[MUSIC] Next we have as a guest Dr. Mariana Soto, Medical Specialist in Internal Medicine. Dra Soto will tell us about another therapeutic approach to depression. Welcome Dr Soto. [MUSIC] >> In 1948, the World Health Organization defined health, not just as the absence of disease. But also as a full state of physical, biological, and social well-being. What do we have? Health is usually an intangible asset, which we do not realize we lack until we have some disease. For example, the case of depression. From the point of view of internal medicine, What we do is see the adult as a whole. Where we are seeing all the disease prevention part, and also all the health promotion part. And even, we also get to treat all adults when they have some diseases, such as depression. Internal medicine is in charge of seeing the adult, really, as a whole, and not only offer pharmacological strategies. But also many lifestyle changes, that can help us manage the disease. [MUSIC] Without a doubt, we always have many other additional alternatives to pharmacological management. In fact, when we look at what is like the ladder and the steps to follow in the treatment. We are going to realize that always the first step is all the part that leads to lifestyles. This is obviously a job that is challenging, for the professional and for the patient. Because what we as professionals are going to do is accompany you, but ultimately the decision is up to the patient. And if we talk specifically about lifestyles, we could focus on three main things. 1, how are we going to feed ourselves. 2, what kind of physical activity are we doing, and how we are going to focus on meeting those goals. And 3, and also very importantly, how we are sleeping. [MUSIC] Well, regarding nutrition, that's a really very important field. And there are a series of recommendations that we can make from the consultation for all patients. But also including patients who have depression. The first thing is, we try to have a balanced diet. What does a balanced diet mean? Include basically all the foods that are in the food pyramid, Obviously, in the right proportions. How, then, could I know if I am choosing the proportions properly? For this we can divide the plate. How can I divide my plate? I am going to split the dish in two, 50% will correspond to the vegetables part, including the widest variety, and in fact the ones that I like. There are patients who like some vegetables, other patients who like other vegetables. And additionally, the dressing that I can put, olive oil, balsamic vinegar. I am going to divide the other 50% of the plate in two, 25% a protein, trying to choose more than all chicken, fish over red meat. And the other portion, which is the other 25%, a carbohydrate, Mainly complex carbohydrates. And we also have to be very careful with the sauces that we are going to accompany that. We obviously want, to a much lesser extent, carbohydrates that are highly refined. Such as bakery, pastries, confectionery, which is what we have to avoid the most. Regarding, let's say, the part of what we're going to take, we almost always prefer water. If I want, let's say, to include fruit, which in fact I should do two to three portions a day, the idea is that they are chopped fruit in portions. And the juices, reserve them very occasionally. Can I drink alcohol? Yes, eventually I can have a little alcohol. Women one drink a day, men up to two drinks a day. Obviously trying not to exceed that, nor do we get it all together for the weekend, as people usually do. And it not only depends on what we eat, but also how we prepare them, or cooking methods. So, we will always prefer, for example, ideally fresh vegetables, but if I also want to change the preparation. I can use measures like, steaming, bain-marie, trying, let's say, of knowing the technique so that the nutrients are not lost. And, in terms of protein, things like grilled fish, baked fish, more than fried stuff as such. And with respect, well, to the dressings, ideally olive oil, balsamic vinegar, and avoid all sauces that are processed. At home I can also learn a number of recipes. And make my own mayonnaise, well, well, guacamole, there are many other different alternatives. Eventually, we can also include one or another dessert. Always, too the idea is to lean into options that are a little bit healthier. What's more, we can make our own desserts at home. For example, a very good idea is sometimes Greek yogurt, put a little chia seeds. A portion of fresh fruit serves us as dessert, and it is not, shall we say, a lot of sugar. Now, within the food pyramid we can also, eventually, have room for one or another dessert. The most important thing always is that we can plan our meals in advance. As long as we plan and have everything clear, It will be easier for us to comply with all these recommendations. And finally, and one of the most important things, is that we have to set ourselves goals that are achievable in the long term. And that, additionally, last over time. It is unlikely that a person will follow all of these recommendations when we have said that you can never eat anything again. The idea is, initially, to set ourselves some goals that are achievable, where we can also include, from time to time, a dessert, a hamburger. Well, all the things that go as per our daily lives. [MUSIC] Today, let's say, The issue of exercise or physical activity is gaining more and more weight. We know that physical activity not only has benefits, let's say, to lose weight, but also to modify our body composition. And specifically, on the subject of depression, he makes us secrete a series of neurotransmitters that help us reduce stress. To improve as such the symptoms of anxiety, to sleep much better. And additionally it has many other effects on some comorbidities that may accompany depression, eg