying to balance spending enough time with people so they can get real quality care. And I do infuse psychotherapy in that. But for the most part, where I'm helping people right now is in helping them to get an accurate diagnosis.

And then if they need meds, I'll handle the meds. Then I coordinate with a lot of exceptional therapists, in terms of pediatric psychiatrists who are available in my city of about 35,000 people. There are maybe one or two pediatric psychiatrists and about 200 therapists. That's why I'm trying to balance that out, but I love therapy. It is so powerful. It is so effective and it's not something you have to do forever.

Alison Cook:  Two questions: One, we keep hearing some of these headlines about the mental health crisis, anxiety and depression going up. I'm curious what you think about that, if you're willing to answer that. And then number two, I'm curious, before we dive into the topic of depression, what nuggets of wisdom or advice would you give to the listener who is really desperate for a clear diagnosis or trying to figure out how to find someone to help them on that, not therapeutically, but get to the root of what's going on so that they can get the right care that they need.

Len: These are good questions. Let's start with the first part, which is, how common is depression right now? If we look at adults, it's concerning because the most recent data from a Gallup poll showed that around 29 percent of US adults have experienced depression in their lifetime. This is self-report that they were told by someone that they had major depression. That's a lot.

Alison Cook: Yeah.

Len: And it's an average. So it's an average of adults across ages and between men and women. If you break down the data further, over a third of women have received a diagnosis of depression in their lifetime.

And for men, it's like a fifth, it's 20%. Guys, they avoid doctors like the plague. So how are they going to get diagnosed if they don't ever see anybody? So the concern is that the rates are high now. It's not everybody, obviously, but the rates to me, that seems high. They would argue that that's about a 10 point increase over maybe the last decade. So rates have gone up, and life is harder over the last decade. 

So maybe that's part of it. The pandemic was not easy on anybody. But what I would say is that depression is real. And it can cause tremendous impact in your life. If you think you have it, how do you get it diagnosed and then where do you go from there? So one would be distinguishing, what is depression?  

I think it's worthwhile to take a second and talk about, what are some of the symptoms or signs of depression? So some of the symptoms or signs of depression would be: significant sadness, sadness that is lasting half a day or a whole day and happening maybe half the days of the week or more. And not in a reaction to something. It's like you wake up that way or it hits you randomly, and you don't have to have all these symptoms, but maybe a cluster of these symptoms: your motivation and energy are low. You are dragging. Your mind might not be working as well; concentration problems. 

You might be feeling a bit hopeless. or helpless, or worthless. Your appetite, your sleep may be off, you might be crying all the time, maybe even have some thoughts of wanting to die or a death wish. That's like, oh God, take me now, or if I went to sleep and didn't wake up, it wouldn't bother me, or even if I had a terminal illness, at least I wouldn't be on this earth much longer.

Sometimes these are passive thoughts, or maybe it's even more intense than that. And then this other thing, anhedonia. It's not always there, but it's there the most commonly among all the others besides sadness, which is anhedonia. And anhedonia is this fancy old word for saying loss of joy in life.

And it's why I titled my book that way. I was trying to find a better word for it, so I made up a word called unjoy. I think unjoy captures this loss of joy that happens where fun things aren't fun anymore. If all of these symptoms or a cluster of these symptoms are happening for a couple of weeks or more, it's usually considered depression.

Why it's so important to know if you have it, is that you should do something effective about it. There are other things in life that might mimic depression. We could talk about that but I think there's this other element that I try to do as a doc, which is to make sure that I'm looking for other conditions like, is a person depressed or do they have such intense anxiety, it's as though they have depression? 

Is their life so hard or miserable right now that maybe they have burnout, or maybe the depression hits occasionally but it hits like a ton of bricks? And other times your mood is normal or actually elevated. Some people have bipolar disorder, but they only really come in when they're depressed. And when they're depressed, they don't even necessarily remember the highs, the depression hits so hard.

