Depression is an illness that deserves treatment

depressed woman staring out the window
More traditional systems of support may not help clinical depression — and sometimes people regard depression as a personality characteristic that one just has to live with. This isn’t true and is a dangerous point of view.

Posted on June 2, 2010

By Robert Hales, M.D. 

Everyone gets the blues sometimes. But when a few days of the blues turn into weeks and affect many aspects of your life, it’s time to get help. 

Most people think of depression as a feeling of overwhelming sadness. While this is often the case, psychiatrists recognize that depression instead may take other forms. Often, depressed individuals simply lose interest in normal activities. They may become withdrawn from work, hobbies, socializing with friends and being with family.

Sleeping patterns are often disturbed as well. Some feel lethargic and sleep a lot during the day. Many have insomnia with early morning wakening. There may be a slowing down of thoughts, with problems concentrating and making decisions. Some people become restless and agitated. Many people have frequent thoughts of death and suicide.

About the author

Dr. Hales © UC RegentsRobert Hales is a psychiatrist with UC Davis Health System. He is the Joe P. Tupin Endowed Chair and Professor for the Department of Psychiatry and Behavioral Sciences.

15 percent experience depression

Depression is a common disorder that is too often ignored and left untreated. About 15 percent of the population experiences depression some time in their lives, with women affected about twice as often as men. 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.

Unfortunately, traditional systems of support may not be up to the task of helping with clinical depression. And sometimes people regard depression as a personality characteristic that one just has to live with. This isn’t true and is a dangerous point of view.

Untreated, depression has a significant mortality rate. 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. 

woman riding bike on path
Getting more exercise has been shown helpful in alleviating symptoms of depression.

Several effective treatments available

Fortunately, effective treatments are available. I advise you to work with your doctor until you find what works best for you. Some people, especially those with mild to moderate depression, may wish to talk through problems. A good counselor can help an individual develop a more positive self-image and learn how to better cope with stress and relationships. Getting more exercise has also been shown helpful in alleviating symptoms of depression.

For some people, these steps aren’t enough. Depression is associated with disturbances in levels of neurotransmitters in the brain. A variety of drugs have specific actions that target this problem. Medications may take a few weeks for improvement to start being felt.

Finding the right medication

Suicide risk

Suicide is a real danger for depressed individuals, and it is important that family members and close friends assess the risk. Some people are afraid that asking about suicidal intention “puts ideas in people’s heads.” But for most people who are considering suicide, it can actually be a relief to unburden these terrible feelings.

Individuals who have an actual plan to commit suicide (for instance, a set date and a means of doing it, like a weapon or stash of pills) are most likely to be in immediate danger. Professional help must be sought without delay.

It’s important that each individual find the right medication. Some people need to test 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.

Two-thirds of depression patients who take antidepressants benefit from them. Newer antidepressants — such as Prozac, Zoloft, Paxil and other selective serotonin reuptake inhibitors or "SSRIs" — are safer and much better tolerated than the older tricyclic antidepressants such as Tofranil, Elavil and others.

Antidepressant medications are usually taken for at least six months for a first episode of depression. For people who have an ongoing problem, taking the medications indefinitely is indicated. 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. 

Cognitive therapy can help

Psychotherapy and, in particular, cognitive-behavioral psychotherapy is as effective as antidepressants in treating mild-moderate depression. 

When psychotherapy is combined with antidepressants, the percentage of patients successfully treated is even higher than antidepressants or psychotherapy alone.