EPISODE 15: Depression and Anxiety

ALYSIA: Welcome back to Autoimmune Adventures. Today we're going to be talking about depression and anxiety. Studies have shown that over half of people with autoimmune disease also experience mental health conditions, particularly depression and anxiety. There's a strong correlation, and we would be remiss not to talk about it.

It is a complex relationship between physical and mental health, and poor physical health can impact our mental well-being and the reverse is true as well. So in essence, physical and mental health are not separate entities, but rather interconnected pieces of a person's overall well-being. It's important to address both aspects of health in order to live our best life.

So before we jump in and talk about how to do that, I'm going to give my good bit minute for the week. It's news from my hometown in Minnesota. Starting in 2025, Minnesota will ban PFAS chemicals. These are found in many products, including nonstick cookware, clothing, cosmetics, and even food and drinking water.

These are also known as forever chemicals because they don't break down, and they remain in the environment indefinitely. These toxins have been shown to have harmful impacts on human health. We're talking cancer, immune suppression, thyroid issues, liver problems, even affecting unborn babies. This is the most restrictive ban on these chemicals in the whole US, and we're hoping other states will follow suit, eliminating these harmful toxins from our environments and hopefully from our bodies as well.

BECKY: We want to understand the connection today between autoimmune diseases and how they contribute to depression and anxiety. And that happens in several ways, and the first one that I think a lot of us are probably familiar with is chronic pain.

Most autoimmune diseases involve chronic pain, fatigue, sleep disturbances, and unfortunately, along with all of those, also a sense of hopelessness. If you're in pain all the time, sometimes it can be really challenging to have a positive outlook on things. It can be challenging to even just do your day to day activities, and these kind of things can contribute to depression and anxiety.

Another big one to be aware of is that a lot of times autoimmune diseases can disrupt our hormone levels, and so you can have hormone imbalances that can affect your mood and increase your risk of depression and anxiety.

STACY: Inflammation is also a really big problem. I think that most people with any kind of autoimmunity know this, but because autoimmune diseases involve chronic inflammation, it can also affect brain function and it can increase the risk of mental health problems because your body's already in a state of trauma, and that overwhelms our mentality as well. It can cause physical limitations. Some of the physical symptoms of autoimmune disease limit a person's ability to participate in activities that they enjoy, and that makes it harder to maintain your social connections, and that can lead to feelings of isolation and depression.

And then, of course, the medications that we have to take for autoimmunity, they can have side effects. And one of those side effects is that they contribute to depression and anxiety. That means it's really hard to cope.

ALYSIA: One other thing I wanted to mention here that is a connection is your gut health. And we will talk about that a little bit later, actually coming up here pretty quick. We'll talk about that, but there is a very clear connection between gut health and mental health. And if you have autoimmune disease, you have impaired gut health. There are several ways that we are affected, but we have coping strategies, and we would love to hear if you have some as well.

But here are some of the ones that we have learned. One of those things is understanding and acceptance. This is really hard for a lot of people. It was, I know it was for me. I don't think mental illness is as taboo as it was. Um, when, I mean, even 20 years ago, but as I was growing up, nobody talked about depression as if it were an illness.

They talked about depression as if it were an emotion. Do you know what I'm saying? There was not this understanding that depression was an illness that needed treated. We came from a family with a lot of very real anxiety issues. It was just not really talked about as an illness. It was, "Oh, that's that happens."

So, understanding that depression and anxiety are illnesses that can be treated, understanding that it's okay that it's happening to you. It's terrible. It sucks. Nobody wants to deal with that. If you notice yourself, um, feeling different, thinking different, just being down, not yourself, you need to start paying close attention, because if you have never experienced depression, if you have never experienced anxiety, you might not know what is happening to you, you might not understand. Learn about depression, anxiety, educate yourself about your autoimmune diseases - disease or diseases - and, and about mental illness, because understanding the symptoms and the potential triggers is, is...they're going to help you, that's going to help you manage them better.

And then accept your limitations. It's hard to do that. I know, but it's okay to acknowledge that your conditions may limit certain activities. So focus on what you can do rather than dwelling on what you can't. And when you're feeling up to doing those things, do them.

