Knowing the Signs of Depression

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In the world of mental health, depression seems to be one of the most prevalent struggles that people face today. But how do we know when depression is actually present? Is it something everyone is susceptible to or just certain people? And if you do see the signs, how can you seek help? New Vista's Regional Director of Emergency Services, Darcy Miller, sits down with us to answer these questions and more.


Kevin Wallace 0:11 Hello, and welcome to the Good Ahead Podcast, where we host conversations in the areas of mental health, substance use and intellectual and developmental disabilities. I'm your host, Kevin Wallace with New Vista. In today's episode, I invited Darcy Miller, the Regional Director of Emergency Services at New Vista to talk about knowing the signs of depression. You'll hear us explore the different complexities of what depression is and what you can do if you're experiencing symptoms. I think these kinds of conversations are so good to be having in order to help break the stigma that comes with dealing with depression, which is also something that we touch on. So we're happy to have you tuning in and hope you enjoy. Well, welcome in to this first conversation that we're having for The Good Ahead Podcast. And today we have with us Darcy Miller, the Director of Emergency Services at New Vista. So welcome in Darcy.

Darcy Miller 1:15 Hi, thank you for having me.

Kevin Wallace 1:17 Let's get started by just tell us what you do here in New Vista, in being the Director of Emergency Services.

Darcy Miller 1:23 Well, I'm a Licensed Clinical Professional Counselor, and I supervise several programs that focus on helping people that are having a behavioral health crisis, whether it's assessment, whether it's our crisis line phone calls, scheduling to get someone in either long term or quickly, going out to the community and doing an assessment with law enforcement, for people that are struggling with suicide, having some type of mental health, psychosis, you know, something that would lead to a crisis level situation for behavioral health.

Kevin Wallace 2:00 Cool. Well, today, we're going to be talking about knowing the signs of depression. And so I guess we can't really talk about it without knowing what it is first. So let's Can you shed some light on what depression is? Maybe who's susceptible to it? Your experience in that area of expertise of your expertise? So yeah, what is the definition of depression.

Darcy Miller 2:25 So just a general definition of depression is that kind of constant feeling of sadness, right? feeling lethargic, loss of interest, you don't want to do your normal activities. But it also may look a little bit different, you may feel more irritable, angry, and you just don't want to do the things that you normally do. Um, it may affect your cognitive function, like how you think you may have a hard time, problem solving, thinking clearly things like that. So it's just that kind of it ranges from kind of mild to severe, so mild, maybe you're feeling kind of the blues, just kind of Yuck, right? But you're still able to go to work, or you're still able to do, you know, fixing dinner or things like that. And then you have more severe depression, or somewhere on the continuum where you just kind of sit, you don't feel like doing anything, you may be able to go to work, but you're not functioning the way you used to. Or you start calling in sick. You have a hard time getting out of bed, or you've functioned some but you come home at the end of the day, and you really don't do anything like you have a hard time fixing dinner, you don't spend time with your kids or your significant other things like that. So there's a whole range of what that looks like.

Kevin Wallace 3:47 Yeah. So there's varying differences of what depression could be. That's interesting. Like, is it hard for you to maybe know how to diagnose someone with depression? Because some someone could be very clearly having depression, right? But maybe some someone's showing very little signs of depression. Is it hard to say maybe somebody who's experiencing very little depression to be like, Okay, that's still depression. And let's diagnose you with that.

Darcy Miller 4:19 It can be because we do rely on self report. So what you bring to the table, like what you bring to the session,

Kevin Wallace 4:26 So you're relying on the clients word of this is your experience, clearly what's going on

Unknown Speaker 4:30 But we do have some really good screeners that have been developed and the PHQ9, the Beck Depression Inventory, and those are kind of short, simple to the point. And there have been times where, like, I haven't put I think it's an adjustment issue, like it's a life experience that they've had. But they come in and maybe things aren't getting better. Or it seems to be getting worse. And I'm like, Hey, let's kind of figure out what's going on here. Why don't you take the screener and that can give some really good indicators because sometimes people don't know what to tell you. Or they don't have the words to tell you. Right? And if you're feeling sad, and it's affecting how you think it's really hard to put words on that sometimes,

Kevin Wallace 5:12 Definitely, and who, who is actually susceptible to depression? Is there an age is there, maybe we talked to talking about gender differences. All that is a whole nother conversation maybe. But again, just who can be susceptible to depression?

