AUGUSTA, Ga. (WJBF) – The Means Report’s Mental health matters because you matter series continues with the return of Dr. Vaughn McCall, the Chair of the Department of Psychiatry and Behavioral Health at the Medical college of Georgia at Augusta University. He gives us a closer look at what depression is and how to see the warning signs of suicidal ideation.

Brad Means: Dr. McCall, thanks for coming back. You did a great job with us last week and I appreciate you returning

Dr. Vaughn McCall My pleasure, Brad. Thank you.

Brad Means: All right. So let’s focus on a couple of things you talked about last week when we look to specific types of mental health issues. Depression is one, and so I guess we’ll start with that. What are some warning signs of depression?

Dr. Vaughn McCall So both from the patient’s perspective and also that of those that live with them, some of the more obvious things would be long periods of otherwise unexplained tearfulness, loss of appetite, maybe leading to significant loss of weight, persistent sleeplessness, and a general negative attitude about the future. Those are some key features.

Brad Means: All right. So let’s focus on sleeplessness. That impacts a lot of people. That’s not necessarily depression ’cause you have a bad night sleep. It’s that if it lasted a long time?

Dr. Vaughn McCall So as it turns out, probably 10% of adult Americans have almost nightly sleep problems. And about half of adult Americans have occasional sleep problems. The occasional sleep problems clearly are a nuisance but don’t raise the same level of concern as nearly nightly sleep problems. And one of the more interesting and tragic facts of medical epidemiology as far as sleep goes is that if you live with nightly insomnia for a full year, without it getting addressed, your chances of developing a major psychiatric disorder maybe is 30 fold increase.

Brad Means: My word.

Dr. Vaughn McCall Huge risk. So we take sleeplessness very seriously.

Brad Means: What about the crying part? Some people cry all the time at commercials, TV shows, you’re not talking about that.

Dr. Vaughn McCall No, this would be crying that doesn’t seem to be related to any obvious precipitant in the environment.

Brad Means: Oh, Okay. Can you have short term depression? Can you have periods where you may say, oh, I have a lot of those signs that Dr. McCall just mentioned, I’ll try to wait them out and then they go away.

Dr. Vaughn McCall You can. And we have a cluster of diagnoses and mental health called the adjustment disorders. And the adjustment disorders are exactly what they sound like. So do you have a, potentially a setback? Maybe it could be a major setback like a job loss or a loss of a life partner, loss of a pet. And there’s an expected emotional reaction to that. And if that lasts for a number of weeks and then resolves over a few weeks or a month, then we would typically say that was a clearly understandable reaction to an otherwise unfortunate but relatively common life event. But for the may major depressive illnesses, these run on typically for months at a time, and you can wait them out. But the misery that’s associated with having that depression is so bad most people don’t really wanna wait it out.

Brad Means: They don’t wanna it, they wanna go get help. And I hope that they do. Can your diet cause you to be depressed? What you put in your body.

Dr. Vaughn McCall Possibly. There are a handful of vitamins and nutrients that we think are critical for all aspects of mental health, not just related to mood and…

Brad Means: What can you eat or drink that makes you better, that makes you good? Like do blueberries make you happy? I’m not trying to… You hear so many, that’s a super food, right?

Dr. Vaughn McCall Sure.

Brad Means: What can you put in your body that might make you more prone to better mental health?

Dr. Vaughn McCall So I think folate is a basic vitamin that seems to be good for a lot of things, including mental health. We think vitamin D is critical. And I think a large proportion of adults, including myself, who don’t spend enough time outside or vitamin D deficient, have to take a vitamin D pill. If you are vegan and severely restrict your intake of meats, you might be low on vitamins like B12.

Brad Means: Iron.

Dr. Vaughn McCall Iron, all of these things. So if your diet is very restricted in one direction, there’s a possibility that a nutritional deficiency could be contributing to your problem.

Brad Means: Is it hereditary? Should we always check our family history when it comes to that?

Dr. Vaughn McCall I think it’s always important to know your family history whether it’s your family surgical history, medical history or psychiatric history. It’s interesting that in my experience, perhaps because of stigma, families aren’t always ready to tell to the next generation about, let me tell you what happened to me and to my father. So I’ve had patients, that a patient would come in with their parent. And while they’re sitting there, I’d ask the patient, is there any history of mental illness in your family? And the patient would then look at their parent and say, well, and suddenly, and right in front of me, it comes out for the first time that the patient had never knew that there for example had been a suicide in the family. So families differ and their willingness to be open about family mental health problems.

