Ep91 Hope Amid Depression w/ Dr. Anthony Isacco

"The Lord is close to the brokenhearted, saves those whose spirit is crushed."
~ Psalm 34:19

Is it a sin to be depression?
Is depression really able to be treated and healed?
How can I help my loved one who is suffering with depression?

In the first ever episode of "This Whole Life" recorded in front of a LIVE audience, Pat is joined by Dr. Anthony Isacco to dive into the realities of depression—what it is, how it affects individuals and families, and its complex relationship with faith. The conversation explores common misconceptions, clinical symptoms, and ways to distinguish normal sadness from major depressive disorder. Listeners will find hope as Dr. Isacco shares evidence-based approaches for healing, emphasizing the power of behavioral activation, social connection, and integrated spiritual practices. Full of relatable anecdotes and practical advice, the episode stresses that depression is treatable and offers tangible steps for listeners to support themselves or loved ones. Whether you’re seeking understanding as a parent, friend, or clinician, this episode delivers empathy, science, and faith in one thoughtful package.

Anthony Isacco, PhD is program director, professor, and head of clinical research in the new MS in clinical psychology program at Saint Mary’s University of Minnesota. He is a licensed psychologist and is the principal of a small private practice focused on helping clergy, seminarians, and women religious live healthy, holy, and happy lives in their vocations. He is a graduate of Franciscan University of Steubenville (BA), Boston College (MA), and Loyola University of Chicago (PhD). Dr. Isacco lives in Pittsburgh, PA with his wife and four daughters.

Episode 91 Show Notes

Reflection Questions

Chapters:

0:00: Introduction and Highs & Hards
11:13: Understanding depression
19:46: The relationship between depression & faith
26:36: Is it a sin to be depressed?
36:51: Suggestions for someone who is depressed
43:14: Early signs of depression
50:45: Challenge By Choice

Chapters

• 0:00 Introduction and Highs & Hards
• 11:13 Understanding depression
• 19:46 The relationship between depression & faith
• 26:36 Is it a sin to be depressed?
• 36:51 Suggestions for someone who is depressed
• 43:14 Early signs of depression
• 50:45 Challenge By Choice

Transcript

Anthony Isacco [00:00:00]:
You don't have to live a depressed life for the rest of your life like it is. It is healable. It is changeable. There's lots of people I've worked with who have been depressed, and it seems like an unchangeable condition.

Pat Millea [00:00:14]:
Right.

Anthony Isacco [00:00:15]:
And lots of success stories out there, tons of them.

Pat Millea [00:00:28]:
Welcome to This Whole Life, a podcast for all of us seeking sanity and sanctity and a place to find joy and meaning through the integration of faith and mental health. I'm Pat Millea, a Catholic speaker, musician, and leader, and I'm happy to bring you this podcast along with my bride, Kenna, a licensed marriage and family therapist. This is the stuff she and I talk about, all the doing dishes in the car on a date. We're excited to bring you this podcast for educational purposes. It's not therapy or a substitute for mental health care. So come on in, have a seat at our dining room table and join the conversation with us. We are so glad you're here. Well, friends, it is a glorious, beautiful, sunshiny day in Rochester, Minnesota, and this is a special day in the history of This Whole Life.

Pat Millea [00:01:25]:
Today, for the first time in three and a half years of podcasting, for you, our beautiful listener, we have a real life audience. You guys say hello. Cheer. What are you doing? Yeah.

Anthony Isacco [00:01:35]:
Hey.

Pat Millea [00:01:38]:
Let me give you some background. So we are currently at a building affiliated with Kenna's master's degree alma mater, St. Mary's University of Minnesota. She was more involved with the Minneapolis campus up in the Twin Cities. There's also an undergrad campus in Winona. We are in Rochester because it's a happy medium right in the middle. And there is a brand new program in clinical psychology at St. Mary's University headed up by Anthony Isacco, PhD.

Pat Millea [00:02:07]:
Anthony is with us here today. Anthony, how are you?

Anthony Isacco [00:02:09]:
I'm doing great. Thanks for having me, Pat.

Pat Millea [00:02:11]:
Excellent. I am so glad to have you with us. It is great to be with you. You and I have got to know each other a little bit online, and I had forgotten when I pulled up today that I have never met you face to face, so I kind of buried the lead. I'm sorry about that.

Anthony Isacco [00:02:25]:
This is it. This is our first time in person. We are thrilled that you and Kenna have joined us for our residency here in Rochester. Thank you so much.

Pat Millea [00:02:33]:
You're very welcome. Yeah. And Kenna was with you and all of you good people yesterday for a little keynote about living the therapist life, just what life can look like as a therapist. The highs, the lows, the struggles and the beauty. So as I said you earlier, she is the best that you're going to get. I am just the pinch hitter that comes in later on. And Anthony's here to really carry the show. So really excited for you to be here.

Pat Millea [00:02:57]:
Excited for all of you to be here as well. Anthony is the program director, the professor and head of clinical research at this new MS Degree in clinical psychology at St. Mary's University. He's also a licensed psychologist. He's the principal of a small private practice focused on helping clergy, seminarians and religious to. To live happy, holy, healthy lives in their own vocations. He sits on a number of advisory boards with dioceses, seminaries, things of that nature.

Pat Millea [00:03:24]:
He's a proud graduate of Franciscan University in Steubenville for undergrad. Went on to get his MA at Boston College, which as a Notre Dame grad. I will not hold it against you. Jesus said to love your enemies and I'm gonna do my best to be fair.

Anthony Isacco [00:03:35]:
The rivalry is pretty one sided in Notre Dame's favor. I will give you that for sure.

Pat Millea [00:03:40]:
I wasn't gonna bring it up, but that's fine. And then he went on to get his PhD at Loyola University in Chicago. And now Dr. Isacco lives in Pittsburgh with his wife and four daughters.

Anthony Isacco [00:03:52]:
That's right. Yeah.

Pat Millea [00:03:53]:
Yeah. Great. Western PA. That's right.

Anthony Isacco [00:03:55]:
Steelers have just won recently, so we at least have that going for us in terms of sports.

Pat Millea [00:04:00]:
That's a big day. Yeah. So my question is, first of all, we're going to get really deep right off the bat. In the world of second person plurals, are you a you guys or are you a Yinzer?

Anthony Isacco [00:04:14]:
Okay, that. Now that is going. Jumping right into the deep end.