Darcy Miller 5:32 Well, I think anyone can be susceptible to depression. And I heard a psychiatric nurse talk once that with with any of the right circumstances, someone can walk in our door, because they need treatment for something depression, anxiety, PTSD, whatever, whatever it is, so anyone can be susceptible there, there are some things to look out for. Like if you start looking at percentages, the highest percentage age group that are diagnosed with depression are actually 18 to 29 years of age, it's 21%. And again, that ranges from mild to moderate to severe 40 of the ages 45 to 64 is the next group, and that's at 18.4%. But they tend to have more severe depression, which is interesting. If they get diagnosed with major depressive disorder, and then ages 65 and older is also 18.4%. And those are different issues, depending on where you are in your stage of life.

Kevin Wallace 6:34 Why do you think that is then? That was 18 to 29? Why do you think that is the area where the highest percentages for depression?

Darcy Miller 6:45 Well, if you look at the stages, and this is just kind of looking at it, a lot of these are life changes, right? You have a lot going on between 18 and 29. Yeah, graduating high school, learning to adult Yeah, learning to adult, right and a lot of transition. That's usually when people marry their significant other and get in a more serious relationship, when you look at kind of your mid to late 20s. Maybe start having children, and then things seem to settle down in your 30s. And maybe you feel more confident financially, you feel more confident in your relationships, there's less change. But when you look at ages 45 to 64, and empty nest and you know, potential retirement and financial issues, there could be job loss, it's really scary. If there's, if you're 45-50 years old, and there's a job loss, how do you get back in? Like, how do you get another job in that workforce? That's a hard age group sometimes. And then with 65 and older, you see a lot of loss of maybe some their partner has passed away, or their children have moved away. And there's some loneliness that is there. So some are, that can be a diagnosis, like a medical diagnosis that can cause some depression, things like that.

Kevin Wallace 7:57 Yeah. So how does this even develop in a person? You talked about some factors. But yeah, I'm interested to hear what those factors are most most common factors that you see of somebody who has developed depression, what are the things that create that depression in their lives?

Unknown Speaker 8:16 Well, the four categories that I would look at is one is genetics. There, there are people that have a disposition, a genetic predisposition to depression, with your chemistry and your makeup and things like that. There's some research that shows that if you have a parent or a sibling that has been diagnosed with depression, you are three times more likely to yourself have depression. So that genetic link is something to look at and to pay attention to. Especially if you have another mental health diagnosis, like bipolar disorder, schizophrenia, generalized anxiety disorder, things like that. Another category to look at is substance abuse. If you struggle with alcoholism, or any type of drug addiction, did it start? It's kind of what came first the chicken or the egg, right? Did you struggle with some type of mental health issue or depression? And you're kind of self medicating with alcohol? Or did did your body have a reaction to that drug or alcohol and you become addicted and then things have happened because of that addiction and that disease and things, choices that you've made in your life that you weren't very happy with, or relationships that have been hurt. And so depression develops from that. So there's a high correlation between those two. The other is early childhood experiences, you know, were you raised in a home where there was abuse or domestic violence with trauma, always experiencing constant criticism. If you look at ACE's, adverse childhood experiences, and the more that you experience different, the more negative childhood experiences that you have, the more likely you are to have mental health issues as an adult. And then there's also just plain old major life events; breakups, divorces, death, job losses, business failure Like, you know, we were talking

Kevin Wallace 10:01 Things that you can't really even prepare yourself for, but just happen as a result of living life.

Darcy Miller 10:05 Right. Or if you have multiple at one time, you've had someone that you love pass away, and then you got laid off from your job. Yeah, they both happen at the same time. Yes. So all those things are things to pay attention to that can help lead to depression. Yeah.

Kevin Wallace 10:23 And are there differences between men and women when it comes to depression?

