- 2 days ago
In this month’s Stay Well Health Chat, Andrew Salciunas talks with Tyler Veterano, DO, Lead Physician of Virtua Inpatient Behavioral Health, about treatment-resistant depression and what hope can look like when standard approaches aren’t enough.
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00:02Hello, everybody, and welcome in to another Stay Well Health chat with my friends over at Virtua.
00:08I've been doing this for a couple of years now, and I absolutely love it because I have family members
00:13that have worked in the medical field,
00:14so I'm really passionate about this kind of stuff, but I don't know really anything when it comes to the
00:20information that the team at Virtua has,
00:23which is why I love doing these, because I always get to learn more, and I hope you guys get
00:26to learn more.
00:26And today, we have a really important conversation, especially for everybody, but I would say for us guys, for me
00:34personally, and for a lot of you personally as well.
00:37I think this is a very important conversation, so I want to welcome in Dr. Tyler Vetterano, who is the
00:43lead physician of Virtua Inpatient Behavioral Health,
00:47and this is a topic that comes up a lot in sports, but it's also a topic that comes up
00:52a lot in our personal lives.
00:54Dr. Vetterano is dedicated to providing meaningful recovery for patients experiencing treatment-resistant depression through compassionate and personalized care.
01:03And you're a South Jersey guy.
01:05So am I.
01:06So we know the same area.
01:07We know how sort of a lot of our mindsets work in the Jersey area.
01:10Dr. Vetterano, thanks for joining me today.
01:13Thanks for having me.
01:14I'm really excited to be here.
01:15So mental health, the reason why I say it's very personal to us guys, but I know this is all
01:22genders, right?
01:23But I know how my brain works, and I know how a lot of other males work when it comes
01:29to mental health.
01:30There's a lot of pushing it to the side.
01:33One of the big things about the pandemic, I know that was a very tough time for a lot of
01:38people,
01:38but the pandemic was also a time where I think a lot of people started realizing their own mental health,
01:45both the good and the things that they need to work on.
01:47I don't want to say the bad, just the things that they need to work on.
01:50But why do you believe, for men specifically, it's something that a lot of guys want to be hush-hush
01:57about?
01:58Why is that?
01:59Yeah, you know, I think it's perceived to be a sign of strength if you're not showing any, you know,
02:08need with support with things like anxiety and depression.
02:12But, you know, I think that the thing that a lot of guys miss is that if we do that
02:16and we try to put on a, you know,
02:19a strong front that, you know, we're really kind of suffering on the inside and we don't necessarily have to
02:24be.
02:24It doesn't have to be that way.
02:26You know, you can still be yourself and, you know, portray yourself the way that you identify with strength and
02:34things like that.
02:34But it doesn't necessarily mean that, you know, you can't also get help on the side and feel a lot
02:39better
02:39and maybe even be a better version of yourself.
02:42And I think, especially when it comes to the world of sports, right, that's where I'll come from because that's
02:47what I do.
02:48As the host of Kincaid and Salchunas on 97.5 The Fanatic, there's sometimes a, why is he acting like
02:54that, right?
02:55So a player right now in Philadelphia, unless he gets traded, but a player right now in Philadelphia that posted
03:01just a couple of days ago,
03:02a nine minute video talking about his struggles with mental health is a guy like A.J. Brown.
03:08I still remember a couple of years ago when Kevin Love, who plays in the NBA, was really at the
03:14forefront of trying to express mental health
03:17and being an advocate for it and then credit to the NBA for being so open about it.
03:23What is it when you hear people say, well, why are they acting like that?
03:28Why don't they just go seek help?
03:30I think that's one big thing for a lot of people is, well, why don't they just do it?
03:34And I think a lot of those people may not have the same struggles and don't realize just how difficult
03:39it is to deal with.
03:41Yeah, I mean, 100 percent.
03:43Also, these athletes being under a microscope constantly, especially in a market like Philadelphia, it is extremely, extremely difficult.
03:52And so I always have kind of a soft spot, you know, for those guys.
03:56I can only imagine what they're going through.
03:59Why is it that, you know, they don't just seek help and get, you know, treatment?
04:04Well, first of all, it may not always just be that simple.
04:07It may not be that you get the help and boom, I'm fixed.
04:09It's not, you know, always, you know, like treating a blood pressure, take this pill and you're done.
04:14But also they may not know that they need help.
04:17They may not be able to fully identify that, hey, actually what's going on right now is I'm super anxious
04:22and that's affecting how I'm behaving, you know, or if I'm depressed.
04:28And that's affecting how I'm approaching things.
04:31I think a lot of times we don't even realize that those are the underlying issues because we're so good
04:37at pushing it down, down, down.
04:39But that really is probably the stimulus for a lot of these behaviors that may be confusing to us in
04:45the public.