Pat Millea [00:04:17]:
I hate to put the pressure on you.

Anthony Isacco [00:04:19]:
It took a second for me to like process that question. Like, okay, where do I go from here? But yeah, no, there is a distinct Pittsburgh accent, but I think I've lost mine over the years and I've lost some of the lingo as well too. So I'm more of a you guys person instead of a yinz. But I have plenty of friends and family that still go with yinz guys. You know, the Pittsburgh accent.

Pat Millea [00:04:41]:
So if he slips into it, that means you guys. If he says yin's, that's not like a restaurant chain. That means all of you over there. That's what that means.

Anthony Isacco [00:04:49]:
Downtown is Danton. I don't know where they came up with this.

Pat Millea [00:04:53]:
I think that's a French last name. Oh, brilliant. Well, throughout the course of Our conversation here, friends, as I mentioned before we started recording, we're going to have a little Q and A at the end of our time together. So if you have any questions of all at all related to what we're talking about, write them down, pass them to your right. And I'm sure that somebody that's listening on the podcast has the same question. And we really love to benefit from hearing the answer that Dr. Isacco has to offer. Anthony, we love to start out episodes with some kind of a high and a hard just to help folks get to know you and what life has been like lately.

Pat Millea [00:05:27]:
Any high and hard from the past few weeks or so for you?

Anthony Isacco [00:05:30]:
Sure. I mean, we've just launched into 2026. Before I came to Rochester last week, I went to my first SEEK conference in Columbus, Ohio. I had the privilege and the blessing to be around 16,000 young adults, college students who are on fire for the faith. And so I was able to talk about the program there. I took my two older daughters, Sophia and Claire, with me and they got to talk about St. Mary's University and our program, but also participate in some of the masses and adoration and talks that were there. So it was, I mean, we were like kind of on a high for four or five days from Seek.

Anthony Isacco [00:06:13]:
And then the hard is kind of related to that high in that we came back from SEEK on Sunday. I had Monday to get ready to turn and burn because my flight to Rochester was Tuesday morning at 6am where I get another high being on this residency with our new students and to launch a new cohort for our MS in Clinical Psychology program. Great.

Pat Millea [00:06:40]:
So a little high hard sandwich. The hard of being home for like 20 hours, but sandwiched by two wonderful things, correct?

Anthony Isacco [00:06:47]:
Yeah.

Pat Millea [00:06:47]:
That's great. That's so good. Thank you for sharing that. Appreciate that.

Anthony Isacco [00:06:50]:
You're welcome.

Pat Millea [00:06:50]:
That's great. I think my, my hard lately is that we have seven children, freshmen down to kindergarten right now and, and some of them are just going through some difficult stuff right now. None of it is, as far as we can tell, hopefully particularly traumatic, but just difficulties in different stages of childhood. You know what I mean? So some, some kind of internal interior stuff that we're helping kids navigate as best we can as their parents. Some of it is just like normal developmental middle child syndrome type stuff of just.

Anthony Isacco [00:07:25]:
Which is still hard.

Pat Millea [00:07:25]:
It's still hard, exactly. Mostly for us, I think. But that's just putting the spotlight on me. Yeah, just kids in different stages, different challenges. We've got three daughters that are six year old twins and a five year old. And they are the best of friends. Except for when they're the worst of enemies.

Anthony Isacco [00:07:40]:
Correct.

Pat Millea [00:07:41]:
And when they are the worst of enemies. It's hard for everyone in the room, but it's beautiful. And all these stages have their own blessings. But there are just some hardships right now and I can live with those. The high I think lately is on Tuesday. No. Yes. No.

Pat Millea [00:08:01]:
Wednesday. I don't even know what day it is. Who knows?

Anthony Isacco [00:08:03]:
Today is Friday.

Pat Millea [00:08:05]:
Is it January? That's all I care about. 2 days ago on Wednesday, we got to Kenna and I got to present to the group of missionaries with NET Ministries, which is a group that we've done a lot of work with informing them in spiritual and mental and relational health for their time out, doing mission work throughout the year. And it's just such a joy. I love being able to work with Kenna and present with her. So I get a lot of life that. It's a group that we're very familiar with. So it's become kind of like a family a little bit where you can kind of joke around with each other and kind of have some fun. And it's a.

Pat Millea [00:08:36]:
It's a bunch of primarily young adults who are between, you know, typically 19 and 24 is probably most of the people in the room. And it's the kind of people who really are just hungry to take some of these are kind of like deep relational mental principles and to really apply them to their life. So it's like the definition of an ideal audience. Like they're just soaking it all up. They want to be holy, they want to do good work, they want to be connected to people and they're just kind of sorting out what that means in their own life. So it just was a real joy. It's always a joy. But it was on Wednesday again.

Anthony Isacco [00:09:10]:
Yeah. I met some NET people at Seek and they really seem to be doing some good work and I enjoyed my conversations with them.

Pat Millea [00:09:17]:
Yeah, yeah. They are the definition of joyful people too. Sometimes. If you're having a bad day, they might be annoyingly joyful sometimes because they're just so happy. But what do they call it?

Anthony Isacco [00:09:27]:
Like toxic positivity? Now that's the NET people.

Pat Millea [00:09:32]:
Is that a thing? People say that?

Anthony Isacco [00:09:34]:
Well, I guess you just did. I guess I've heard of it, but I've never called anybody toxic positive before.

Pat Millea [00:09:40]:
Positivity. I'm totally going to weaponized joy. I'm going to use that. That's going to Be great. Oh, my gosh. Well, maybe ironically, speaking of toxic positivity, the conversation that you and I are ready to launch into today is around the experience of depression and what that looks like for people individually, what it looks like in family systems, what it looks like related to someone's faith and spirituality. Just for background, when I was working in Youth Ministry for 15 years in a variety of different parishes, I came across. I encountered a number of different youth and adults, their parents as well, who were at times going through just some really low periods, some really low seasons.

Pat Millea [00:10:24]:
And some of that was maybe temperamental. Maybe somebody was just more inclined to kind of depressive experiences and symptoms. Some of it certainly rose to the level of being clinical and something that they really needed resources and outside help for. But it was the first time that I really came around to the idea that, especially for people of faith, it can be really hard sometimes to untangle the experience of depression from just kind of normal, healthy emotional sadness and also from spiritual desolation or the feeling of, like, distance from God or something like that. So I know that this can be a really big topic. And I was telling Elise, one of our assistants on the way down to Rochester, that I was. I'm a little embarrassed that we've gone 91 episodes of this podcast and not gotten into the topic of depression specifically. So maybe if we can just start there.