Almost always you'll feel better if you do push yourself a little bit, but there is nothing wrong with, if you are having a bad anxiety day, there's nothing wrong with saying, okay, I can't go do this social gathering today, or whatnot. Understand the signs of mental illness, understand your autoimmune disease and look for those symptoms, look for those triggers, accept your limitations.

I promise guys, this is not an area where you want to bully yourself. You just have to be, have to be your bestie here. You have to be really sweet about this with yourself, because it's hard. It's really hard when you don't feel like yourself anymore. Your mental health tanks. And like I said, you might not know.

What's going on, people around you that love you and are very close to you, they will have an idea of what might be happening, and talk to them about it. And then, talk to your doctor. Moving on from that, we're going to talk about self care. Surprise, surprise, we're going over several of our Big Six again because they have an impact on your mental health.

BECKY: They do. And it's important to remember that we call them our Big Six because not any one of these is going to be a cure all. And unfortunately, with autoimmune, you could even be doing all of them and still have some symptoms, and still have some depression and anxiety. These are just the things that we're telling you are going to be some of the best things you can do to improve your symptoms and improve your situation.

The first one, is try to have a positive attitude and a sense of humor. It almost feels counterintuitive, especially when you're talking about depression and anxiety, and it can be hard to do sometimes. But you know what? If your sense of humor is a little bit on the dark side because of how hard it is, That's okay.

You know what? There's some fun things to do. I've actually joined some Facebook groups that do like autoimmune memes and honestly a lot of dark humor going on there. You know, it's people who can relate to you and it's uh, it's good that that that is available.

ALYSIA: On that note, if you are into dark humor, I came across such a fun little book a few months ago. It's called Disappointing Affirmations by Dave Tarnowski. In the Beginning of the book, he talks about his own journey with mental illness. He has these dark, but humorous affirmations throughout the whole book. I love, I love how very real he was. Some of them are really dark and some of them are just funny, but for example, one of them, I mean, and it's really cute, he's got like these pictures of beautiful scenery in the background. And it says, "No one is coming to save you. You are the adult. I'm so sorry." So there's ones like that and then "You're doing the best that you can, which is pretty sad." So, you know, there's just some fun ones. It's a really funny little book.

I love it. It's very, he's very real and it can, it does take that little bit of dark humor and kind of turn it on its end. If you want to look into something like that, if that's your jam, great. If not, pick up your like, pick up a funny book. Read the, read the comics. Uh, you know, there's a million different comedy shows on TV you can watch. Just do the things that you know are gonna cause you to laugh and be in a better mood.

BECKY: If you genuinely have clinical depression, laughing is not gonna necessarily pull you out of it, but it is certainly gonna make you feel better and put you in a much better headspace.

STACY: We just have to remember one important thing, everyone. We have to choose to cultivate our joy. It's not something that can automatically happen. We have to cultivate it, just like planting a seed and watering it. You have to be attentive to it. And it doesn't have to take a lot of energy. Some things grow really easily. Sense of humor should grow really easily.

A positive attitude probably is a little more work. But it's still something that can be cultivated. And the more you work on it, the easier it becomes to flourish. It's beautiful that way. And so I've had a lot of people ask us, how are you guys so positive? We work at it. We make a conscious decision to be this way.

ALYSIA: That's what I was just going to say. It is a conscious decision. If you make that switch in your brain to say, okay, I'm going to catch myself every time I'm complaining. I'm going to catch myself every time I want to whine. I'm going to catch myself, and I'm going to just stop, or I'm going to do something else, talk about something else, change the subject, whatever it is. Every time you have that conscious thought and you work on it, it's just that much easier next time, right?

BECKY: As we said, we kind of cultivated...our family, maybe naturally has a little bit of a dark sense of humor anyway. So it's been a little easier for us, but exactly if people If that's something you need to work on, we're not talking about every moment of every day.

We know what autoimmune disease is. There are days you're in pain, there are days when you're lonely, you're tired, you can't do things you used to do, and it's okay to cry.

ALYSIA: I think crying is sometimes just as healthy as having a positive attitude.