04:46So let's talk about signs or at least common signs.
04:49What are some common signs of depression and anxiety that people should look out for?
04:54And I'm not even saying before they go see a physician, right, not even to go see you, just finally
04:59realizing, OK, I have something that I need to seek help for.
05:03What are some of those common signs?
05:05Sure.
05:06So, you know, sleep and appetite, you know, derangements are always going to be something that are a telltale sign.
05:13If you're so anxious it's affecting your sleep or you're so anxious that you're struggling to have an appetite, you
05:19know, that's an easy, obvious indicator.
05:22I think the more subtle ones that are even more important and what I always harp on is how are
05:27you interacting in your daily life?
05:29Is our mood affecting our relationships?
05:32Is it affecting our work?
05:33Is it affecting the enjoyment that we used to get out of doing certain things?
05:37Once those things start to get affected, that's when we really got to, you know, be more cognizant of what's
05:45going on and how we're feeling.
05:47It's always going to hark back to when we have it affecting our daily lives and our relationships.
05:54That's when it really needs to be addressed.
05:57You know, I think a lot of spouses will, you know, help in this and be able to kind of
06:02identify when maybe we need to seek help.
06:06Friends, family, you know, when they're bringing these things to you, I think that we should listen and hear them
06:12out because, you know, these are the people that know us.
06:15These are the people that really care about us.
06:17And if they're saying that we may need to, you know, get, you know, checked out and talk to somebody,
06:22it may be worth your while.
06:25So one of the things that I love about Virtua and I learn every single time I speak to a
06:30different member from the Virtua Health team is that you guys are always the forefront of like the next big
06:34thing.
06:34And that's why I love Virtua so much.
06:36But before we get to some of the advanced treatments of anxiety or depression, when you talk about, hey, go
06:43seek help, somebody seeks help.
06:45What do they what can they first expect after that?
06:48What are some of the initial first steps to try to treating some of the stuff that we struggle with?
06:53Sure.
06:53So the first thing you should do is reach out to your primary care physician.
06:57They are trained to identify these problems and triage what level of care the patient is going to need to
07:05address the issue.
07:06And so a vast majority of these cases, you can go to therapy and therapy will make dramatic improvements and
07:14changes.
07:15You know, we're going to talk about other modalities and maybe even medications and things like that.
07:20But I want to be clear at the end of the day, therapy is the cornerstone of psychiatry.
07:26Everything goes back to therapy.
07:28Even when I talk about the things that we can do that are more intensive in treating depression, it's to
07:35make it so you can go and do the hard work in therapy.
07:38Doing the hard work in therapy is what's going to provide the most relief.
07:42And so I always want to be consistent in making sure the patients know that that is it's you're not
07:47taking any medications.
07:48You're not taking anything and putting it in your body.
07:50You are talking these things out and getting relief.
07:53I think that that's something that's underplayed and something that probably needs to be, you know, better understood by the
07:59public as being so beneficial.
08:01I think people think that if I'm just talking, how am I getting better?
08:04But there are techniques, there are different ways of thinking, and we have plenty of research to show that it
08:09works.
08:10Now, I won't mention who, but like somebody very close to me personally in my life went and saw a
08:17therapist, just did not click.
08:20And that happens.
08:20Like, I'm sure you have experienced that before where maybe this isn't the right one, but let me refer you
08:26to somebody else.
08:28If it then gets to a point where the second or third therapist has not necessarily unlocked you from the
08:35stress that you're dealing with, the depression, the anxiety, what would be those next steps?
08:40Yeah.
08:40So that's a great question.
08:41So first, I just want to mention you're 100% right that it may not just be a great fit
08:46from the beginning.
08:47That does not mean that therapy is not for you and that, you know, we should give up and not
08:50do it.
08:51You should always be trying and finding that really good fit.
08:55But when it comes to a point where therapy may not be enough, your therapist will likely be able to
09:01identify that and refer you to a psychiatric provider that could talk to you about medications that may be beneficial
09:08and may be able to help out.
09:09So, again, just helping you get to a point where you can engage in therapy even more so and get
09:15more out of it.
09:17And if therapy is not necessarily the best thing for somebody, we mentioned that there are advanced treatments.
09:23What are the advanced treatments that Virtua offers?
09:26Because, again, as I said a couple minutes ago, the team at Virtua always seems to be a step ahead
09:31of a lot of people.
09:32You guys are always at the forefront.
09:33The amount of doctors I've spoken to, other than just yourself, Dr. Veterano, that they've said, we're the first in
09:39the South Jersey area to do this.
09:41Or we're the first in the Tri-County area to do that.
09:45What are some of the advanced treatments that the team at Virtua can offer?
09:49So, you know, we have a dedicated interventional psychiatry department.