Pat Millea [00:11:14]:
Anthony, is there kind of a framework that you can help us build around what is depression? How would you explain depression to somebody who maybe has seen it in movies and TV shows, had conversations with family and friends? But how would you kind of frame that for us?

Anthony Isacco [00:11:30]:
Sure, yeah. I mean, like, to your point, you know, earlier, back in, like, the 90s and early 2000s, there was, like, a really popular book called Prozac Nation, and, like, depression was just, like, a really hot topic, but I think now it's been drowned out by, like, anxiety, trauma, these other kinds of hot topics, and mental health, but is still considered like, a common cold of mental health. And what I mean by that is it's. It's. It's still around, and a lot of people still experience depression. The CDC released a report in 2025 that said that 1 in 8 adults and adolescents experience a clinical depression, which is double the rate of 10 years ago, with teenage girls actually experiencing the highest rates right now. As a father, three teenage girls, that report really caught my attention. But, yeah, I mean, to call it a common cold, I think, is also to kind of, like, minimize it.

Anthony Isacco [00:12:29]:
It can be incredibly distressing. And Debilitating and cause a lot of dysfunction in someone's life where you just feel bad about yourself, you feel depressed. It can be very episodic. You have other symptoms like gaining weight, losing weight, can't sleep, can't sleep enough, loss of appetite, low sense of self worth. Those are some of like the diagnostic symptoms that go with with depression. But it is that just kind of really significant feeling of feeling sad, worthless down. Depressed is what is what depression is, basically.

Pat Millea [00:13:10]:
Yeah. Yeah. And how would you maybe distinguish between the emotional experience of sadness, which is certainly healthy and appropriate, and a normal human response to situations of loss, grief, things like that? How would you distinguish that from true depression in a clinical sense?

Anthony Isacco [00:13:32]:
So a few years ago, I was working with a young man in a session and he said, Dr. Isacco, you know, I feel like, you know, very lonely. I said, all right, let's kind of unpack that. And I said, you know, when do you feel lonely? He said, whenever I'm at my house, like, okay, like what's happening at your house? And you feel this loneliness? And he goes, well, I, I feel lonely whenever I'm alone at my house. And I said, well, that's kind of a normal feeling. Like if you are alone, it's normal to feel lonely. And so that's in this kind of cultural milieu that we're in right now, we tend to over therapize things right now. Like we are taking normal emotions and pathologizing them and thinking the worst.

Anthony Isacco [00:14:20]:
And so I think it's good to kind of dial down some of that over pathologizing and remember that we are human and as humans we have emotions in reaction to different events. And so if we have a death of a loved one, if we don't do well on a test, if we don't do well on any other kind of activity that we're trying to, you know, get a sense of accomplishment from, but we fail to meet our standards or the standards of someone else. It's normal to have a negative feeling about that. You know, it's normal to feel sad or grief. And so what distinguishes clinical depression from normal feeling is, you know, some of those things that get into, you know, functionality, you know, can you get up out of bed in the morning and go to work and do your daily activities? If you can't do that because of that feeling of depression, that, that's usually like the sign that it's, you're more on the clinical side of things rather than the non clinical side of things.

Pat Millea [00:15:22]:
Right.

Anthony Isacco [00:15:23]:
And it's Also, you know, if that feeling kind of sticks around for a longer period of time, you know, if you don't do well on a test, you might feel bad for a day, but you bounce back.

Pat Millea [00:15:34]:
Sure.

Anthony Isacco [00:15:34]:
You know, clinical depression is two weeks or longer, for example, and usually it's like a combination of symptoms all at once as well, too. You know, it's, you know, you can't sleep, poor appetite, feel like crap, can't get out of bed in the morning. All those things happening all at once is a sign that it's more on the clinical diagnostic side as well.

Pat Millea [00:15:57]:
That makes perfect sense. Yeah. Yeah. We do a lot of work in some of the speaking and consulting work that we do around emotions and around helping people, including people of faith, grasp the idea that some emotions are. They're just truth tellers. They tell us what our experience, what our response is to the world around us. And it doesn't mean that our emotions get to be dictators and they don't tell me what to do, but they are good information. Right.

Pat Millea [00:16:23]:
And it. It is it at the same time, like you're saying, it can be really uncomfortable to be sad. So I get why some people might be tempted to pathologize and to maybe overstate the weight of that sadness, because nobody wants to be sad. It's not a pleasant experience, but it is. It's a helpful experience because it helps us appreciate the love that we have for someone who has died or the hopes that we had for a dream that has been dashed or anything that can lead to that grief and loss. It really helps us kind of identify our relationship to whatever that thing was. I think. Yeah, that's really healthy.

Anthony Isacco [00:17:01]:
Yeah, some. I think some of the. The best kind of clinical approaches right now, like, such as acceptance and commitment therapy, are based off of, like, the hypothesis that you need to, like, allow people to accept their emotions.

Pat Millea [00:17:15]:
Right.

Anthony Isacco [00:17:16]:
And allow people to not fight against them and give them permission to kind of feel what they're feeling. Because if you naturally try to push something away and kind of hold it out here. Right. Your arms get tired.

Pat Millea [00:17:31]:
Yeah.

Anthony Isacco [00:17:31]:
You know, and like, you want to, like, you don't know what to do, versus if you accept it and bring it in closer to yourself, it's easier to deal with, paradoxically. So I like some of those newer approaches to. Because I think they're meeting people where they're at right now.

Pat Millea [00:17:48]:
That's really good. I, you know, I. My understanding. I love being able to be a part of this podcast because I am not a clinician. Like yourself, or like Kenna, or like all the good people in this room are preparing to be. So I just get to be the layman over here who doesn't know what the world is exactly like. My understanding is that no mental illness has one singular cause per se. There's no one thing that causes an experience of depression.

Pat Millea [00:18:14]:
But are there certain. Not indicators? Are there certain causes, certain patterns maybe that might lead to an experience of depression for folks?

