You’re sitting in one of the exam rooms at your primary care physician’s office. You’ve just finished explaining that you don’t feel like yourself. You’re having trouble sleeping.
You can’t seem to concentrate. You don’t have any energy. You’ve started to gain weight because you’re inexplicably eating too much.
Clearly, there’s something wrong with you, and you need to figure out what it is. And you’re surprised when the doctor tells you that you’re experiencing the hallmark symptoms of depression and suggests that you take an antidepressant and seek counseling to help you return to normal.
While the diagnosis might catch you off guard, it’s not an uncommon one, especially in recent years. According to Christopher B. French, PhD, licensed clinical psychologist and chief executive officer of Northside Psychological Services Inc., “People are increasingly feeling the stresses and strains of major life events, both local and global. Events like 9/11, national and global disasters like Hurricane Katrina and the earthquake in Haiti and the wars in Afghanistan and Iraq have all produced anxiety and a sense of a lack of control over one’s life. When anxiety is heightened, it can develop into depression.”
Kimball Johnson, MD, medical director of the Jobri Center for Integrative Health, notes that today’s technology might be adding to that heightened level of apprehensiveness—and ultimately depression—in many people. “We are overstressed, over-connected and there’s a lack of downtime with the technology,” she explains. With bad news streaming on television, online and on an array of gadgets practically around the clock, people are being inundated with negative reports from around the country and the world. Of course, their personal situations can have equally adverse effects on their mental and emotional states.
French continues, “The economic downturn in the United States has caused a great deal of anxiety in many people in the last 5-10 years. People who have worked hard their whole lives to build a secure life for themselves and their family can no longer count on their hard work paying off; in many cases, people have lost a substantial amount of their life savings due to the economy and have taken hits to their current earning potential due to job loss. Across the country, this has caused a sense of a general loss of control, a feeling that you can no longer depend on your ability to work hard in order to break even or get ahead. This kind of long-term loss of control is overwhelming and can change the mindset of an individual, making them much more prone to mental and emotional health issues.”
Differences in depression
While you’re probably acquainted with the term “depression,” you may not realize that there are different types of depression. To tackle the mental disorder in the right way, you have to know what you’re dealing with first. All forms of depression fall under the umbrella of mood disorders, according to the National Institute of Mental Health (NIMH), and each one is a physical illness that has its own distinct characteristics. They do share symptoms, however, which include:
- Persistent sad, anxious or "empty" feelings
- Feelings of hopelessness
- Feelings of guilt, worthlessness or helplessness
- Irritability or restlessness
- A loss of interest in activities or hobbies that once felt pleasurable
- Fatigue and decreased energy
- Difficulty concentrating, remembering details and making decisions
- Insomnia or excessive sleeping
- Overeating or a loss of appetite
- Persistent aches or pains, headaches, cramps or digestive problems that do not ease even with treatment
- Thoughts of suicide or suicide attempts
The type of depression you experience is directly related to the number of symptoms you have, as well as their severity and how long they last. With this in mind, the NIMH defines the following as some of the most common types of depression:
- Major Depressive Disorder: Also referred to as clinical or major depression, major depressive disorder is diagnosed when the symptoms you experience interfere with your ability to function on a daily basis. The depression usually occurs in episodes and can happen only once or several times during a person’s lifetime. Thomas Bradford “Brad” Johns, MD, medical director of the Ridgeview Institute in Smyrna, notes that the presence of at least five symptoms of depression will help lead to a diagnosis of a major depressive episode; the NIMH reveals that this disorder affects 14.8 million American adults and is more prevalent in women than in men.
- Chronic Depression: Lasting at least 2 years in adults or 1 year in children, chronic depression, known as dysthymic disorder, affects 3.3 million Americans, or 1.5 percent of the adult population. Johnson explains that chronic depression, which features symptoms that are less severe but more persistent, is not attributable to a specific cause or event—it’s simply a condition that appears and can be punctuated by episodes of major depression. Again, women experience chronic depression more often than men.
- Postpartum Depression: Experienced by women who have recently given birth, postpartum depression usually occurs within 1 month of delivery. The NIMH reports that between 10 and 15 percent of women experience this type of depressive disorder, which can be moderate to severe and typically requires treatment.