hypertension, diabetes. Well, the weight without a doubt, the joint pain. What is like the general recommendation for people who usually do not have no comorbidity of cardiac origin? It is that we manage to do more or less 150 minutes of physical activity a week, of moderate intensity. How can we split this? More or less periods of 30 minutes for 5 days. Now, if I eventually see that it will not be so easy for me to comply with that scheme, well, I can modify it a little bit. I can do 3 days a week a little more. I think that the key to all of this is that we always bear in mind that it is warm-up is very important. And at the end of the sessions also stretching. All this will help us to enjoy exercise much more, and to prevent injuries. Another thing that is very important is to start and move forward gradually. For a person who previously did not exercise. Well, possibly start with 150 minutes of physical activity a week, it's a bit challenging. So, we have to set goals, where we increase more and more until we achieve what we want. When we have patients who have had previous illnesses, especially when it is at the cardiac level. I do think it's worth seeing a doctor. Because with it one can set a series of goals, especially, especially in terms of the heart rate part. But for everything else, we can start exercising. Possibly one wonders, and what is the best exercise? Actually, for each patient there will be his type of exercise. Each patient is a completely different world. And the most important thing is that we do an exercise with which we feel satisfied. Without a doubt, what is going to be important, is to mix the different types of exercise. Aerobic exercise is important. But at the same time it will also be important, at least twice a week, include exercises that are strength, balance, and elasticity. In this way, we are going to generate our own exercise plan with the that we feel good. And with which, in the long term, we are going to see that the symptoms, possibly also from medications. [MUSIC] Actually the sleep problems have been, shall we say, in relation also to the exacerbation of the symptoms of depression. Literally this ends up turning that vicious circle, why? Because, lack of sleep leads me to worsen my symptoms of depression. And at the same time, to the extent that symptoms of depression are exacerbated, I'm starting to have a lot of trouble falling asleep. However, we know, also from many studies, that it is important to sleep well. Because to the extent that we sleep, well, we have a repair of our physical weariness. We also avoid other comorbidities such as hypertension. In the weight part it is also related to sleep. And without a doubt, well, all mood disorders. For this, the different organizations have given us a series of specific recommendations. That we could group in a term called sleep hygiene. So, we're going to start, let's say, like enumerate them, but the idea is. First, try to create a routine for getting up and going to bed Always at the same time. They may go out a little bit on the weekends, but ideally try to have this routine. Second, not taking naps, or in case I take naps throughout the day, that they be short naps, and that they never exceed 45 minutes. Third, I have to be very careful with the drinks, suddenly, What am I consuming at bedtime? Ideally about 4 or 6 hours before one should not consume drinks that have caffeine. Including, for example, tea, chocolate, well, coffee as such, some soft drinks, the same as substances with liquor. With respect to food, we should also eat more or less about 3 to 4 hours before going to bed. To prevent what we eat from being bad for us when we go to bed. Additionally, we must generate a series of you habits such as, say, in our environment. So, one, wear appropriate clothing for bedtime, Well, that's what we have pajamas for. But well, sometimes people fall asleep dressed, they get lazy, well. Additionally, that our space is of a good temperature, and that it has all the necessary conditions. For this, what do we have to work on? One, turn down the light at bedtime. Many times we sleep with the television on, they have like all the flashes screen light, and also noise levels. It is important that we try to remain as calm as possible. And finally, that we reserve the bed space, usually, or, for the sexual intercourse part, or for you the sleeping part. It is not recommended that we work in bed, that we read the book in bed, Let's finish homework in bed. And additionally, let's try to reduce the time of exposure to the screens. Many people finish work, close the computer and go to sleep at once. And he hasn't had as much time to generate this ritual for sleep. The same with the cell phone. So, close to bedtime, let's try not to use screens, and to make ourselves available. What additional things can also help us? Episodes such as meditation, mindfulness, that all this helps us to fall asleep. How much should an adult sleep? More or less 6 to 8 hours, and well, ideally that our sleep is restorative. So if we summarize, basically we have. Lifestyles, which are summarized in food, exercise, and sleep. These are recommendations that are not always as within reach. Because many times the queries are focused on answering questions about medications, dosage, adverse effects. But these are things that, without a doubt, all patients and all doctors need to know. Today there is more and more talk, this is primary prevention, which is the most difficult, as we talked about. But this is what we have to do in the query. Advise our patient, give him all the instructions on how to eat well, how to exercise, how to sleep. And in each consultation, ask him to know if the patient has been achieving it. With this, we are not only going to enhance, but possibly, on occasion, prevent some patients from requiring pharmacological management. [MUSIC]