09:53And within that, we house our ECT, which is electroconvulsive therapy, as well as TMS, transcranial magnetic stimulation.
10:02I know that those are big mouthfuls and are probably not intuitive.
10:07But these are brain stimulation techniques that for certain individuals where medications alone are not enough, these techniques are extremely
10:17effective at getting patients into remission so that they no longer meet criteria for depression.
10:22And we can get them back to living their full lives.
10:26Now, when would you consider that?
10:28Because, again, you don't do therapy once and say, oh, you know, this isn't going to work.
10:34When would you consider somebody that would need the ECT or the TMS?
10:39Because the other words that you said are way too big for my vocabulary.
10:42So for ECT, TMS, when would you consider that for a patient?
10:47Yeah. So really, we like to say that once you've you've done therapy, which we've discussed, and if you've given
10:55two antidepressants, a full trial, typically taking them for anywhere from six to eight weeks and failing two different medications.
11:04At that point, the likelihood of finding a medication that's going to magically unlock everything that we need is is
11:12quite unlikely.
11:13And that's when these brain stimulation techniques can be extremely effective at very rapidly improving a patient's condition and getting
11:22them back to themselves.
11:23So, Tyler, I'm going to be honest with you. When you talk about brain stimulation, when you talk about ECT
11:28and you talk about TMS, and again, these are things that if I had a half hour more to sit
11:32down and talk, I would get even more educated on it.
11:34But I would imagine somebody hearing brain stimulation and not just medication might scare them a little bit.
11:40So if you could just further explain ECT or TMS and maybe some of the misunderstandings about what those are
11:48as well.
11:48Sure. So just really briefly, TMS is an outpatient procedure. You're coming in.
11:56It is five days a week for typically 36 sessions, but you're driving in, you're driving home.
12:01So people come in on their lunch break, they get a treatment. It takes as little as five minutes in
12:06some cases, and they're out the door.
12:08No side effects, no nothing. You know, the worst case scenario is you have a little bit of tenderness where
12:14the the pulses is going.
12:17But really extremely well tolerated. And, you know, those patients, on average, about 60% can meet remission and no
12:25longer feel depressed.
12:26So truly, truly a wonderful, awesome option for other patients that maybe are having way more serious thoughts, maybe some
12:36thoughts about not wanting to be around anymore.
12:38ECT is typically something that then comes to the forefront.
12:42I do want to be careful to be clear that ECT is not a treatment of last last resort, that
12:48if you're struggling and ECT is going to work for you, why wait?
12:51Let's get you in. Let's get you feeling better. I do not want to sit around and wait until X,
12:57Y and Z happens before we get get you treated.
12:59But ECT gets a bad rap. One flew to the cuckoo's nest, you know, in particular, took aim at ECT.
13:06They used it to punish patients. You know, so when I have visitors coming in and seeing ECT now, they're
13:12expecting something very different than what happens.
13:15I always joke that they're going to see a boring medical procedure, unfortunately, when they're expecting to see something much
13:21more interesting.
13:23But that is something that we typically do three times a week, and it may seem intimidating and scary, but
13:30we've been doing ECT for 90 years.
13:32It has changed dramatically over 90 years. It is extremely safe over the 90 years, and we've gotten better and
13:39better and better at it.
13:40You talk about us being at the forefront. It's an old technique, but we are always adjusting our protocols and
13:47reading the latest literature
13:49to make sure that our technique is as safe and as effective as possible.
13:54And then the last thing that I always say is my job is to treat you guys, treat the patients,
13:58and have you go live your life.
14:00I don't want you to be tethered to having to come see me.
14:03My job is to get you better and get you out and living your life and doing the things you
14:07want to do.
14:08ECT is a great vehicle for some people.
14:12People will always tell me that they wish they had done it sooner, that they wish they could get their
14:16so-and-so to do it,
14:18so that they also get relief, but it can be scary.
14:22But if you talk to your provider who does it, they will be able to answer all those questions.
14:27They will be able to take down all those barriers and make it so that it's something that you feel
14:32comfortable
14:32and make sure that it's right for you or your loved ones.
14:35So I know early on you and I sort of talked about the stigma for men,
14:40but it's not just men that struggle with depression and anxiety.
14:43Everybody does. Everybody can have that moment where they're down.
14:47So I'm curious, for somebody in your position, what is the message that anybody that's watching this right now,
14:53regardless of age, regardless of background, regardless of gender,
14:57something that you would want people to hear, to understand, because there is a stigma to it, unfortunately.
15:03I think society's gotten much better at it.
15:06You could speak to that more than I can, but even just from the sporting world,
15:10I know that society's gotten much better at it.
15:12But for people that are still hesitant to speak to a therapist or to take the steps or to realize,
15:18hey, you're struggling right now, what are some of the messages that you would give people?