While situational depression is not officially listed as one of the leading forms of depression, it is getting more attention as people find themselves facing unfamiliar and uncomfortable circumstances that eventually foster symptoms of depression. As French explains, “People can certainly experience situational depression, commonly referred to as an adjustment disorder. Adjustment disorders are short-term conditions that occur when you are unable to deal with a specific environmental stressor, such as a major life event, including the death of a loved one, getting a new boss or moving to a new city. To be diagnosed with situational depression, the symptoms must have begun within three months of experiencing the stressful event, and the specific stressor must have caused distress that is above and beyond what one would normally have expected to experience in response to the event.”
Chris F. Riddell, MD, medical director of WellStar Psychiatry LLC in Marietta, adds, “The symptoms of situational depression are usually in the form of grief, and most situational depressions are caused by a loss. They tend to focus around feelings of grief, sadness and fearfulness. And situational depressions can happen to anyone. In fact, situational depression is quite common, and everyone will experience a ‘situational depression’ during the course of their lifetime.” Typically, he continues, the situational episode will last 2 to 3 weeks and can require clinical intervention. French also asserts that while situational depression can occur to anyone regardless of age, race, creed or gender, it is “more common during those life stages when transitions are most likely to occur, such as adolescence, middle age and later in life.”
The key to knowing when you need to seek treatment, Johns says, is understanding the difference between feelings of sadness and those of depression. “With sadness, you feel that you have lost something,” he says. “When it comes to depression, you have a loss of self-esteem. You take your feelings of anger or the inability to control your life and turn it against yourself. With grief, there is a healing process. But when you experience a sense of hopelessness or even have thoughts of suicide, you need to seek treatment.”
TaJuana Bayless-Pearson, MD, chief of behavioral health for Kaiser Permanente, explains that, traditionally, there are two methods of treatment for depression, whether it’s major, chronic or situational: medication and psychotherapy. Oftentimes, the two go hand in hand. As Johns explains, if you visit your family physician or other doctor when you begin to reach out for help, these professionals can begin the first phase of treatment, which usually involves a prescribed antidepressant to help alleviate symptoms. “The bulk of antidepressant prescriptions are made by primary care physicians,” he says. “For more complicated cases, they may then refer the patient to a psychologist or psychiatrist. But it’s a good first step for the patient because he or she started to get treatment somewhere.”
Sharon Bent-Harley, MD, board-certified OB/GYN and founder of the Harley Anti-Aging Institute in Atlanta, believes that, while some people ultimately may not need medication, seeing a family physician or a gynecologist to discuss physical symptoms can be a very effective place to start because sometimes medication is needed to help get a patient to the next level of treatment, which typically includes some form of psychotherapy. If the symptoms are severe enough to stop someone from doing daily activities, then visiting a counselor can be especially challenging. With the help of an antidepressant, though, that next course of action, including getting a full clinical diagnosis, will be easier to handle.
Fortunately, there are a number of pharmaceutical options available today. According to French, they include:
- Selective serotonin reuptake inhibitors (SSRIs). SSRIs include Prozac, Paxil, Zoloft, Celexa and Lexapro.
- Serotonin and norepinephrine reuptake inhibitors (SNRIs). These medications include Cymbalta, Effexor and Pristiq.
- Norepinephrine and dopamine reuptake inhibitors (NDRIs), such as Wellbutrin.
- Atypical antidepressants and Tricyclic antidepressants.
- Monoamine oxidase inhibitors (MAOIs). MAOIs include Parnate and Nardil.
Although taking an antidepressant can be very helpful, it’s important to remember that therapy can be just as beneficial. “Psychotherapy is an important modality in the treatment of depression,” Johns states. “Our brains didn’t evolve just to take medications—they evolved so we could talk to other people.” And just as there are different types of medications on the market, there are a variety of therapy options. Dave M. Davis, MD, DLFAPA, FABFP, medical director of the Piedmont Psychiatric Clinic in Atlanta, notes that cognitive behavioral therapy (CBT), which is based on the idea that thoughts cause feelings and behaviors and can be changed so you can act and think better, is one of the most common treatments for depression. There is also psychoanalysis, which is based on Sigmund Freud’s theories and explores the underlying reasons for the depression, and a host of other choices. You simply have to find the right fit for your individual needs.