BECKY: It's okay to have all the emotions because you're going to...because there are just going to be some days where as much as you want to laugh, you hurt so bad that maybe that just isn't an option for you right there. This is where we're hoping that maybe some of these other coping mechanisms can come in and help. One of the ones that we've mentioned before, again, it is one of our Big Six, but the three of us also kind of have a testament that it is one of the best things that has personally helped us is having a healthy diet. The nutrients that we consume can directly influence our brain chemistry. That shouldn't really be a surprise, because we talked about how that gut health and brain connection is a real thing. Your gut and your brain are connected through the vagus nerve. They communicate using neurotransmitters, and if you have a healthy gut microbiome, which is influenced by your diet, it can actually positively impact your mental health. And I think we all know that when we're eating well, We also feel good physically. We feel better physically. And again, we are aware that that can be a challenging thing.

Before we were doing this episode, we were actually just discussing that even though diet is one of the most helpful things for us, it is one of the most challenging things for us as well, because when you're tired and you don't feel good, and you're having a rough day, it's really hard to take that extra effort to actually make yourself a nutritious meal when there are alternatives to just popping something in the microwave.

And don't like guilt yourself if you occasionally have those days where you need to just pop something in the microwave, because again, you're taking it on a day by day basis, but really the standard American diet kind of lacks a lot of the essential nutrients that we need for proper brain function.

Loaded...all those processed foods, unhealthy fats, they cause all kinds of awful inflammation for us. Focus on getting those whole foods, the nutrient dense fruits and veggies, lean proteins and healthy fats. And like we've said before, if it's really hard for you to get rid of the processed stuff at first, bring the good stuff in, add it first, and then slowly remove things.

You'll find that as you add the good stuff and you're feeling better, it's easy to release and let some of the bad stuff go. The other one is avoiding toxins. Alysia was talking a little bit about that. They're, you know, exposure to chemicals and heavy metals like lead and mercury. Those things actually are linked to higher rates of depression, and exposure to toxins can disrupt the body's stress response system with and cognitive impairment. We need to do our homework on those, and we really need to start doing what we can to reduce the toxic load on your body. And this, again, is about research. There's a lot there, and there's so many things, I mean, our family always jokes around about literally everything out there is going to kill you in some form or fashion, again, dark sense of humor coming out, but we talk about that although there are so many chemicals, there are so many toxins and things, that don't get overwhelmed by everything. Like, "Oh my gosh, I can't use like everything in my kitchen now," or whatever. Take them out a little bit at a time, do what you can do. And just recognize that even every little bit you do is just a little bit less, and that is going to be helpful.

STACY: One other thing that you can do that helps a lot is exercise. It's another one of our Big Six, and I'm telling you, it is hugely important for mental health. I cannot emphasize enough how important it is. Reduces your stress. It allows you to sleep better. It increases your endorphins, which by their very nature help you be less depressed. It lifts your mood. You just need to find, like we talked about in our joyful exercise episode, you need to find something that you can do to do exercise you enjoy.

And then just start slow, listen to your body, enjoy the process, let those endorphins flow, because sometimes it takes a little while to get that going, but once it does it makes a huge difference in your life. And as I said, regular exercise also helps with sleep, which you have to prioritize when you're having mental health struggles because sleep is when your body heals. It's when it recovers from stress. It's when it reduces all that inflammation. And when we deprive ourselves of sleep, we disrupt the balance of the hormones in our body that regulate our moods. And that's really problematic for us. It's going to lead to more stress, a lot more anxiety, and then of course that leads to depression.

Not to mention the effect it has on our cognitive function. So, sleep really needs to be a priority. And if we're sleeping the way we should, and we're exercising the way we should, then we're managing our stress more effectively, because chronic stress is going to exacerbate your physical health, which as we know, impacts our mental health, and it can significantly increase the risk of developing mental illness as well as worsening any mental illness that we already have present.

So, we need to practice relaxation. We need to use meditation, deep breathing and yoga and develop mindfulness, and you really need to cultivate some gratitude. And if we regularly acknowledge these positive aspects of our life, even on the difficult days, then that stress will reduce and we'll feel better.