Anthony Isacco [00:18:26]:
Well, I like to use kind of a biopsychospiritual social model of understanding etiology and causes and contributors. So you're right. Very rarely is it like that's the thing that caused my depression right there. I mean, that can happen. You can have a triggering event that then kind of cascades into the deeper depression. But usually it's okay. There might be a family of origin vulnerability to depression, which is more of the bio side of things. And then you might be having difficulty in your social relationships, friendships, or romantic relationships.

Anthony Isacco [00:19:06]:
That's the social part. You might be struggling with your faith and your relationship with God. That's the spiritual part. And then the psychological part is what's going on your mind as you kind of try to process and work through all these kind of conflicts and things like that. And that's the psychological part to the framework.

Pat Millea [00:19:26]:
So lots of contributing factors, and probably difficult to parse out exactly what the cause is for one experience, but really valuable to. To see what the patterns might be. Work with somebody especially. We'll get to that in a moment here about what to do in the case of an experience of depression. Where to go, where to turn. You mentioned the spiritual impacts of someone's faith life and their struggle in faith, that. That can be a contributing factor as well. And I know that there are many people of faith who really have a hard time in moments of sadness because there can feel like a lot of bleeding over into either a spiritual experience that.

Pat Millea [00:20:09]:
That I have offended my loving God because I have this. This sad kind of depressive feeling, or maybe a bleed over into the psychological space that because I'm sad I must be depressed. But there can be this kind of entanglement between faith and psychology. So how would you start to characterize the relationship between depression and even a Catholic or Christian understanding of the world of who we are, of who God is, to help kind of keep those things in their rightful place?

Anthony Isacco [00:20:43]:
Yeah, that's a really good question. I think one of the kind of theories or frameworks that has helped me kind of bridge that gap is just existential Philosophy and psychology. I think one of the classic books out there is Man's Search for Meaning.

Pat Millea [00:20:58]:
Right.

Anthony Isacco [00:20:58]:
Have you read it? Yeah. I mean, for. If you have not read Man's Search for Meaning or. No. Victor Frankl, it's like a must read. He was a psychiatrist and he lived during World War II and was in the concentration camp and think about like the worst environment and social condition possible. That's, that's that. And you know, his theory that he developed from that experience was anybody can develop meaning and purpose in their life despite like the worst conditions that they're living through, you know, and.

Anthony Isacco [00:21:37]:
And suffering is part of the human experience and can often generate meaning and purpose in, in one's life. That philosophy, I think really is congruent with the Catholic faith and our theological understanding of the human experience too. You cannot avoid suffering. Suffering has a redemptive value to it. And we can grow and develop as people and grow closer to the divine through our suffering as well. And so feeling a sense of suffering, while we might want to kind of get through that as quickly as possible, has some psychological and theological and spiritual benefits to it as well. Now that's a tough message for people to hear. Yeah, that's why we call it like an existential moment.

Anthony Isacco [00:22:33]:
Like you'd really need to be able to feel it for that to digest and process. But when people do, you can see the light bulbs go off and things start to click whenever they have that existential insight.

Pat Millea [00:22:48]:
It's thinking of a couple different things, as you say that I think I've seen various studies where a lot of times in our kind of western mindset, we might assume that with an increase in wealth comes an increase in experiences and feelings of happiness and joy. And I've seen a number of different studies that have indicated that as wealth increases, the likelihood that someone will have suicidal ideation or attempts also increases. That wealth actually is a pretty decent. It's directly correlated more with depression than it is with joy, which I think gives lie to the idea that money is the source of our meaning, which we all know, and I think everyone would probably say that, but we get so tempted into to the idea that, well, money buys nice things and don't nice things make people happy? You know, and sure, for five minutes, but not for a consistent light, long standing time period. You know, go ahead.

Anthony Isacco [00:23:54]:
Along that line, have you been following like Arthur Brooks and some of his writings and presentations? Yeah, like that. You know, he's looked at some of the research behind that very point point. And he's like, you know, money, material possessions, of course, like give you some baseline sense of security and well being. But only attribute like a certain percentage to, to happiness and it's like a comparatively low percentage to like some of the four factors that he identifies as the main sources of happiness, which is a practice of your faith, having friends, having family, and having like work that is meaningful and purposeful to you. And those are all things that are largely within our control to develop on a daily basis. And I think that's. I think that's largely true. I think, I think he kind of hit the nail on the head there, which is worth.

Pat Millea [00:24:46]:
We'll come back to some maybe kind of forward thinking thoughts toward the end of our time. But that's a great place to just put a pin in right there. That if someone is looking to not avoid feelings of sadness because as we said, those are natural, those are all well and good and they're actually helpful for us to understand ourselves in the world. But for someone to avoid a deep seated experience of depression, practicing your faith, having good social connections, family relationships, meaningful work, these are all things that, that are within reach for most folks, you know, and if they're not, maybe they've at least got someone in their life who can help them start to work toward those things, you know, that's a, that's a really beautiful kind of active point, I think.

Anthony Isacco [00:25:26]:
Well, one of the oldest theories of what causes depression is a behavioral theory called behavioral activation theory.

Pat Millea [00:25:35]:
Right?

Anthony Isacco [00:25:35]:
And it's a very simple theory, like anybody can understand it, which is people get depressed because they do things that make them depressed.

Pat Millea [00:25:44]:
Wait a second, hold on, let me wrap my mind around that.

Anthony Isacco [00:25:47]:
Should I back that up and rewind and say that over?

Pat Millea [00:25:51]:
No, I said I'm not a clinician. And here you go using inside language. Okay, that's okay, got it, Keep going.

Anthony Isacco [00:25:56]:
So the flip side, the treatment, so to speak, to feel not depressed anymore, is to do things that make you feel happy.

Pat Millea [00:26:05]:
Wait, what?

Anthony Isacco [00:26:06]:
Yes. It's all based on behavior and on action that's within our control.

Pat Millea [00:26:12]:
Yeah, Yeah, I love that. Okay. Do things that make me happy. Okay, Are you all writing that down, by the way? Do happy things. Okay, great.

Anthony Isacco [00:26:19]:
That has been a theory. It's been around for decades. It's been researched, empirically supported, and the treatment for that is called behavioral activation treatment. And it's all based on let's get people to do things that make them feel better about themselves.

