FEATURE | Posted Aug. 14, 2014

Depression is an illness that deserves treatment

When the blues last for weeks and affect much of your life, it’s time to get help

Depression can destroy joy for living and make it impossible to focus on work and responsibilities.

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 such as major depression, persistent depressive disorder, medication induced depression and bipolar depression.

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.

Robert Hales is a psychiatrist and the Joe P. Tupin Endowed Chair and Professor in the UC Davis Department of Psychiatry and Behavioral Sciences.

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.

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 They may become withdrawn from work, hobbies, socializing with friends and being with family.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.

Suicide risk

Suicide is a real danger for depressed individuals, and it's important that family members and close friends assess the risk.

Here are the questions that should be asked if you suspect someone is considering suicide.

Read more

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.

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 death 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.


Several effective treatments available

Fortunately, effective treatments are available. 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 therapist 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

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.

Approximately 75-80 percent of depression 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 mood stabilizers (Lamictal, Tegretol, Lithium) or antipsychotic medications (Zyprexa, Seroquel, Abilify).

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 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.


Psychotherapy can help

Various forms of psychotherapy and, in particular, cognitive-behavioral psychotherapy may be as effective as antidepressants in treating mild-moderate depression. Other forms of psychotherapy are also helpful especially when combined with medications. These include psychodynamic, interpersonal, supportive, marital, family and group psychotherapies.

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

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. Read more

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.