Unknown Speaker 10:28 So women are two times as likely to be diagnosed with depression. And I want to clarify, they're more likely to be diagnosed. That, there's some debate of whether they really have depression more than men. Because depression in men look a little bit different than it does in women. And I don't, typically, just because I say men have these types of symptoms doesn't mean that women can't rally them. But women are more likely to be sad, allow themselves to cry, feel lethargic, things like that. Men are more likely to be irritable and cranky and angry. So they both may have sleep issues, they both may have appetite changes, and the sleeping could be they sleep too much, or they don't sleep enough, or they're eating too much, or they're not eating enough. They may have cognitive issues where they feel like they can't think clearly you're problem solving or whatever. But a woman may be more likely to cry about it, and a man may be more likely to be mad and irritable and getting fight about it. So that kind of stuff sometimes gets missed in men, because people when they think of depression, they think of pulling the covers up over your head and not talking to anybody

Kevin Wallace 11:36 Totally. So you can't really necessarily put this in a box of like, if you're a man, and you're experiencing this, this and this, then you have depression. But there are some, like you said, there are some indicators of and differences between men and women. Yeah, yeah, that's interesting. And so, what do you what can you do if you think you do have depression? How do you seek help for this? And yeah, what are the steps that you can take? If you're hearing this, and you say, Okay, well, I, you know, I've experienced that in my life, maybe a little bit more consistently. And I would like to hear more about, you know, steps that you can take to seek treatment.

Darcy Miller 12:19 So if you're looking at kind of mild to moderate depression, and usually, those are some of the, when I talked earlier about functioning depression, right, you're feeling kind of sad, but you're still able to go to work, but you still feel that feelings of hopelessness or some sadness or just unmotivated can't think real clearly. If that starts lasting more than two weeks, and you may want to seek some professional help, you may want to call for a counselor. Sometimes people go to their primary care and talk about medication. But I will tell ya, medication and counseling tend to go hand in hand that is the most effective. There's also some just kind of basic self care type stuff that you can do if you're not ready to make that jump. And that is, look at your eating, look at exercise. Are you isolating yourself, like if you are doing that, because that can kind of happen with depression, then maybe it's time to call a friend, I know, it's a little bit more difficult with the pandemic right now. And things are beginning to open up. But talking on the phone, getting on a zoom or FaceTime, can make the world of difference. You know, if you're in the gaming community, talk to a buddy in the gaming community, things like that. Write a letter. Start reaching out to people. But if it becomes more serious, it always is helpful to look at counseling and look at therapy and call the call or crisis line. Get yourself connected with somebody.

Kevin Wallace 13:47 Yeah. You mentioned the pandemic a little bit too. How do you think that pandemic has, has really affected people? And maybe is the been an increase of depression that you've seen? And even how like we can talk about telehealth to the role that that plays in treatment for depression. What are the things that you've seen? Just coming, hopefully coming out of this the end of this pandemic soon? What were the things that you've seen that? Yeah, that the pandemic has affected the people's lives in the realm of depression?

Darcy Miller 14:23 So the interesting thing, and some of this will be anecdotal, because you know, the statistics come out about a year or two later Yeah, right. But kind of what we're seeing is in the crisis-world of mental health is that the call volume hasn't changed as much. It's changed a little bit more recently about people reaching out talking about depression and anxiety and things like that. But those that were struggling with depression, it seemed to make it much worse. So it's called high acuity level like they were they were a little bit sicker. They were a little bit more depressed than they normally would have been. And kind of managing that and I think there's also been this is kind of global The Blues, like we've all kind of experienced it, like I've seen it in my own family, I've seen it in my friends. This kind of when you see someone in person, like there was a time when you saw someone in person, it was almost kind of exciting that because that was outside of your family. Because you've missed that interaction we are not. We as a people in general are not made to be hermits. That's why there's only a few. And some people more need more interaction than others. But everybody needs some level of interaction. So that has been difficult isolation can lead to depression. So being more purposeful, that and that and connecting with that. So I think that has been different and learning how to do that in a new way with the pandemic. And those who live alone would, how do you manage that? Right? So being purposeful of I've seen people kind of create a small community that they like you would in your own family, like, you know, we're going to be careful, we're going to monitor where we go and what we do and and reduce the risk. But we're each other's support system and reaching out that way.

Kevin Wallace 16:12 Yeah. And thank goodness for technology too, right. So, like we, you just don't know how vital technology is like FaceTime, Zoom calls, all this stuff that just just how important that has been until you experience something like a pandemic.