Pat Millea [00:26:33]:
Yeah. Yeah, I love it. That's great. I was thinking through, you know, in that same kind of relationship between depression and faith. There are a couple different places in scripture, especially in Paul's letters, where we are told things like, rejoice always. I say it again, Rejoice. Right. A real focus on the joy that comes from the life of a disciple.

Pat Millea [00:26:57]:
And I wonder if there are folks who are afraid that an experience of depression is somehow against the law of God or opposed to God in some way, maybe even up to the point of asking the question, is, is it a sin to be depressed? What would you have to say about that?

Anthony Isacco [00:27:19]:
Yeah, I think it's a real thought provoking question. And I think it's one of those questions you can kind of go a lot of different directions. You know, I think there is, you know, a biological basis to depression. As we talked about, we had that biopsycho spiritual social model that we laid out. So if someone's like, predisposed or vulnerable to depression, family genetics, things like that, you know, of course that's not sinful or, you know, that was not something that was of the free will to. You know, I don't. I've never met anybody that woke up, came to my office and said, I wanted to be depressed. You know, I wanted this to happen to me.

Anthony Isacco [00:28:00]:
And I made a lot of bad choices to make that happen.

Pat Millea [00:28:03]:
Sure, right, right.

Anthony Isacco [00:28:04]:
But certainly, you know, people can feel depressed because of sinful behavior and bad choices. You know, I'm thinking of, you know, young men that I've worked with clinically over the years. Young men in college. You know, they go off to college and, you know, they don't always make the best decisions in college, you know, and so one of the things I'll do is I'll say to them, you know, walk me through your day, tell me what you do. And by the end of the day, it's like, all right, so you've slept around, you've smoked a lot of weed, you skipped classes, you've tried to cheat on your assignments. Like, no wonder you don't feel good about yourself at the end of the day. Like, I'm kind of getting a little depressed hearing about your day. And so that kind of moral behavior or immoral behavior can certainly contribute to depressive feelings.

Anthony Isacco [00:28:57]:
And again, it kind of goes back to, like, behavior. Like, we have to change some behavior so you feel better about yourself. And that's where there's like an intersection between healthy psychological behavior and healthy moral behavior as well.

Pat Millea [00:29:12]:
Right, right. Yeah, it's. I think it's really interesting to consider, kind of. And I've heard Kenna talk about this as well from her clinical experience that as you mentioned, some contributing factors to depression or the lack thereof are just biological. They are, they're temperamental. We might say that they come with some people's chemistry, brain makeup, biology. I personally am not a person who is prone to depression. I have a thousand other weaknesses, but I'm missing that one, thanks be to God.

Pat Millea [00:29:47]:
So I do not. And sometimes, actually it's really hard for me to understand people's experience and I really have to listen hard because it's, it is so foreign to me. It's hard for me to grasp. And Kenna, from her clinical practice has had the same experience that she is not prone to depression either. And when folks have been in her office presenting symptoms of depression, there's a, you know, kind of a weaker, fallen part of her who just wants to say, like, just stop it. Just get up, get out of bed, go, go do something. You know what I mean? And she stops herself because that is not helpful, I presume in a clinical context, but maybe there's a place for it, I'm not sure. But no, she stops herself and just is able to have good empathy, create some kind of strategies with the person.

Pat Millea [00:30:31]:
But is that a challenge to create action and motivation or to help someone to create motivation of their own in the midst of an experience that is so inherently passive and kind of demotivating?

Anthony Isacco [00:30:49]:
Yeah, I mean, one of the kind of the, the foundational skill sets that we teach our students and that we've learned as professionals whenever we were students is kind of the micro skills of building a relationship. Okay. You know, and those include like active listening, asking open ended questions, being able to listen to people and hear their stories. And perhaps the most powerful micro skill is empathy and being able to have empathic regard for people. Those are all things that build trust in relationship, build rapport. And that becomes the foundational, you know, kind of mechanism, so to speak, to the therapeutic relationship that allows you to do the harder work. Like you need to get out of bed in the morning, you need to go to work, you need to get dressed, you need to brush your teeth, you need to plan something else that gives you pleasure in your life to kind of break this cycle of depression. And so the micro skills kind of facilitate all the harder work.

Anthony Isacco [00:31:51]:
And that's why kind of next week and you know, whenever we move from our residency into kind of week two and week three and week four, the first semester in the program, the students are going to start doing some role plays they're going to start learning some of those micro skills, practicing those micro skills because they're so foundational. When I get lost in a session, I will often just kind of refer back to the micro skills. Let's just get back to basics. I mean, hear what's going on. Because from the client's point of view, it's so validating. They feel affirmed and they feel connected to you. And whenever you feel affirmed by someone and you feel connected to someone and you feel validated, you're more likely to kind of go along with their program on what they think is going to be helpful for you, you know, so, you know, using some of these techniques to kind of break, you know, that that kind of diagnostic sense of depression requires some hard work. It requires some courage, you know, like the people really, you have to kind of like motive, get some motivation going.

Anthony Isacco [00:32:57]:
You know, they've been kind of going in one direction for a while now, and you're basically saying, stop.

Pat Millea [00:33:03]:
Yeah.

Anthony Isacco [00:33:04]:
And we're going in this direction.

Pat Millea [00:33:05]:
Yeah.

Anthony Isacco [00:33:06]:
And so, you know, that's where the therapeutic relationship comes into play and those micro skills and sets the stage for some of that harder work.

Pat Millea [00:33:15]:
Yeah. We just had. Our last episode was with a friend of ours named Beth Hlabse, who heads up the Fiat program for faith and mental health at Notre Dame.

Anthony Isacco [00:33:25]:
Yeah, Beth is great. I know her.

Pat Millea [00:33:26]:
Oh, you know Beth as well? Yeah, she's fantastic. And that was part of the conversation. We had a whole conversation about how to love persons who are suffering with mental illness because it brings up so much in the rest of us, so much fear and anxiety and heartache for them. And she was talking about this exact kind of principle of just wanting to get into fix it mode, like, analytical mode. Like, I want to diagnose, I want to understand, I want to solve. Because, you know, some part of that is very beautiful and well ordered because I want the person that I love to be out of a place of suffering. But I think if we're honest, if we dig deeper, there's something in there that says I want them to stop suffering partially because it hurts me for them to suffer. So there's an element of that fix it mentality that is actually about me and not about them.

