Depression as Shutdown of the Polyvagal Theory / ep44 show notes

Updated: Mar 27



SHUTDOWN OF THE PVT RECAP

  • Body is preparing for death, last resort

  • Immobilization is numbing in preparation for death with little pain

  • Immobilization is also numbing and dissociation which allow for possibility of escaping should the opportunity to arise

  • Humans get stuck in shutdown

  • Animals can emerge when the moment is right or after a set amount of time

**Disclaimer: This information is NOT meant to diagnose. If you feel like you may be experiencing symptoms of depression, consult with a mental health or medical professional. We are speaking in generalities. Your specific situation, diagnosis, treatment and medication are entirely between you and your provider.


DEPRESSION IN THE DSM

The DSM-5 outlines the following criterion to make a diagnosis of depression. The individual must be experiencing five or more symptoms during the same 2-week period and at least one of the symptoms should be either (1) depressed mood or (2) loss of interest or pleasure.


Depressed mood most of the day, nearly every day.

  • Shut down - feeling down, empty, numb, sad, lethargic, tired chronically, lack of motivation, isolating

  • While stuck in shutdown, this is entirely within the normal range of experience

  • Everything slows down, there is no energy


Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.

  • Preparing to die, pleasure in things is not a priority

  • Pleasure requires some level of safe and social state


Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.

  • Metabolism has slowed significantly - Metabolism is the process of your body utilizing the energy you put into it, or more simply, burning calories. http://www.eatingwell.com/article/290811/can-losing-weight-slow-your-metabolism/

  • In shutdown, the body needs to conserve energy for potentially surviving

  • While in shutdown, you may be consuming less, which reinforces the body’s natural tendency to reduce metabolism when less calories are coming in

  • Clear connection between Major Depressive Disorder and: obesity, metabolic syndrome, type 2 diabetes, heart attack https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2948264/

  • metabolic syndrome - a cluster of conditions that occur together, increasing your risk of heart disease, stroke and type 2 diabetes https://www.mayoclinic.org/diseases-conditions/metabolic-syndrome/symptoms-causes/syc-20351916

  • Obesity greatly increases the risk of diabetes - https://www.health.harvard.edu/a_to_z/type-2-diabetes-mellitus-a-to-z

  • Decrease in appetite - disconnect from the mind to the body, not feeling hunger cues or not feeling them due to conservation

  • Increase in appetite - does this mean increase in hunger or increase in eating?

  • Over eating as a way to cope? That’s not necessarily an increase in appetite/hunger

  • I wonder if eating stimulates the ventral system - uses the jaw, the mouth, the neck - mastication muscles necessary for sucking/swallowing when an infant

  • Is the increase in eating actually a sign of climbing the ladder? I wonder if a return of energy could be too much, the coping skill could be to eat instead of sitting with the intense energy


A slowing down of thought and a reduction of physical movement (observable by others, not merely subjective feelings of restlessness or being slowed down).

  • Someone in shutdown has lost their glow

  • Prosody is gone, smiles are gone, eye contact is gone, stare off

  • Even when you’re with them, there’s a disconnect


Fatigue or loss of energy nearly every day.

  • Same as above


Feelings of worthlessness or excessive or inappropriate guilt nearly every day.

  • "Story follows state" - Deb Dana

  • Worthlessness matches the state; Incompetent, incapable, dumb, less than

  • Thoughts that reflect negatively back to the individual

  • Fight thoughts are about others, blaming; Flight thoughts are about others, fear

  • “Inappropriate guilt” - guilt that doesn’t belong, that doesn’t match the situation


Diminished ability to think or concentrate, or indecisiveness, nearly every day.

  • One of the skills that is lost when not in safety

  • Sharpness of flight/fight is not there either

  • Lack of self belief in decision making

  • Foggy, grey, cloudy


Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

  • For another time


To receive a diagnosis of depression, these symptoms must cause the individual clinically significant distress or impairment in social, occupational, or other important areas of functioning. The symptoms must also not be a result of substance abuse or another medical condition.

  • Shutdown can be very noticable, but there’s degrees of severity

  • Depression doesn’t look the same for all with the dx

  • Shutdown exists on its own


The latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the DSM-5, added two specifiers to further classify diagnoses:

With Mixed Features – This specifier allows for the presence of manic symptoms as part of the depression diagnosis in patients who do not meet the full criteria for a manic episode.

With Anxious Distress – The presence of anxiety in patients may affect prognosis, treatment options, and the patient’s response to them. Clinicians will need to assess whether or not the individual experiencing depression also presents with anxious distress.

  • may tackle these another time


ANNOUNCEMENT -

The Embodied Trauma Conference is coming February 3-8. An online conference with some major names: Levine, Porges, Lyon and many more. Go to https://www.embodiedtrauma.com





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