And it's so severe. They don't even really remember the highs. It is important to get to the bottom of things, like what kind of diagnosis do I have? Because the treatments vary. Sometimes you have a stellar primary care provider, whether that's a medical doctor or like a nurse practitioner or PA, but some people have a very stellar primary care provider. 

And sometimes their primary care provider is not stellar in terms of mental health. There are some free rating scales that are out there in terms of depression screeners. There's even some bipolar depression or bipolar screeners that are out there, but that's a place to start and it is a challenge.

I have a private practice so I can decide how much time I want to spend with patients and I spend a lot more than the average person. I've made this decision in my private practice to focus on quality over quantity. I have a bit of a wait list, but once you're in, then we'll take the time that we need. So I can only help who I can help, but once you're in, we will take the time that's necessary to get to the bottom of things.

Alison Cook: That's so good, Len. That's so good. I love how you're differentiating; you really have to think about what's really at the root because that I'm sure affects what medication you use, or even holistically, what other interventions you might use. It might affect how long somebody is on medication.

It might be a stop gap or it might be something that is needed for much longer. Tell me, in your experience, because your book Unjoy, the subtitle is, Hope and Help for 7 Million Christians with Depression. What are some of the stigmas that your patients who come from a Christian background or come from a faith background face when it comes to a diagnosis of depression or dealing with depression?

Len: There's a variety of things. And I think a lot of it stems from the Christian community that they're in, the church that they're in, their friend and family support network in terms of how accepting people are of mental health. So one comes from your community and whether or not you would feel comfortable sharing something like that.

It's interesting, because no matter how much stigma there might be in your Christian community about mental health, for other medical conditions, it’s no big deal. If you had diabetes, they're not like, where's the sin in your life? You have diabetes. People don't talk that way usually. Or like you have asthma. Where is your undisclosed sin? You have asthma. Nobody talks that way, and so people are fine sharing about a lot of medical conditions

Alison Cook: Yes.

Len: When it comes to stigma with mental health, I think it starts with our community. With stigma, people are afraid to talk about it. And then another, I would say, in some communities, they treat mental health conditions as almost made up, or like a weakness. And that can be another kind of source of people not reaching out for help if that's the message that they're getting.

Alison Cook: Yep.

Len: Sometimes there can be a fear of secular resources or helpers. Sometimes doctors or therapists or other professionals are looked at or treated with suspicion. And then there's this other thing that I would say a lot of people feel, not Christians, but sometimes there's this fear that if you acknowledge that you have depression, it's almost like there's this fear that you're acknowledging that somehow you have some deep flaw.

I don't see depression as different from asthma or diabetes or other really big medical conditions. I really see depression as an illness of the brain that can get better. I think some of the major messages that need to get out there is that depression is real. It's treatable.

Alison Cook: I love that. And you say that pretty strongly in the book, from mild all the way to severe depression, you really believe people can get better. And I really want the listener to hear that because I agree with you. I think one of the reasons, apart from faith, apart from all the stigmas, one of the reasons we are afraid to name it, to really get honest about, oh, this is something I'm struggling with, is because then we're afraid that then we're stuck with it, when in fact naming it might be the next step toward really finding freedom. 

I want to talk about that a little bit, Len. We're going to link to the book–such a helpful practical resource. I want to give the listener a glimpse into the kinds of things that might be helpful. You talk about mild depression. Let's start there. How prevalent is it? And how do you, as you look at someone who you think is experiencing mild depression, how do you look at the different ways of treating it?

Len: So oftentimes people, when they have mild depression, they haven't even reached out to a professional resource at that point. They're trying to sort things out on their own. They might be going through this process of discernment, what is going on, what can I do on my own to start getting things back on track? 

One of the things I mentioned in the book that I think we should talk about today is one of the most powerful natural treatments for depression, and it's called behavioral activation. The research would show it's far more powerful even than antidepressants. Now, obviously, if behavioral activation alone isn't working maybe you should get on an antidepressant. But behavioral activation is this concept that you put yourself on your schedule for the day. It's about filling your day with activities that are in alignment with your values. 