Pat Millea [00:34:18]:
And I think it's really healthy to acknowledge that and to just say, like, is that part of my temptation to just switch to fix it problem solve mode? And would it take. What I'm hearing you say, I guess is even outside of a clinical setting, how beautiful of an opportunity this is for. For parents for spouses, for siblings, for neighbors, to be able to just practice some of those micro skills that you're talking about to, to not switch directly into, well, what made you depressed, let's eliminate the thing and let's be happy again. We're going to go to a movie and all your problems will be solved. Right. Like. Well, it may take a little bit more than that. And it may take not just trying to, quote, unquote, solve the problem, but really meet the person and to try to understand them on a deeper level and to know their experience better so they don't feel so alone in the experience, even if it doesn't get taken away immediately.

Anthony Isacco [00:35:09]:
Yeah. Your wife Kenna made a couple of these points yesterday during her presentation. I'll highlight. One is for people of faith, you can't just pray away a negative emotion.

Pat Millea [00:35:20]:
Right, Right.

Anthony Isacco [00:35:21]:
You know, and number two, as clinicians, you know, one of her themes that really seemed to resonate with the students and we talked a lot about afterwards was spiritual poverty of the clinician and that we only have so much to offer to the clients that come to see us. There's only so much we can do. There's a lot that we want to do, there's a lot that we want to change in the clients. And. But at the end of the day, you know, we have a spiritual poverty in terms of the change that we can enact. And it's ultimately up to the person, you know, and their responsibility. And that's. It was a beautiful reflection.

Anthony Isacco [00:36:02]:
And the scientific side of me also kind of came out and said that's. That's largely backed up by science in terms of what drives therapeutic outcomes. The person, the client, their motivation, their willingness to change. That has, you know, if you put all that into an equation and algorithm and you study all the factors that drive change, it's the intrinsic motivation and what the client puts in to therapy that produces the best outcomes, the most positive outcomes.

Pat Millea [00:36:34]:
Which is the perfect segue. It's like we scripted it. It's the perfect segue. But before we segue, last call for anyone who is physically in the room with us, if you have any questions for Dr. Isacco that you would like to write down, you can pass those to your right. The lovely and talented Elise will collect them up and then we will deal with them momentarily here. But thanks to your segue to kind of put a bow on the more formal part of our conversation, someone experiencing true clinical level depression with some of the symptoms that you laid out at the very start here needs Genuine mental health care. They need resources that they probably don't have within themselves.

Pat Millea [00:37:15]:
What kind of suggestions or hopes would you have for someone who's listening, who either is experiencing depression themselves, whether it's ever been diagnosed or not, or for someone who has a loved one who is in a time of depression? What kind of encouragements or suggestions might you give folks who are in a spot like that right now?

Anthony Isacco [00:37:36]:
Yeah, well, I mean, the most basic suggestion, and it's very true, like, you don't have to live a depressed life for the rest of your life. Like, it is. It is healable, it is changeable. You can. You can work on it to feel less depressed and, you know, grading it out to the point of, you know, feeling joy and happy, happiness and. And flourishing. You know, there's. There's lots of people I've worked with and other clinicians who, who've worked with people who have been depressed and it seems like an unchangeable condition.

Pat Millea [00:38:09]:
Right.

Anthony Isacco [00:38:10]:
And lots of success, success stories out there, tons of them, you know, and so in part, because the science behind it is pretty rock solid right now in terms of, like, we know the therapeutic modalities and approaches that can treat depression. You know, things like behavioral activation, cognitive behavioral therapy, acceptance and commitment therapy, interpersonal process therapy. They're all out there and we've all learned them or will learn them, and, you know, they can create, you know, the needed change. So there's lots of hope. I think, as a main message that I want to get out there, including things that people can do on their own, free of charge, that don't require a therapist therapeutic approach. So the basics, you know, are get better sleep, have a better diet, exercise more pray, go to mass, do a daily examination of conscience. Those are all just kind of lifestyle, behavioral activities that have all been empirically associated with better mental health, including lowering levels of depression in people.

Pat Millea [00:39:27]:
Beautiful. That's great. I love it. All right, I'm feeling motivated. Elise, it looks like you've got some submissions from folks. Thank you all for doing that. Q and A would have been very boring without any questions, without any Q's to A, if you will. So let's just work through some of these.

Pat Millea [00:39:44]:
We're going to do as best we can with the time that we've got. And if there are any that you just don't want to answer, Anthony, you let me know, okay?

Anthony Isacco [00:39:52]:
Is there a pass button?

Pat Millea [00:39:54]:
There's. Yes, exactly. Pass. No, thank you. Can you have major, major depressive disorder and still work and function?

Anthony Isacco [00:40:06]:
I guess Possibly, Sure. I mean, one of the diagnostic criteria of major depressive. Major depressive disorder is that you are experiencing some dysfunction in some part of your life. Sure. So it doesn't necessarily mean it's in your work life. It could be in your social life, your spiritual life, or another part of your life. And so guessing, you know, I've worked with people who've had MDD and have been in school. They haven't been doing great in school.

Anthony Isacco [00:40:36]:
They've been working again, they haven't been. They haven't been killing it on the job. They've been struggling. But, you know, to have those two things going at once is possible, but it's usually. It's usually harder. People usually notice that they're not at like 100%, you know, they're down, you know, some percentage. And whenever that depression is kind of treated or addressed in some capacity, then you notice there's kind of like an uptick in their productivity, their functioning in those different domains of their life.

Pat Millea [00:41:09]:
Yeah, that makes sense. That makes sense. Next question. In your experience, what symptoms of depression are most commonly overlooked or misinterpreted?

Anthony Isacco [00:41:25]:
Overlooked or misinterpreted? Misinterpreted. I think one of the ones that is misinterpreted is probably suicidal ideation. And so if we want to go into that darker of a place for a moment, yeah, sure. I think when people hear depression, they automatically think someone is thinking of hurting themselves and ending their life. And that's not always the case. And even whenever someone who is depressed that has suicidal ideation, they really don't want to die. They really don't. They really do want to live.

Anthony Isacco [00:41:59]:
But it is a byproduct of just living in this kind of, like, suffering state. And they're like, I've tried different things and I just want to escape this suffering stage. This seems like the only option right now, you know, and so. But it's misinterpreted in the sense of once you give other people. Once you give people other options on how to live and you give them that light through the tunnel, that. That suicidal ideation goes away pretty quickly, in my experience.