BECKY: I think we need to recognize too, that with stress, there's kind of almost two types of it. We have the type of stress that comes into our lives. Whether it's our illnesses or maybe it's a job loss or somebody you love passes away or whatever, there are many things that are things we can't control stress related, but there are also stresses that we almost bring on ourselves by taking on more than we should. Not saying "no" when we should learn to say no to things.

I know that that's actually a huge problem. I have sometimes recognized that when you're doing stress management, the coping things are going to be helpful, especially if it's stuff that you can't control, because that's the aspect you can control - is how you react to it. If you're doing things that are causing yourself stress that you actually have control over, like over-committing yourself, getting involved in too many things, consider scaling things back so that you're limiting your stress levels.

ALYSIA: I actually wanted to add something in here too, as I was listening. I wanted to add something in here too, before we move on when talking about exercise and stress management, walking is really, really helpful for both of those things. And if you can walk outside, it's even better. If you're really lucky, you live in a place that is beautiful to walk. Even if you don't, even if you have to walk around your apartment complex, or, I mean, I live somewhere where it's cold for half the year, so I don't really want to go outside, but there are places I can go around inside and walk, and that is better than walking on a treadmill in your house. But if you can only walk on a treadmill in your house, that is perfectly fine.

I know, and I think studies will support this, that if you get out of your house and walk outside is best, even if you can't do it outside, go somewhere outside of your house. And just walk. That is a huge, that will have a huge impact on you. The other thing I wanted to bring up because I know it's helpful in my life for stress management is animals.

I have mentioned before, I am a crazy cat lady and my cats, they know. When I am having a bad day and they come to me and they give me love, and they make me laugh. They make me smile. And my little dog makes me get out and walk. I think that animals are medicine. I've said it before. I'll say it again. I'll say it till I die. Animals are medicine, not just for your physical body, but for your mental health as well.

BECKY: My dog, especially he knows when I don't feel well and he compensates. He's a very large dog and he can actually tell when my joints are sore and I'm having a rough day. And he will actually come and walk alongside me almost like a little extra crutch, and support me because he can tell when I'm not doing well. Then it is, it's, it's its own medicine.

ALYSIA: They are very intuitive.

STACY: Well, I can tell you that as a childless dog mother, that, um, they're a huge part of my support system because we have to have a support system in order for us to have healthy mental faculties and an ability to operate and deal with all the things that are put in our lives.

And my dogs are hugely beneficial and I consider them a large portion of my support system. I'm blessed to have a great husband. I know not everyone has a wonderful significant other, but for those of us who do, it's a huge blessing, but I'd say even this as wonderful as my husband is, my biggest support is coming from the other people who are suffering from problems like me.

Like my sisters, like my friends at work, like my best friend. These are all people who are also suffering from autoimmunity. And if I'm not isolated, it's a lot easier for me to have good mental health. For those of you who don't know someone else, reach out, contact a support group, get an online community of people that you can commiserate with and talk to and ask help from.

It's hard to do this by yourself. And it's so much easier if you can maintain relationships with people who are willing to hear what you have to say and not feel that you're complaining. You just need good advice.

BECKY: I know I have mentioned before that I'm in a couple of Facebook groups, but there's a couple of them that are really good support systems I've seen. Like Stacy mentioned, we have each other as students. Sisters and stuff. So we have kind of a built in support system, but I have seen people on some of these forums that literally have no one that are completely alone in what they're doing. And I have seen other people on these forums who rally around them and are like, Hey, you know, I've personal message, personal message, do my phone number, give me a call. We can chat. I will chat with you online, whatever, like, there are good people out there. And there are people that are suffering from similar things. It is so important that we support each other. Because there are a lot of people out there who need it, who are scared, who are, I mean, and this is, again, where we're talking about the anxiety and depression come in.

When you feel alone and you feel isolated and you're suffering from autoimmune disease, that is a huge contributor. Finding these ways so that you don't feel so isolated can be very helpful for that.

