Could You be Depressed?

Everyone has bad days when we feel discouraged or a little blue. We feel grief or sadness after the death of a family member or the loss of a job or an important relationship. These are normal reactions to life events, and we can expect them to resolve after a period of adjustment.

Depression is a medical illness which may result from stressful life events or may arise without an identifiable trigger. It differs from normal grief or sadness in that symptoms go on almost every day for at least two weeks and disrupt a person’s functioning at work or in other relationships. While depression is sometimes associated with sadness or frequent crying, it may instead be characterized by loss of interest or pleasure in activities. Other symptoms include feelings of guilt or worthlessness and thoughts of death and suicide. Many people who suffer from depression also experience severe anxiety. Physical symptoms include poor concentration, decreased energy, increased sensitivity to pain, sleep disturbances, unintended weight changes, impaired sexual desire and performance and restlessness or decreased activity that is noticeable to others.

The cause of depression is unknown but probably involves a combination of factors including genetics, personality type, stressful life events and other illnesses or medications. Depression is very common, affecting 10 percent of men and 20 percent of women—or 32 million people in the U.S.—during their lifetimes. Although it causes great pain and suffering in patients and families, it is often undetected and untreated.

Depressed patients often feel hopeless and may view depression as a sign of weakness or as a character flaw. As a result, they may not seek help from their doctor or, when diagnosed, they may be reluctant to accept treatment. Studies have shown that primary care physicians typically fail to recognize depression in 30 to 50 percent of their depressed patients, making it even more difficult for the depressed person to receive treatment.

Appropriate diagnosis and treatment is vital. Untreated, severe depression has a 10 percent risk of death by suicide. It also leads to increased medical illness in people with many medical conditions, including coronary artery disease and diabetes.

Many good treatments are now available, including drugs and psychotherapy. Fifty to 60 percent of patients who are treated by their primary care physicians get better with the first drug that is prescribed. More than 80 percent are eventually matched with a successful medication. Psychotherapy involves talking with a therapist, often over a 10- to 20-week period, and learning better ways to solve problems and change pessimistic thoughts that may worsen depression. I will address the treatment of depression in more detail in next month’s North Hills Monthly column.

If you have symptoms of depression, recognize that the negative feelings of hopelessness are part of the illness. They do not typically represent the reality of your situation. Do not expect too much of yourself during this time. Try to be with other people and participate in social activities or light exercise. Remember that help is available and see your doctor. Help your doctor to make the diagnosis, if appropriate, by telling him or her that you believe that you are depressed. Point out specific symptoms that you have been experiencing.

If someone you care for seems depressed, help them get an appropriate diagnosis and corresponding treatment. Get them to see a doctor and accompany them if you feel it’s necessary in order for the doctor to have enough information to make the right diagnosis. Offer emotional support and a willingness to listen. See that they continue appropriate treatment until symptoms resolve and a doctor agrees to discontinue medication. Encourage them to participate in activities. Don’t ignore talk of suicide—notify a family member or doctor immediately. Remember that the depressed person can’t just “snap out of it,” but requires patience, understanding and appropriate treatment.

Dr. McMahon, a graduate of Yale University and the University of Pittsburgh School of Medicine, is board certified in Internal Medicine. She is a member of the American College of Physicians and the Allegheny County and Pennsylvania Medical Societies. She is in solo practice in the North Hills of Pittsburgh.