Pat Millea [00:42:33]:
That does make sense. Yeah. Yeah. And it's maybe just to follow up there too, is. Is there besides the. The clear. The clear kind of. If someone tells me that they are having thoughts of hurting themselves, ending their life, that's an immediate, clearly 911 or 988 call, that's immediate help.

Pat Millea [00:42:57]:
If they are threatening harm to themselves right now. Are there other red flags or signs that folks can be aware of, that maybe someone isn't, if they don't have a plan in place, if they're not thinking of hurting themselves today. Are there kind of things earlier in the process that we can be aware of in folks that we're around that we love?

Anthony Isacco [00:43:21]:
Social isolation is usually like a big kind of thing to kind of, to be aware of and to track. So if you have a friend, a buddy, family member that you're used to kind of seeing and hanging out with, and all of a sudden they start to really retreat, withdrawal, they don't want to hang out anymore. They're kind of hold up in their house doing whatever. That can be like a real kind of flare up in the sky. Like, yeah, something's going on here. And it really ties into our anthropology as human people. You know, God created us to be relational, to be in community, to be around other people. And so it's counter to our anthropology to be isolating and withdrawn.

Anthony Isacco [00:44:03]:
And so that, that's usually a sign where maybe you want to drive over to your friend's house, knock on the door and say, hey, what's going on? Yeah. And if someone is isolating, one of the best things to do is just get them around other people. I've. I've developed whole treatment plans around getting someone to be more social for that very reason, because it just makes you, it does make you feel better over time.

Pat Millea [00:44:28]:
I love that. I just love the idea of you sitting in the office, like your homework today. Go to friend's house. Here you go. I'll see you next week. That's correct.

Anthony Isacco [00:44:37]:
Go, go to a baseball game with someone, go to the intramural game, go to the cafeteria and have lunch with someone. We've literally mapped out a day by day kind of step by step approach based off of that philosophy. Yeah, yeah, yeah.

Pat Millea [00:44:50]:
That's hilarious. I love that. I love. Yeah, therapy would be. It would get a better rap if people thought they would be required to go to sporting events and movies, you know what I mean? But probably not the treatment for every situation. That's fine. Next question.

Pat Millea [00:45:05]:
It's kind of related to depression, but is maybe even more of a broad question, but certainly relates enough that I think it's very appropriate. How can you help clients, patients understand that therapy and meds can coexist with faith?

Anthony Isacco [00:45:20]:
Yeah, I get that question a lot around medication. Like can a person of faith, someone practicing their faith, take medication? And I've heard this discussed a lot and everything that I've read every, every priest I've talked to for consultation on the matter, has basically concluded that, yeah, you can take medication for mental health reasons. It's not a sin, it's not immoral, it's not contrary to the faith. If we put faith and science together here, the scientific evidence shows that, you know, if someone is experiencing that major depressive disorder diagnosis, medication plus therapy gives you the most bang for your buck, so to speak. You know, kind of leads to the best treatment outcomes. And so I, you know, I've never been anti medication whenever it's been clinically, clinically indicated and prescribed by a provider.

Pat Millea [00:46:14]:
Yeah, yeah, that's the understanding that we've had as well. And again, poor man's perspective. But talking to my very intelligent bride, she'll talk about it in terms sometimes of, you know, she's not a psychiatrist, but she has a lot of clients who are also prescribed medication. And for those clients, what she says is that their function is so inhibited by their symptoms that the medication is never going to solve someone's problems. It is not the silver bullet that's going to take away every negative experience. What it helps many clients do is get from a negative 8 back to a zero. So they can at least be in a place where they can start to receive the benefits of good evidence based therapy. Where without that medication it might be just kind of be like spinning your wheels, you know, My image, not hers, feels like kind of like trying to win the Tour de France on a BMX bike, you know what I mean? Like, yes, it's legal and like, yeah, you can pedal, but it's good luck out there, you know what I mean? But if you give someone like a real bike that is built to function the way it's supposed to, then a lot of that other work is really beneficial.

Pat Millea [00:47:18]:
You can actually do some things in training to really, to really be effective.

Anthony Isacco [00:47:23]:
I think that's a good way to put it. I would agree with that.

Pat Millea [00:47:25]:
Thank you. I'm gonna use that BMX image all the time now. That's great. It just came to me. Must have been the Holy spirit. Okay, this may be the last question that we have time for and I want to ask it because it has a word that I have no idea what this means. Okay, so this is not a test, but if you don't know what it means, somebody in this room is going to have to explain it to us. All right.

Pat Millea [00:47:42]:
How do you treat someone experiencing anhedonia? A N H E D O N I A

Anthony Isacco [00:47:49]:
That's loss of pleasure and things that they previously found pleasurable.

Pat Millea [00:47:54]:
Thank you. See, he beat you out there. Who asked it? See, you were testing the good doctor and he succeeded. I did not. So how do you treat someone experiencing anhedonia as a symptom of depression?

Anthony Isacco [00:48:07]:
It's a very common symptom. And if you haven't been able to tell already, I am a big fan of behavioral activation theory and therapy, so I'll kind of go back to that to answer this question, which is, you know, you experience depression because you're not doing things that are pleasurable anymore. So behavioral activation gives you an opportunity to say, well, what, what? Let's hype, let's kind of explore here. Let's hypothesize this. Let's experiment. What do you think could give you pleasure? Now, you know, if we don't want to go back to playing racquetball, how about squash? You know, if you don't like this parish over there, how about a different parish over here? You know, that's, that's. You still have to do something that gives you meaning, purpose, and pleasure that can lead you to happiness. Now there's lots of room for conversation on what that might be at this point in your life.

Anthony Isacco [00:48:59]:
And so that's kind of identify and explore and experiment. And we can always like, readjust. We don't have to go back to something that isn't gonna work for you right now in your life.

Pat Millea [00:49:09]:
Sure, sure. That's great. I love that. What I'm most struck by is the fact that squash and racquetball are not the same thing.

Anthony Isacco [00:49:16]:
They're very different sports.

Pat Millea [00:49:18]:
They're very different, yes. Like how different?

Anthony Isacco [00:49:20]:
Well, squash, I mean, you're playing with like a dead ball, basically. It doesn't bounce very. I mean, very low bounce, really, to it. Racquetball, the ball could be kind of going all over the court. Yeah, like that. It's a very bouncy ball.