ALYSIA: You definitely have to push yourself as somebody who has. S who has battled both anxiety and depression. There are just weeks and sometimes months at a time where I would just be totally fine to stay home and not talk to or see anybody that's not helpful for your mental health, push yourself. Even if you're talking to people online, even if you're making phone calls with family, friends, whatever, push yourself to reach out, push yourself to serve other people, because you, when you are so focused on your own miserable situation, you miss those opportunities to do things for others. Like Becky was mentioning these people online. There are people out there that need you. And right now you might just be thinking, Oh my gosh, I need help. You might, but you might find that help in helping others.

BECKY: Can I say kind of along those same lines, a personal example that I've had that literally just happened this week. I have a very dear friend of mine who doesn't live very far away. Who suffers from rheumatoid arthritis and she is homebound most of the time. She's able to get out occasionally, but not very often.

And, and I know it is very rough for her. Like she has a very hard time with things and she found out that I just had a knee replacement surgery and she went out of her way, she wasn't able to come herself, but she actually sent her husband over with a bouquet of flowers for me. And she was thinking of me even though I know she's not doing well either and, you know, and just talking back and forth, it seemed to cheer her up to know that she did something that helped me. And so I totally agree with what Alysia was saying. Sometimes, even though it seems so hard because we, it's so easy to get consumed with our own problems and our own pain, getting outside of ourselves a little bit can really help with that.

ALYSIA: So now that we've given you some good self care tips, we want to talk about probably the biggest one. If those self care tips are put into practice and they are not giving you the help that you need, or you just need more help than that, you should not be surprised to hear us say. Go talk to your doctor, get professional help.

We listed these things you can do and they are important and there is a time and place for them, but it is just as important to recognize when your efforts are not enough, you need to know that there is no shame in seeking professional help for mental illness, it can be scary and it is very humbling, but there's no reason to be embarrassed about it.

And there's no reason to be ashamed for asking for help. This is one of those times when finding the right medical professional can make all the difference in your journey. General practitioners are helpful. They are important, but they don't specialize in mental illness. And if you do decide to take your mental health seriously, and you If you want to find some extra help in doing that, you are likely going to be best served by finding a psychiatrist or a psychologist.

You can ask your primary care doctor and you can ask your friends for recommendations. Um, if you have a counselor at work or at school or a social worker, all these people can likely point you in the right direction. Mental health professionals can teach you strategies for coping with your symptoms and they can be a listening ear.

They can be a huge part of your support system. There are so many different kinds of helpful therapies out there and there are more being discovered every day. So don't feel hopeless. Don't feel like there's nothing that you can do.

BECKY: I was going to say along those lines, I know that we have a lot of therapists in our area who, along with doing the traditional therapy where you're talking through things and occasionally if you need medications or whatever, they do all that as well, but we have therapists that do art therapy. I'm aware of ones that do yoga therapy, and there's a lot of other options out there that maybe are worth looking into.

ALYSIA: So understand that as we have talked about in the past, how important it is to find the right doctor for you is going to be a journey to find the right therapist for you as well. And so try not to be discouraged if you don't click with the first one that you meet with. Keep advocating for yourself by continuing your search for the right medical professional. And it doesn't have to be, uh, an ugly parting. Like you don't have to fire these people. You just say, no, I'm going to keep looking.

And I guarantee they're not going to take it personally. Anybody in that industry is going to know that it is important to find somebody who is going to work well with you. I do feel very strongly about this, that it is going to be worth your time to work with a mental health specialist. I love my doctor. I love her dearly, but going to a mental health specialist was life changing for me.

So when you get, when you find the right doctor, the right therapist, be prepared for them to recommend medication. It's important that your doctor has your complete medical history, so that they can make the safest and most helpful recommendations for you. There might be medications that can help manage both your autoimmune disease and your mental health symptoms. So, finding the right medication really isn't that different than finding the right therapist.

I am sure it's not going to come as a surprise, any of this information to you guys. You've probably heard this, but it takes several weeks to notice significant improvement with an antidepressant. It usually takes several weeks to notice improvement after you start a antidepressant or an anti-anxiety medicine, although that obviously can vary from person to person, but you can also expect to have side effects, especially in the beginning, right after you start. Oftentimes, they decrease or they go away, but again, that varies from person to person.