Darcy Miller 16:31 And I think about so my son got really interested in the history of pandemics, right. Yeah, I was reading about the last one that started in 1918. And I think kind of finished around 1921 22. And they talked a lot about isolation. Yeah, because they didn't have this type of technology, right? They couldn't connect. So they really were kind of with their families by themselves. There was a essay that was done a woman wrote kind of, to her daughter, she had had a newborn during this time. And she kind of documented her time and said, how it was just it was just you and me baby girl for a year. Yeah. So you know, she didn't have phones that she could go to and play and she had to keep her daughter safe. Yeah, this new infant. Yeah, I wanted to make sure that she survived and thrived. And now her daughter has these letters or this this diary of sorts his journals or it's the documents her mother's time during this. So but that's a coping skill, right? Yeah. So we don't have zoom, but we sure can write things down. And she was forward thinking like, I want to remember this time, I want her to know if this time

Kevin Wallace 17:49 This break in the conversation is a reminder that The Good Ahead Podcast is brought to you by New Vista. Now, New Vista is a community mental health center caring for Central Kentucky communities in the areas of mental health, substance use, and intellectual and developmental disabilities. If you want to know more about New Vista's services, call our 24-Hour Helpline at 1.800.928.8000, or visit our website at Let's get back to the conversation with Darcy Miller. Okay, with your experience in telehealth, let's talk about that a little bit. Sure. What does that been like? Have people been really like receptive? Was there kind of a trial period of how know about this? What's your experience been like?

Darcy Miller 18:37 Their, So it was mixed. There was definitely people that were like, yes, this makes my life so much easier. There are people are like, No, I want to see you in person. This is really difficult. And in the beginning, it's like, well, I'll just wait a few months when you go back in person. That didn't happen. Right. You know, we're still the our Governor and just kind of CDC guidelines are if you can do it telehealth, we want you to continue to do it until Yeah, things have eased up a little bit. So it got more normal. And it I think it has actually been really, really helpful. And we had the wonderful opportunity where they eased up the restrictions that if someone didn't have a screen, laptop, a cell phone or a tablet, whatever to zoom in on, you can also talk to people on the telephone and and be able to get reimbursed for that which has not historically we have not been able to do so I've been really limited. That being you know, something is better than nothing. So talking to people or getting people through that. So having that combination has really made a difference. And a lot of the research shows that I think people think it's a lower standard of care. The research shows that that's not true. Yeah. That the standard of care at the end of the day, people are usually Even though you may want to be face to face, you're still getting good care via telehealth, you're still getting the things that you need. So that was that has been really interesting and the transition that has happened, and the flexibility, I think going forward, we will probably definitely have a hybrid model. Because for some people that works really, really well. It opens up the floodgates of people who work and maybe they need to go on their lunch break, or maybe their lunch break is at 10am. But they can't travel to the office and then travel back to work.

Kevin Wallace 20:32 Yeah, I would say probably travel time is one of the biggest factors of people either canceling or, you know, being skeptical about doing something like seeking help is because it you know, it takes time to get to an appointment and come back and you got to, you know, block extra amount of time on your schedule to do something.

Darcy Miller 20:51 Yeah. And how do you ask for that from your employer? Right? Yeah, work around like with your kids and things like that? Well, telehealth makes that a little bit easier. So if you have that as an option, that's really wonderful. So it, I think people thought it was going to be a lower standard, but it has just not been and I think it's actually really broadened how we provide services, which is just helpful to everybody. Yeah.

Kevin Wallace 21:15 So post pandemic, II think this is something that's going to be here to stay Yes. Because you mentioned hybrid, like, I can see how that would be such an asset moving forward in the area of mental health of just you're getting to have more options to treat people and more options is always great, because then that broadens the horizon of people that are able to come in and seek treatment.

Unknown Speaker 21:43 Well, even as simple as you're stuck in a traffic jam. Yeah. And there's a car accident. And you didn't expect that you call your therapist and say, hey, I can pull over. I was coming to you anyway. Can I pull over? And can we telehealth and instead, I've got my phone. Clock it on your? Yeah. And your car dash and telehealth in Yeah. So who knows.

Kevin Wallace 22:06 Wow. Well, that's great. One of the last questions I have about this, at least in my upbringing, or not upbringing, but growing up. It seems like there's been a stigma for reaching out and getting help in something that is kind of hard to admit about, like, it's not an easy thing to come forward and say, Hey, I'm depressed, right? Or I might be depressed or I'm feeling this way. So why is there a stigma around this? And, you know, how can you break through the stigma of seeking help in like, why is it so important to do that?