Pat Millea [00:49:33]:
The man of all seasons here. This is. You can, you know, everything. I famously, when I was in grad school, my. My assigned mentor was a pastor at the parish that I was working at. And one time he was like, hey, why don't we just have our mentoring sessions playing racquetball? And he was like a 60 year old priest and I was like, excellent idea. That sounds great, old man. Let's do it.

Pat Millea [00:49:53]:
He beat the living bejeebers out of me. It was someone who's good at racquetball. Like they know exactly where to put the ball to make you run five miles. And they don't Move. So I was chasing this ball around. He was just standing in one, but he wasn't even looking at the ball. I don't think he was just embarrassing.

Anthony Isacco [00:50:10]:
I've had that same experience with a 60 year old priest. Seriously, where I've, at the end of the game, I've been drenched with sweat, I've lost 21 nothing. And the 60 year old priest is like patting his brow like, you know, when's the next game gonna start here?

Pat Millea [00:50:26]:
Are they in, like, is there a message board that they have? Are they like inflict their skill on us young folks? Oh my gosh, that's hilarious. And only a little bit embarrassing. Thank you for the questions. That's beautiful. If you have remaining questions, Anthony will be here for the rest of the next two years, so you can talk to him at any time. To kind of wrap this up for folks that are listening, you know, one of the things we like to do is propose a challenge by choice where they might make active and practical some of the things that we've been talking about. I would be happy to offer one, but I suppose that you might even have a better one. Anything come to mind for you?

Anthony Isacco [00:51:00]:
So challenge by choice, I would say in terms of an integrated framework that we've been operating from and what our program is built upon, I'd say kind of take something in your life, a faith practice, whether it be a sacrament, going to Mass, praying, talking to a spiritual leader, like a priest, make it a goal within the next week, week to do, to do one of those things. And then add in, you know, something psychological, social as well too. You know, is there a family member, a friend, an activity like exercise, a particular, like healthy meal that you've been meaning to make, make that a goal over the next week to do one of those things as well. So you have kind of both those kind of goals converging, so you get the spiritual and the psychological social coming together.

Pat Millea [00:51:51]:
Beautiful. I love it, I love it. Yep, nothing too overwhelming, but just really good, practical things that, like you said, scientifically, they actually work. This is not just spinning your wheels. These things really move the needle.

Anthony Isacco [00:52:02]:
This is science, people. Let's follow the science.

Pat Millea [00:52:05]:
I love it. I love it. Well, speaking of faith and science, can we pray to wrap up our conversation?

Anthony Isacco [00:52:10]:
That'd be great.

Pat Millea [00:52:10]:
And then send some folks off to activate their behaviors. Sound good? Okay, sounds great. Name of the Father, Son and the Holy Spirit. Amen. Lord God, we thank you for your goodness, for your love, thank you for the grace that you offer us every day. For your presence with us in this place, for your presence with us in all the circumstances of our lives. Those that are full of joy and beauty, as well as those that are full of suffering and hardship. Lord, we pray in particular today for all of those who are having any kind of experience of depression or despair.

Pat Millea [00:52:48]:
Lord, you know how they're feeling. You know the sense of the ways they feel. Maybe hopeless, maybe like they're. They're walking through quicksand and can't move their minds, their bodies, their souls, the way they desire. And Lord, you know the ways that the things that have contributed to this feeling for them. And most of all, Lord, you know they're good. You know your love for them, you know how valuable they are to you. So we entrust all of them to you today, Lord, that they might recover a sense of their own self worth, that they might recover a sense of your love for them and their identity, not in the things they do, but their identity as a beloved son or daughter of yours.

Pat Millea [00:53:36]:
Lord, help all of us to be people of empathy, people of understanding and love, so that we can help reflect back to those that we love their own goodness and worth and help us to be agents of healing through your holy spirit working in us. We ask all this, Lord, in your holy name, Amen. In the name of the Father, Son and the Holy Spirit, amen. Dr. Isacco, any connection points or anything that you would give for the new program here at St. Mary's University, Ways to stay in touch with you or the program?

Anthony Isacco [00:54:10]:
Oh, yeah, thank you for that question. Well, you can check out our website on St. Mary's University website smumn.edu clinical psychology. So please check out our website. If you know of anybody that's interested in pursuing a career in the mental health profession, you could send them our way. I'd love to talk with them, particularly people who are interested in a faith integrated clinical psychology program. That's what our mission is. And so, you know, we're a growing program that we're launching our second cohort this year and our next cohort will be in fall 2026.

Anthony Isacco [00:54:49]:
And so one of the nice things about being a new program is that everything's new. So we're building it as we're operating it, and we're looking for kind of trailblazers and people with a real adventuresome kind of spirit to them, because that's the nature of our program right now.

Pat Millea [00:55:04]:
Me and Kenna were the first and second groups of our graduate program at Notre Dame. So I can vouch for the, the joy and the terror of being part of a new thing. But I'm telling you, like, that program is now in its 23rd year or something like that. And looking back, like, it's one of the best things I ever did. It's just the best. So if you got a spirit of adventure, give Dr. Isacco a call.

Anthony Isacco [00:55:26]:
Absolutely. Please do. I'd love to hear from you.

Pat Millea [00:55:28]:
For sure. For sure. Friends, thanks so much for being with us. Thanks. For those of you who are in the room with us, thank you for being a part of the conversation. Thank you for listening at home, wherever you are. You can always check out This Whole Life on our website, thiswholelifepodcast.com you can follow us on Instagram @thiswholelifepodcast. We would love to hear what your thoughts and questions are around this topic, around depression or your experience of it.

Pat Millea [00:55:49]:
Folks with loved ones, you can send us a message and we will see you next time on This Whole Life.

Kenna Millea [00:56:08]:
This Whole Life is a production of the Martin Center for Integration.

Kenna Millea [00:56:12]:
Visit us online@thiswholelifepodcast.com. We spent about five minutes at the Alamo.

Pat Millea [00:56:32]:
Same here.

Anthony Isacco [00:56:32]:
Like, that's it. All right.

Pat Millea [00:56:34]:
The Alamo, Rushmore were the same experience for me of like, yep, there it is. And then that's enough. We're gone.

Anthony Isacco [00:56:41]:
Back in the car.

Pat Millea [00:56:43]:
Seriously.