And when we talk about behavioral activation, it's about every 30 minutes to every 60 minutes, do something different. Wake up and do your hygiene and put on clean clothes and leave the house or the apartment and get outside, go for a walk, meet someone for coffee, come back. Not everything's fun. Open your mail. And then, maybe listen to some music and play some music. 

And then maybe do your laundry and then maybe you're going to read next, but even if you're not at work, what activities are you filling your day with that are in alignment with your values? So if that includes reading your Bible, read your Bible! If that includes praying, pray! You can do pleasurable things, just don't have that be your whole day. 

Ice cream and pajamas and binge watching Netflix all day on your couch? Not recommended. I know a lot of people like to treat themselves that way, or oh, I have the day off, so I'm going to spend the whole day in bed–that's actually not good for you, okay? If you get a mental health day from work, if you take a day off from work, you're like, I can't do it. I'm calling off from work. How are you going to spend that day in a meaningful way? 

And that is incredibly powerful. And it's hard! If you're depressed, you don't want to do anything. You don't have energy. You don't have motivation. You're going to have to gut it out, but let me tell you something. If you do that, if you fill your day with activities that are in alignment with your values, one, it might actually help your mood throughout the day.

Two, even if it doesn't help your mood, you will have the sense of satisfaction at the end of the day of, look what I did.

Alison Cook: Okay, so again, this is mild depression because I wanna tease something out here;  this is someone who, for whatever reason, they're still functional, but has this anhedonia, this, I can’t enjoy this. I'm going through the motions of my life and the temptation when you feel that way is to shut down and sink into it. I'm imagining the temptation to stay in bed all day. I don't feel like doing anything. Nothing's bringing me joy. So I'll stop doing everything.

And what I think I'm hearing you say, according to the research, this behavioral activation, it's almost a counter-move; work against that feeling by almost hyper-structuring your day, really making sure every hour you are doing something. You're working against the feeling and you're saying that those actions might begin to change your brain, release the good chemicals, improve the mood. 

At the very least, they can create that sense of satisfaction. It's almost like a sick day where you don't feel well, but instead of a cold, maybe you should go to bed for the day, with depression, it's almost the opposite. It's to keep going mindfully.

And I want to pause here because I could imagine a listener saying, but I did that and I don't feel better. And then they shame themselves or then they're mad. But you're saying very clearly, you're doing this mindfully and intentionally. It may not immediately boost your mood. You're not trying to trick yourself. There's something about keeping those behaviors that is going to activate something helpful and healthy, both in your brain and in your psyche, in your overall sense of satisfaction in yourself.

Len: You're absolutely correct. In fact, doing these activities, even if they don't work for that day, over time do work. Because they light up the non-depressed portions of your brain. And, when you are doing behavioral activation, hopefully you're doing other things that have been proven to help depression like exercise.

Exercise is huge in terms of helping depression and anxiety. And a lot of people say, it doesn't help me. And I'll say, hang on a second. It's very clear that for some people with exercise, there's a portion where they feel better in the middle of exercise. Some don't really see any difference in the middle of exercise, and some feel worse in the middle of exercise.

But at the end of exercise, when it's over, the vast majority of people have a greater sense of wellness. They feel better and they feel less depressed. There is this aspect to not judge yourself and to not give up because the challenge with depression is, it's a big old liar. It tells you that you're worthless when you have worth, it tells you that you should avoid people because maybe you're more irritable and you don't want to be snapping at people, or you feel like people don't like you. 

The other aspects of behavioral activation are connection with others, because isolation and loneliness feed depression. The idea is that your depression, if it's pulling us into all these unhealthy habits, we need to push against those unhealthy habits to get back on track.

Alison Cook: Yeah, and again, this is the science. This is the research. We know that this changes the brain. And again, even when you said, read the Bible, pray, you may not feel magically cured. It's not that suddenly you'll feel like God has cured you. It's that you're doing those things because you value those things. The prescription when you have a mild case of depression is to really keep doing those activities that mean the most to you and that are proven to be good for your mental health.