So, be sure to discuss all these things with your doctors. Um, what I would tell someone who was considering medication, but was scared to try it, I would share my experience. Which I'll get vulnerable here for a minute, trying medication is really scary for me. My struggle with depression started 22 years ago after I had my oldest, and I've tried at least half a dozen different drugs over those years, and had really bad side effects.

One of them made me feel numb. One didn't do anything. It was just ineffective. One stopped working over time. And a few years ago, anxiety decided to make an appearance, and that's a whole other animal. I felt like I was fairly used to working through depression, but anxiety was just completely new for me.

When I finally went in to get some help for it, I had a really bad reaction to a new medication I tried. It gave me a full blown panic attack, and it, and then I was like catatonic for the next day. And it was the scariest thing I've ever gone through. I wouldn't wish that on my worst enemy. But I knew that it was a reaction to the medication.

So I was really scared to try anything else after that. And my doctor, um, sent me to a psychiatrist, and this man listened to my experiences. He reviewed my medical records in detail. He very thoroughly went through all my medical history with me and asked me a bunch of questions. And he did convince me to try medication one more time.

I'm so glad that he did. You guys, it was scary. It was a huge jump for me to try it. And I was terrified to the point of tears to take medication again. But this man was a specialist. He took all the things that I gave him, and he made a judgment call what he would do in this situation. This is where it's really important to have a mental health specialist.

These people are the ones that know what the medications are, what they do, what they don't do, what their side effects are, what they are likely to be helpful for, what they are not likely to be helpful for. These people are the ones that are versed in the medications in the mental health industry. I can't overemphasize how important it is to get with a mental health professional.

And if you have to look and look and look, keep looking, because when you find the right one, when you find the right treatment plan, your life will change.

BECKY: And kind of as we're wrapping things up, just a reminder on the importance of building resilience. Resilience is kind of the thing that's going to get us through this depression and anxiety that is so prevalent for those of us that have autoimmune disease. And we talked a little bit about having a sense of humor and developing a positive mindset, but this goes back to finding joy and purpose. You have to make a choice. It is all a choice. And we need to be able to celebrate our small victories. We need to have self care and compassion for ourselves. And I think that's one of the big ones, is, I don't know what it is about the human condition, but when we struggle with things like depression and anxiety, we want to make it worse on ourselves almost by beating ourselves up about, for having these problems. That is not helping anything. That is just making the condition worse.

ALYSIA: Treat yourself as you would treat your child if they were experiencing what you were experiencing.

STACY: It's really important that we remember that we have to be our best friends. We say that a lot, but when you have autoimmunity, and when you have mental health issues, you have to advocate for yourself. And sometimes that means having a conversation with yourself where you say, "It's okay to not be okay. And I need to go get help, and there is no shame in doing that." And even if you have to just put it on repeat, you can put my voice on repeat saying, "It's okay to not be okay. It's okay to ask for help."

There's no shame in that, because if you don't prioritize your mental health, you're going to be miserable. We can go through this life 1 of 2 ways. Well, one of three, I guess we could not care at all, but that's, that's not a healthy attitude. We can hate what we're going through and love our life, or we can hate what we're going through and hate our life.

And none of us are going to have good days every day. So we have to search for that hope. We have to find the inspiration, so that we can manage our depression and anxiety, and we need to trust in the medical professionals who are trained to take care of these problems to help us. My suggestion is that you take what we've said today and apply it, if it's something you need in your life.

ALYSIA: I just want to remind everybody as we've talked about autoimmunity, um, living with autoimmunity is a journey living with mental illness is also a journey. So be kind to yourself as you find a treatment plan, know that it is going to take a while. It might take a long while to go on and off of different medications to see if they work for you. It might take a lot of work going to different places to find different doctors, talking to different people, doing your research, trying different treatment plans. Like, it's not something that you're going to find a one and done fix for. That's just not the way it works. Wrap your mind around treating your mental illness as a journey, just like your autoimmunity. is a journey.

STACY: We're so grateful you joined us today on autoimmune adventures. Like and subscribe. Find us on the various podcast places, and if you have any questions, we'd love to hear from you.

Remember everyone, you are worthy of joy. Your disease does not define your life. You do.