Darcy Miller 22:46 Well, first of all, I think it's been viewed as a character flaw, instead of disease or an illness

Kevin Wallace 22:52 Yeah like this is something that is fundamentally wrong with you

Darcy Miller 22:55 Right, there's, There's something morally wrong with you. And we are Kentucky, so maybe you haven't prayed enough, or you've done something wrong in your life, or you haven't done the things that you need to do. There can be cultural issues of but it's still that it's still all surrounds that kind of character. It's a character flaw. It's a moral failing, rather than it's chemicals in your brain that are not working. Yeah, that it's a traumatic life event that most people if you were to hear that, you'd be like, well, dadgum it I'd be depressed too. So getting away from it being a character flaw and looking at it is this really is a chemi- even if it's a life event, it still changes the chemistry in your brain. Yeah, that triggers that depression that lack of serotonin and are when you know, whatever happens. So looking at it is this is a mental health issue that is very common, that a lot of people experience and viewing it like how we view medical treatment, right? Like, is it a character issue if you break your leg? No, you just broke your leg. Even if you were doing something silly. Yeah, right. Or even if you broke your leg, like how many people broken their leg because they tripped over something in their house, right. They not because they were skydiving.

Kevin Wallace 24:08 Just because I'm clumsy.

Darcy Miller 24:09 Right. Just because you're clumsy. Well, that's not a character, right, or a moral failing. It's that just happens sometimes. And you go to the doctor and you get it treated and depression is the same way. Things happen. Life happens. There are chemical imbalances in our brain. We don't think it's a character failing if someone has diabetes. Yeah, right are epilepsy. And those are kind of long term illnesses that people get treatment for. And especially if you look at diabetes, not only do you usually do behavioral change, but you get medication too, right? Insulin, what have you. I think the same thing can happen with depression, depending on how severe it is. So viewing that a little bit differently, I think you asked a second part of the question, I don't remember what it was.

Kevin Wallace 24:54 Well, what what would you tell somebody if there's that stigma? Yeah, there

Unknown Speaker 24:59 That it's not a moral failing, many people experienced this. And just cuz they don't tell you that they're not experiencing, it doesn't mean that it doesn't happen, right? It's, it's very common. Most people have some feelings of even if it's not major depression, right, but some level of depression at some point in their life, whether it's after you know that you've heard of postpartum depression right after childbirth. Yeah, and things like that, or divorce or any kind of life changes. So it's just trying to figure out, has it interfered with your everyday life? Is it keeping you from doing the things that you would normally do on a long term? Like not just, yes, I've had a hard time, but I'm still functioning. I'm still laughing, I'm still having that support system, or is all that gone? And if all that is beginning to go, that's when it's like, all right. Just like, you know, if you twisted your ankle, and you're still having a hard time walking on it, now it's time to get the doctor. Yeah. Now it's time to maybe go see a counselor and figure out what's going on. And it doesn't necessarily mean that this is the label for the rest of your life. Yeah, this is just what's going on right now.

Kevin Wallace 26:06 Yeah, yeah, this isn't who you are. It's just maybe something that you're experiencing. And you can you can learn how to have this in your life and still move past it. Learn to deal with this. And let this not be a part of who not who you are

Darcy Miller 26:22 It doesn't define. Yeah, it doesn't just like having diabetes shouldn't define you is, you know,

Kevin Wallace 26:28 At the core of who you are, that is not not depressed. You're not a depressed person. Right?

Darcy Miller 26:32 Yeah. It's just something that you have that you need to treat.

Kevin Wallace 26:35 Yeah. Well, okay, so now going, I guess back to New Vista, how, what are some ways that New Vista like your role, the organization as a whole, have you, you've seen New Vista you know, help people with depression, and journey through that with them?

