UNDERSTANDING DEPRESSION

Depression can be difficult to diagnose because it presents differently in each person.    Depression treatment should be tailored to the individual person based ontheir symptoms.   In order to determine the depression treatment that is right for you, it is important to understand how depression impacts your daily life.  When you think of depression you think of sadness, right?  Unfortunately for many patients the first symptom is not sadness.  It can take a person a while before they identify  they are depressed.  Some of my patients notice that they are irritable, eat less, and struggle with insomnia before they start to feel depressed and sad.  Other patients  sleep more, eat more,  and stop enjoying the pleasure of life for several days or even weeks before they begin to feel depressed.  Depression has many faces and can also be a normal emotion.   Understanding the difference between the emotion and the illness is quite important and often difficult to determine without the help of a psychiatrist or psychiatric PA.

When Does Depression Become a Medical Illness?

Major depressive disorder (MDD) is the illness of depression.  This illness occurs when you feel either sad or lack interest or please in your activities most of the day, nearly everyday for at least 2 weeks in a row.  You must also have at least 4 of these symptoms that occur most of the day nearly every day for at least 2 weeks in a row:

• weight loss or weight gain
• insomnia or sleeping too much
• moving slowly which could include slow speech or walking slowly
• fatigue or loss of energy
• feelings of worthlessness or excessive guilt
• difficulty with concentration
• recurrent thoughts of death or suicidal thoughts

When depression becomes an illness it has a negative impact in more than one area of your life.  This means it is not just occurring when you are work because you don’t like your job.  It wouldn’t just occur at home because you are unhappy in your marriage.  When depression is a medical illness it occurs at work, home, and in your social life.  While you might be able to push through it,  you are unable to function at your normal level.  Key Facts About Depression According to the World Health Organization (WHO) [1]

• Depression is a common mental disorder. Globally, more than 300 million people of all ages suffer from depression.
• Depression is the leading cause of disability worldwide, and is a major contributor to the overall global burden of disease.
• More women are affected by depression than men.
• At its worst, depression can lead to suicide.
• There are effective treatments for depression.

Other psychiatric illnesses that causes symptoms of depression

ADHD can lead to brief bouts of depression that tend to be triggered by boredom, rejection, or disappointment in themselves or others.   While someone with ADHD may feel depressed daily, each bout of depression does not last more than a few minutes or hours.  Most patients with ADHD notice a significant improvement in their mood symptoms once they are on the right medication regimen for their ADHD.    Working with a therapist to learn how to cope with the mood symptoms of ADHD can also be helpful.

Depression commonly occurs in people who have anxiety disorders.  For example, post traumatic stress disorder, obsessive compulsive disorder, or generalized anxiety disorder frequently cause symptoms of depression.  As you can imagine, struggling with feelings of high anxiety for an extended period of time it is quite depressing.  Sometimes anxiety disorders can lead to major depressive disorder.  It is also a common symptom of bipolar disorder, schizophrenia, and schizoaffective disorder.

 Medication Options

Depression treatment and interventions should address your unique needs.   Medications should target the symptoms that are most problematic for you.  It is important to determine the symptoms which are impairing your ability to work and enjoy life.    There are many different types of antidepressants on the market.   The most commonly prescribed antidepressants are Selective Serotonin Re-uptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRI).   The medications in these classes are all effective for depression treatment.  However each has unique features that will impact the individual person’s response to the medication.  For this reason, it is important to work with a clinician who understands the nuances of the medication.    It is also very important to understand that antidepressants do not work quickly.   You typically see a 10-20% improvement each week you take the medication.  You will see the maximum benefit after 6-8 weeks.   Due to the complexity of depression it is not unusual for psychiatric specialists to prescribe more than one medication.  To avoid taking multiple medications, consider improving your emotional health by working with a therapist.

Therapy Options  

Dialectical behavioral therapy (DBT) and cognitive behavioral therapy (CBT) are both effective treatments for depression.  For mild depression, both types of therapy can be effective in place of medication.  For moderate to severe depression DBT and CBT are useful in conjunction with medication.  By adding these therapies to your treatment regimen you will likely be able to maintain stability on less medication.   Take a few minutes to read this article Depression Treatment: Why is Therapy Important in the  Treatment of Depression and Anxiety to learn more.   

Additional Resources

[amazon_link asins=’0452281326,1572249560,1462520421′ template=’ProductCarousel’ store=’amazon0dd30-20′ marketplace=’US’ link_id=’72710b48-91a2-11e7-9f85-63d394223e2a’]

[1] World Health Organization (WHO), Depression fact sheet,Retrieved from, http://www.who.int/mediacentre/factsheets/fs369/en/