15:23So, you know, one of the things that I always say that I really firmly believe in is that we
15:28got one life to live.
15:32We got one shot at this and to have a stiff upper lip and kind of struggle through it, to
15:38me, never really made any sense.
15:41We've got one one shot at this life.
15:43And if we have techniques, if there's a pill, if there's a treatment that you can do that's going to
15:50make you feel better
15:52and get the most enjoyment out of your life, I just I always am pushing my patients to think along
15:59the lines of it doesn't have to be like this.
16:01You can feel so much better.
16:03Do not let something like stigma or, you know, judgment of others get in your way of living your best
16:10life and being the happiest version of yourself,
16:12the best version of yourself.
16:14You can be a better parent, a better son, a better friend, a better brother, a better sister.
16:19And if there's an opportunity for you to achieve that, you know, I think that it's always worth the conversation
16:25and seeing if it's right for you.
16:27And if you could, there are people and I'm not I'm not trying to be rash here, but there are
16:35people that would be the one that judges, right?
16:39Like, I don't know why people judge, but there are people that judge.
16:44So if you could speak to somebody that may have that mindset in terms of a support system for somebody,
16:50like if you do find out that somebody is struggling and somebody is going to see a therapist,
16:55how should the person that's not struggling react to it so that it is not in a sort of way
17:01where you're almost offending the person that is struggling?
17:04Yeah, I mean, you know, I would hope that that would just be an opportunity to support somebody that you
17:10care about
17:11and to let them know that, hey, listen, I'm here for you.
17:14Anything I can do to kind of support you and get you through this period?
17:17You know, I think some people that may judge may actually be experiencing some similar things
17:23and maybe that's contributing to their reaction.
17:26But ultimately, you know, if we're able to support one another and support the ones that we care about,
17:32those are the people that get better even faster.
17:35The better your support system, the better your support network.
17:38You have a group that you can fall back into.
17:40Be the people that can support someone that's struggling because it can make a massive, massive difference in their life.
17:47These are great messages for everybody, even for those of you who do not struggle.
17:51You're blessed that you may not struggle from it, but you can be there for somebody that is.
17:56And if you want to learn more about treatments and resistance when it comes to depression
17:59and all the options that we just discussed today, you can go to the Virtua website,
18:03Virtua.org slash depression.
18:05That's Virtua.org slash depression, where you can even call their phone number
18:08because sometimes it's good to talk to somebody.
18:11609-914-6550.
18:14That's 609-914-6550.
18:18Before we end this, in case people are wondering, all right, what are my steps here?
18:22Like maybe somebody is watching this, and I hope that if you are watching it and you're struggling,
18:25you're going, man, I can really use this.
18:28How can somebody get started?
18:30If they're ready to take that first step to get help,
18:32how can they go to you or somebody from the Virtua team to sort of get that ball rolling
18:38to see if they do really want to take those next steps forward?
18:41Yeah, so I would always encourage people to reach out to their primary care physician.
18:46Your primary will know you, especially if you have an established relationship with them,
18:51and they will know how to triage and ask the right questions and get you to the right treatment.
18:57If it comes to the point where you're thinking about if ECT or TMS are right for you
19:03and you're looking for that extra oomph to really feel a difference,
19:07then we take patients from all over.
19:11You know, there are no restrictions on who we will see in the interventional psychiatry
19:16department for ECT and TMS.
19:18And that phone number that you gave, 609-914-6550, is a way to get in contact with us,
19:24set up an appointment, and come in and get an evaluation.
19:27And we will, you know, we're going to, when we do that,
19:30we always make sure that we're treating the entire person,
19:32that we are not just looking at whether or not we're going to take you for a treatment.
19:37We will direct you where we think is best and make sure that you're getting
19:40the highest quality care possible.
19:42Dr. Veterano, I respect you for what you do.
19:45I respect where you work.
19:46I also respect that you are a South Jersey born and raised and also a Philadelphia sports fan.
19:51You also know what Philadelphia sports could lead to in terms of troubles for us all.
19:54Maybe not as serious, not as serious as some of the talking points that we talked about.
19:59But you know the struggles of being a Philadelphia sports fan, too.
20:03When Ryan Howard struck out and tore his Achilles, I think that that was one of the lowest moments of
20:09my life.
20:09So, yes, I know exactly where I was standing in my college dorm when that happened.
20:14It can be tough, but, you know, I got to remember it's all in good fun.
20:19You're the man, Doc.
20:20I really appreciate the time.
20:21I really appreciate the Virtua health team.
20:23And we'll continue these stable health chats.
20:25This was an important one.
20:26Thank you so much, everybody, for watching.
20:28And, again, if you have any questions and you want to check out the Virtua team, Virtua.org slash depression.
20:33Doc, thank you so much today.
20:34We appreciate it.
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