Unknown Speaker 26:53 So one, you can always schedule appointment through our 1.800 number, or 1.800 line, our customer service line 1.800.928.8000. So you can always schedule an appointment. It also operates as a crisis line, we are lifeline certified the National Suicide Prevention Lifeline. So say your depression gets more severe, you're having suicidal thoughts, it's moving you into some type of crisis, or you're struggling with substance use, and maybe you've been clean for a long time, but you're risking falling off the wagon, or you're like, oh, my gosh, I'm having problems with addiction, or we don't we're talking about depression here. But it could be anything anxiety, it could be relationship issues, it could be job loss, it could be any type of you know, your concern, they have bipolar disorders, anything. You're where your child has ADHD, or anxiety or what have you, you can call for an appointment. And if it moves to the next level, where you feel like hey, I'm really worried that I'm at risk, like I'm having those suicidal thoughts I'm having I don't, I can't see my future. I'm feeling kind of hopeless, or I'm feeling stuck. Or I've heard people talk about feeling like there's darkness surrounding them or feeling like there's a weight on their shoulders, just pushing them down. Yeah, I had one young woman, I was a teenager, actually, we talked about, she felt like she was walking on the bottom of the ocean. And she could see the light at the top. But it's like she couldn't get there. Right. So we're, it's 24/7, we have a crisis line 24/7 that you can talk to someone that you can schedule an appointment, we do emergency appointments, if needed. So I think the first step is to reach out and then once you reach out to us, we'll kind of figure out what you need, and how quickly you need it.

Kevin Wallace 28:38 I think one of the main questions, too, that people might have or maybe even hesitations is how do you financially pay for something like this? You know, there's insurance, health insurance cover it? What if you don't have health insurance, you know, all these things that could play into this

Unknown Speaker 28:56 Health insurance definitely covers it. Yeah. And whether it's like a private health insurance through your employer, or with the exchanges, or if you have an MCO Medicaid program, we cover all of that. We also have a sliding scale fee. That's the nice thing about being a community mental health center is that we are kind of the safety net for people who don't have insurance or their insurance has lapsed, or especially during this time, so many people have lost their jobs, or kind of that gig economy where they put some things together and they were able to pay for their own insurance, but they don't have that money coming in. So we do have a sliding scale fee and that is already set up. And we also have referred people to especially if you've lost your job or you're unemployed for some reason you call in and you don't have insurance. We recommend and we connect, we try to connect them with like a Medicaid navigator to see if they qualify. And if they don't, it doesn't matter. We'll still use the sliding scale fee. But if you're struggling financially, that may be a good connection. And you may think that qualify, but you might you never know. But maybe people are afraid to reach out or they're used to not qualifying in the past, but they do now because of life circumstances. And just kind of it helps get you through it helps with the finances. But don't be afraid to call because of pay, or we'll help you figure it out.

Kevin Wallace 30:18 Yeah, that's great. Well, as a final note, I think it'd be fitting to end on just a word of encouragement for somebody who may be listening and experiencing depression. And maybe they've already seeked help and treatment, or maybe they're on the fence about it. What, what are some things that you'd say to encourage that person in that state?

Darcy Miller 30:39 So my motto in emergency services is kind of using that crisis of the worst day of your life as an opportunity, and it not just being the worst day of your life, but our opportunity for change, for to going to the next step and getting the help and really starting to journey for something positive and wonderful. So not staying in. You know, for lack of a better term, like not staying in the darkness, right in the isolation and the loneliness. But taking that step and being it's so hard sometimes to be brave, because, again, we look at it as a character flaw, but it's not a character flaw. It's not a moral failing. It's taking that next step and saying, Hey, this is what I need to do for myself, not only to help myself, but my family and my loved ones and get me where I need to be on the path of healthiness.

Kevin Wallace 31:30 Wow, that's so good. And yeah New Vista, we're here to help you to however, we do we see the good ahead. Well, Darcy, thank you so much for coming in and talking with us about depression and everything that might come with that. I know I learned a lot about it. And hope this was helpful and insightful to our viewers or listeners.

Darcy Miller 31:51 I hope so too.

Kevin Wallace 31:52 Alright well, thank you very much. Well, thank you for joining us in today's episode, just a reminder that this podcast is brought to you by New Vista. We assist individuals, children and families in the enhancement of their well being through mental health, substance use, and Intellectual and Developmental Disability Services. We see the good ahead for all individuals in our communities. Again, if you need help, call our 24-Hour Helpline at 1.800.928.8000 or visit our website We hope you enjoyed today's episode, and we'll see you next time.