Depression is an illness that deserves treatment
When symptoms of depression last for weeks and significantly impact your life, it’s time to get help
By Ladson Hinton, M.D., and Robert Hales, M.D.
Everyone feels down, depressed, or sad sometimes. But when these feelings last more than a few weeks and begin to impact important aspects of your life, such as work and family, it’s time to get help.
While most people think of depression as a feeling of overwhelming sadness, depression can actually be experienced in a variety of ways. Individuals may experience hopelessness and depressive symptoms such as sadness and tearfulness throughout the day. There may be a slowing down of thoughts, with problems concentrating and making decisions. Some people become restless and agitated. Other people may experience depression primarily in terms of feelings of uselessness, worthlessness, or even anger and irritability.
Sleeping patterns are often disturbed, as well. Some feel lethargic and sleep a lot during the day. Many have insomnia with early morning wakening. Most feel guilty and lack energy to accomplish tasks. Also, people with depression are usually uninterested in sex.
Robert Hales was the Joe P. Tupin Endowed Chair and Professor in the UC Davis Department of Psychiatry and Behavioral Sciences from 1998 until his retirement in 2018. Ladson Hinton, M.D., now serves as the Interim Chair and Director of Geriatric Psychiatry.
Depression can destroy joy for living and make it impossible to focus on work and responsibilities. Often, depressed individuals simply lose interest in normal activities. They may become withdrawn from work, hobbies, socializing with friends and being with family. Thoughts of death or suicide may enter their minds.
People who suffer from depression often have other mental health conditions, which can include anxiety, post-traumatic stress, alcohol overuse, and other substance use disorders.
Suicide is a real danger for depressed individuals, and it's important that family members and close friends assess the risk.
Knowing the warning signs can help if you suspect someone is considering suicide.
10 percent of Americans experience depression in any given year
Depression is a common disorder that is too often ignored and left untreated. Major depression is the single most widespread mental disorder, affecting 10.3 percent of Americans in any given year. The highest rates occur for individuals between 25-44 years of age, with women affected about two to three times more often than men. But depression is common across the life cycle.
Untreated, an episode of depression may last for months, and even years. And, people who are prone to depression are likely to experience recurrent episodes throughout their lifetimes. If untreated, depression can also worsen the outcomes for other medical conditions and raise the risk of death. Studies have shown that heart attack patients who are depressed are more likely to die than heart attack patients who don’t exhibit depression. And, of elderly people admitted to nursing homes, those who were depressed had higher death rates. Suicide, of course, also increases the mortality from this disorder.
While family and friends can be important sources of support for people who have experienced depression, there is often a need for professional help, as well. Friends and family can sometimes play an important role in encouraging someone who is depressed to seek care or by supporting their treatment. However, sometimes family, friends, or the person with depression themselves may view depression as a “normal” reaction to stressful life events or health conditions. While depression is often triggered by these situations, it is a medical condition that deserves treatment.
Several effective treatments are available
Fortunately, effective treatments are available. The first step is to get a good diagnosis and to make sure that an underlying medical condition or substance use disorder is not triggering depression. This can be done by a primary care physician or by a mental health professional. Work with your doctor until you find what works best for you and, if necessary, to refer you to mental health professional.
Some people, especially those with mild to moderate depression, may wish to talk through problems using an evidence-based form of psychotherapy usually delivered by a clinical psychologist, social workers or nurse. Effective forms of psychotherapy include problem-solving therapy, interpersonal therapy and cognitive-behavioral therapy. A therapist, for example, can help an individual develop a more positive self-image and learn how to better cope with stress and relationships. Even behavioral changes such exercise, scheduling activities that are or have been a source of enjoyment or pleasure, regular sleep, and mindfulness meditation (a form of stress reduction) can be helpful.
Medications can also be an important part of treatment, particularly if depression is more severe or psychotherapy alone doesn’t work. While there is still a lot we don’t know about why antidepressants are effective, they may impact neurotransmitter levels in the brain that are implicated in depression. A variety of drugs have specific actions that target this problem. When psychotherapy is combined with antidepressants, the percentage of patients successfully treated is even higher than antidepressants or psychotherapy alone. Additional treatments such as transcranial magnetic stimulation (TMS) are also now approved for depression treatment.
Finding the right medication
A number of medications are approved for depression treatment and finding the right medication is critical. Some people need to try a few different ones before they find one that works well and has the fewest side effects.
Some medications may not be combined with other medications or used if certain conditions are present. It’s also important not to mix prescription antidepressant medications with herbal antidepressant remedies, such as St. John’s wort.
Up to two-thirds of depressed patients who take antidepressants benefit from them. Often patients improve drastically within the first 3-4 months after being treated. Newer antidepressants — such as Prozac, Zoloft, Cymbalta, Effexor, Wellbutrin and others — are safer and much better tolerated than the older tricyclic antidepressants such as Tofranil, Elavil and others. Sometimes antidepressants are combined with other medications, such as thyroid supplementation, mood stabilizers (Lamictal, Tegretol, Lithium) or antipsychotic medications (Zyprexa, Seroquel, Abilify).
Medications may take a few weeks for improvement to start being felt, frequently require adjustments in dose, and often need to be continued for at least 6-12 months after someone is feeling better. For people who have an ongoing problem, taking the medications indefinitely may be indicated because of the high risk for recurrence. Antidepressants should only be discontinued with the advice of a doctor and should not be stopped abruptly. Some types of medications need to be tapered off slowly in order to avoid a rebound reaction with even more intense depressive symptoms.
Know the signs and take action
It’s important to recognize the signs of major depression, a biological or medical illness just like other physical ailments. Important questions to ask if you suspect someone’s depressed are:
- Do you feel sad, anxious, tearful, irritable, or hopeless for most of the day, almost every day?
- Have you lost interest in eating, sex, socializing, or your favorite activities?
- Are you eating more or less than usual? Have you gained or lost weight?
- Are you sleeping more or less than usual?
- Do you feel as if you’re talking or walking in slow motion? Do you fidget constantly or find yourself incapable of staying still?
- Are you always tired? Are you too weary to tackle even small chores?
- Do you feel worthless or guilty about something?
- Are you having problems in thinking, concentrating, or making decisions?
- Have you been thinking more and more about death? Do you ever think you’d be better off dead? Have you thought about killing yourself?
Many people will answer “yes” to at least one of the above questions. If you are feeling down, you might respond “yes” to two or three, perhaps four. If you answer “yes” to more than four questions, you may need professional help, either from your primary care physician or a psychiatrist. If you are thinking about harming yourself, or know someone who is, tell someone who can help immediately.
In summary, similar to other medical disorders, depression may be treated and most people can get better. The important task for all of us is to recognize when a friend, co-worker or loved one is suffering from depression and to recommend that they seek treatment.