That's the two aspirin that you need to take in that sense. That's great. Okay. Let's move into, Len, when you start to see more, you call it stubborn or severe depression. What's the difference? How do we differentiate that? How do you know you've got a more stubborn type of depression and how do you like to approach that?

Len: I would start by saying there are different intensities of depression. You could see this on depression rating scales where someone's numbers look like they're in the mild range or the medium range or the severe range. And then when you talk with people, you're saying, ballpark it for me. How bad do you feel like this depression is? Does it feel like a small amount, medium amount or large amount? Those usually line up really well with the numbers. And when they don't, it gives me an opportunity to say, oh, let's explore this and find out what I'm missing here.

If you're dealing with moderate to severe depression, or if you're dealing with suicidal thoughts, you want to be working with a professional. You want to be working with someone who really knows what they're doing, who knows how to help you learn the skills for staying safe. The interesting thing, to digress for a second, the interesting thing about suicidal thoughts that a lot of people don't know, is that you can actually do something helpful about them. 

A lot of people feel like if I'm feeling suicidal, I need to hang on by my fingernails, hang on until that wave passes. And there are actually many strategies that you can use to enhance your safety while you're feeling this, that are unique to you, that you choose to help improve your life.

If you're having thoughts of suicide, working with someone who knows that and knows how to coach you around that and who knows how to help you practice those skills so that you're not feeling at the mercy of suicidal thoughts can really improve your health and safety. So that's another thing I would say. 

For people with severe depression or suicidality, or for people who've had depression that's lasted years, sometimes decades, or they keep having these episodes of depression, I had it for whatever, a few months or a year, got rid of it, and it came back. That can be really challenging to treat. And yet it's still treatable. That is definitely the time when you want to be searching for help, and it might take time to get through someone's waiting list. It might take phone calls. 

You might have to run through a few therapists or psychiatrists before you actually find somebody who clicks and who really gets you, and it's going to be able to get you out of the depression. But medicines can make a big difference. Antidepressants and other medicines that are used to enhance the effect of antidepressants. Psychotherapy is incredibly important for learning skills for not managing mood but helping you to manage your behavior around your depression and staying safe. 

And then there are some interventional treatments that are out there. And sometimes if you think about a medical intervention, it might sound a little scary because it sounds intense. The one that has probably the most stigma is one called electroconvulsive therapy or ECT. That's one that has gotten highly stigmatized, but it's one where the treatment creates a seizure that over time alleviates depression. 

It can have some side effects, but it saves lives. There are other treatments where they don't involve seizures and don't involve a whole day, but might involve an hour or a few hours during the day. One's called transcranial magnetic stimulation, TMS. And I had been providing TMS in my practice for about four and a half years, and it's tremendously helpful. I had trouble keeping it going because of the pandemic, but we're going to be getting it back in Helena this year. 

There's ketamine which is a newer treatment for depression and it helps suicidality. And then there's yet more research coming forward. They're looking at this compound found in nature called psilocybin, which also may help with depression. There's something new out and I want people to not give up. If the standard treatments haven't worked, or if you tried one or two things, it might feel like you tried everything, but if you're working with a professional, who's really skilled in what they do, they'll be able to help you see, I think you haven't tried everything, or I think there's something different that we can try to help you.

Alison Cook: And Len, do you go through the nuances of some of these different interventions in the book in Unjoy? Good. So folks are interested in learning more. You've got years of experience with this. You've treated, I would imagine, thousands of people, and I love what you're saying. There's new advances every single day. 

I do think one of the things I think that's hard is if you are experiencing depression and you don't have a professional, it can be hard to have the gumption to really, like you said, go through and meet with different therapists and find someone and even work with your health insurance to figure it out. Maybe that's where you could ask a friend to help or ask a family member to help you. 