Brad Means: Well, you may have through my next question which has to do with stigma. We’ve done so much. You and I have had so many talks to try to shatter the stigma associated with mental illness when it comes to things like depression, suicidal thoughts which we’ll talk about in a moment, is there still that societal reluctance to even talk about it? Are we making any headway?

Dr. Vaughn McCall I think we’re making a little headway with selected categories of problems. So for example, my impression is that depressive illness people are somewhat more willing to talk about that. Attention deficit disorder, which is a condition I would say psychiatry and psychology share with neurology and primary care so we don’t own that one entirely. But ADD and depressive illness, some anxiety problems, I think people are less likely to feel stigma about. But there are others, bipolar disorder comes to mind where people might be understandably reluctant to be completely open about it, for fear of the consequences it may have in the workplace. You wanna make sure that your boss has total confidence in you. And I understand why people would be a little bit reluctant to share that, say in the workplace.

Brad Means: Let’s look at suicidal tendencies or thoughts. And let’s start with the person who may be having them. How does that individual determine whether they’re just having a brief battle with the blues or if they really should believe what their brain is telling them they might hurt themselves?

Dr. Vaughn McCall Suicidal ideation follows a fairly clear sequence of intensity. And at the very beginning, we’ll see patients who’ll say things like, if I don’t wake up tomorrow it’s perfectly fine. They really have no intention of harming themselves, but they’re disgusted with their position in life. And if they died in their sleep, that’s basically they’re saying that would be okay. Now that’s a tragedy. But I don’t think that’s necessarily imminent suicide risk. We would call it for example, a passive suicidal thought. If I die in my sleep, that’s okay. I’m not gonna do anything. The next step would be someone that’s thinking, I might could kill myself, but I don’t have a thought about how that would happen. That’s more concerning but we’re still not quite at what I’ll consider an emergency stage yet. When you cross the emergency line, would be if a person had a clear method and a plan for how they’re gonna carry out that method and the intention to do it. So method, intention and planning, that’s almost always an emergency. And that person needs to be taken to see a caregiver immediately.

Brad Means: Is there anything we should not do in that situation? I wanted to ask you what we should do. Grab them, drag them to the doctor. Anything we should be careful with and not say or do to a person we think is having those thoughts or tendencies.

Dr. Vaughn McCall I would say almost the opposite. That is what we should definitely not do is be afraid to talk about it.

Brad Means: Okay. Don’t be.

Dr. Vaughn McCall Don’t be afraid to talk about suicide with your loved ones if you’re concerned. And there’s been some nice research showing that you are not gonna put that idea in someone’s head. There was a concern at one point that if someone were depressed but not suicidal, and you began to talk to them about, are you suicidal? You’re now actually creating a problem.

Brad Means: That’s what I thought.

Dr. Vaughn McCall You might think so, I understand. But the research shows it’s not true. That we’re not implanting that idea in the head of someone that didn’t have it. So there really is no… There’s no risk to the patient or to your loved one by asking the question.

Brad Means: And is there an age where it’s too young? Now that you’ve told me that I’m likely not gonna plant thoughts, how young a person can I go up to and say, okay, let’s check on you.

Dr. Vaughn McCall So the risk of suicide in children is small but it’s not zero. And you occasionally hear of a child five or six years old that commits suicide. It’s unbelievable to even think about that, but occasionally can happen. Partially we, and I’m not a child psychiatrist, I’m slightly out of my depth, but your children, as you would imagine, don’t have a terrific understanding about what of death is, the permanence of it and so forth. And so you almost have to speak in a different language to a child that you think might be suicidal because their concept of death is very different from an adult’s. Thankfully, suicide in little bitty kids is very unusual. But the real risk is gonna up in the teenage years.

Brad Means: I have 30 seconds left. Can you take a patient who has suicidal thoughts and turn them around and put them in a brighter, happier place?

Dr. Vaughn McCall You can. And typically the time course to do that might be as little as three or four days if you’re lucky.

Brad Means: Wow. That’s it?

Dr. Vaughn McCall Yeah.

Brad Means: Dr. McCall, thanks for the insight as always. And thanks for being on back to back Means Reports.

Dr. Vaughn McCall My pleasure Brad, love being here.

Brad Means: Me too. Very informative, always with Dr. Vaughn McCall.