If you're struggling to find the person to walk with, that's something you could ask for help from a church community or from a neighbor, or from a friend. And again, without that stigma, if we went to our neighbor and said, I'm dealing with diabetes, could you help me find a doctor? Most people would say, sure. So to remind yourself to normalize, I'm dealing with depression. Would you be willing to help me for the next few weeks to do the work? Because I'm struggling to find the gumption to get to that person who can be with me regularly through this.

Len: Absolutely. Absolutely. And I think for the listeners that you have on today, if they don't have depression, they probably know somebody who does. They could consider whether they could be that encourager and that helper.

Alison Cook: Yeah.

Len: One of the chapters is on, how do you help a friend or a family member who has depression? I love this quote–one of my colleagues, a fellow doctor, had this quote that when she was trying to distill what it is that we really do, she said, we are the keepers of hope for those who have lost theirs. 

If you have depression, you need somebody who has your back and who will support you. And if you don't have depression, you might know somebody who does, and you can be the keeper of hope for them until they get theirs back.

Alison Cook: I love that. That's beautiful. That's beautiful. Thank you so much for taking the time to walk us through some of this today. And again having the conversation, normalizing it, naming it we'll link to a lot of the resources that we discussed in the show notes for folks. I want to ask you, Len, as we close, two questions I like to ask my guests. Number one, what would you, the Len who you are now, say to that young college student getting ready to make this shift in your major to become a doctor? What words of wisdom or words of encouragement would you say to that younger you from what you know now?

Len: That's a good question. I think I would encourage myself to take the risk. I'm glad I took a leap of faith. I think the other thing is to, I think everybody deals with feelings of insecurity. I say, you're good enough.

Alison Cook: That's beautiful. And what's bringing out the best of you right now, Len? 

Len: I was thinking about this last night because I got that question from you and I want to be careful because I feel like these are things I aspire to and I'm trying to get good at, but it's not necessarily like I'm awesome. Okay. One of the things is I'm trying to make an active effort not to throw my life out of balance.

What I'll do is, I'll get to projects and then everything else goes out of balance in my life. So I've been trying to live my life more in balance. And I would say that was one of the biggest things and one of the little habits that I've developed is, after I do morning devotions, I've been walking every morning before work. And I do other things like, my wife Krista and I, we do some yoga exercises together every morning, and that helps us to connect as a couple, doing an activity together every morning. 

But after I do my morning devotions, I go for a walk. And as I walk, I listen to audiobooks. Because it's an easy way to read if you can hear it. And it's been lighting up my mind every morning with new ideas. And I would say it's been so awesome because there's books that I can listen to as an audiobook that I'd have a very hard time even opening the cover–some non-fiction thing on some topic that looks dry and I can hear it and I can still hear the ideas and it really is a wonderful way to light up my brain every morning after devotions.

Alison Cook: I love that. I love how you say that it lights up your brain. Because even for those of us facing the normal challenges of life, those practices do literally, I know for me, if I've had a really hard day or I'm irritable or frustrated, I can feel music changing my brain. It puts me in a different part of my brain.

And I hear that in what you're saying with that morning walk. That's beautiful. Thank you so much. What's the best way for people to connect with you and to find your work, especially your book, Unjoy?

Len: The book is available on Amazon and you can order it through like your local Christian bookstore as well. Most places where they sell books, you can access it. I have written on a lot of other topics related to depression, anxiety. I've written a lot on parenting actually, and that's at my website, psychiatryresource.com

And people can find my work there. People can actually message me there, but it's partly why I'm not on social media. I can't really offer medical advice to people if they're not actually patients, but I do respond to emails from people who contact me. 

Alison Cook: I'll be sure to link to all that in the show notes and I really appreciate your time.

Len: This has been such a pleasure. I'm so thankful that you invited me here and it's so nice to reconnect again. This has been such a treat for me today.

Alison Cook: There's a lot of synergy between what we're doing, through this work of faith based mental health. Thank you, Len. I really appreciate your time.

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