Today, medication and psychotherapy are not the only treatment options available to cope with depression. As Lissa Corcoran, executive director, and Jennifer Huffaker, LMSW, program director, of Flying Change Equine Therapy note, “We are fortunate to live at a time when our understanding of mental health issues is better than ever before, and there are more treatment options. Alternative approaches include acupressure, herbal medicine, Bach flower remedies, hypnosis and biofeedback, to name a few.” Johnson also points to such activities as life coaching, yoga, medication, laughter therapy and exercise as possible alternatives.
One area that’s growing in popularity is equine assisted psychotherapy (EAP), which renowned physician and TV personality Dr. Oz listed as one of the top 2 alternative treatments available. “The experiential nature of EAP allows clients to develop a new awareness of their thoughts, feelings and behaviors through experience, while also allowing them to discover new solutions and practice new, healthy coping skills,” Corcoran and Huffaker explain. “Under the guidance of trained counselors and horse professionals with specialized training in the field of equine assisted mental health, we use proven interactive experiences with horses to foster emotional, social, spiritual, and psychological growth. Clients take part in an equine assisted activity, and then discuss feelings, behaviors, and patterns. The horse becomes a mirror of the feelings and behaviors the client brings with them. Our program provides clients with experiential opportunities to practice healthy life skills in a physically and emotionally safe environment, and the confidence to take those skills back into their family and life.”
Whatever type of treatment options are pursued, whether it’s hypnosis, massage therapy or another type of relaxation training, Riddell advises, “These treatments should be approached generally in conjunction with traditional treatment, and not to replace traditional treatment such as psychotherapy and medication management. You should research the particular practitioner you are thinking about seeing, as well as the type of alternative treatment being offered.”
Could it be something else?
Paying a visit to your primary care physician, OB/GYN or internist can be very important if you are seeking treatment for what you believe is depression. The reason is simple: there is always a possibility that it is not depression. “There are so many conditions that can mimic depression,” Bent-Harley reveals. Oftentimes, the condition is related to a treatable hormone imbalance that simply needs to be identified and administered to. According to Bent-Harley, two of the possibilities could include:
- Hypothyroidism, which occurs when the thyroid gland does not secrete enough of the T3 and T4 hormones and your metabolism, as well as the functioning of your body, slows.
- Premenstrual dysphoric disorder (PMDD), which is a acute form of premenstrual syndrome (PMS) and affects 3 to 5 percent of menstruating women; it is marked by severe depression, shifting moods, anxiety, low self-esteem, irritability and a host of other symptoms.
For women, menopause can also be a culprit, while a progesterone deficiency could plague both women and men. Bent-Harley notes that, as with all other medical issues, clinical testing is needed to achieve a correct diagnosis and pinpoint the right treatment.
Take action today
Regardless of the type of depression you might be experiencing, it is crucial to seek assistance as soon as possible, as symptoms can worsen when left untreated. According to Corcoran and Huffaker, there are more treatment options to address depression than ever before. They encourage people to take care of themselves by seeking professional help when they're struggling.
“Happiness in your life, whether personal, professional or financial, is always within your reach,” French concludes. “The main key to happiness is figuring out what you want for your life, and then making the conscious choice to utilize every mechanism within your life to create and achieve that goal for yourself. "Everyone has it within their power to make the simple decision that they will no longer continue to live their life from a negative perspective and will, instead, choose to find contentment, satisfaction and peace with the world around them. By making this choice, you will have taken control of your own life and actively chosen to have the life of fulfillment and happiness you have always dreamed of but may not have achieved.”
Depression and Substance Abuse
Some people who experience the symptoms of depression decide to self-medicate with alcohol or other substances. However, Chris F. Riddell, MD, medical director of WellStar Psychiatry LLC in Marietta, explains that taking this route can create an entire host of other problems, especially for those people who have a genetic predisposition to turn to these alternatives to help them cope. In many cases, the individual can develop a chemical dependency that requires treatment itself. “Substance abuse by definition is an unhealthy coping mechanism,” Riddell says, “and it always exacerbates chronic or situational depression. Fortunately, there are multiple treatments available for substance abuse, including counseling, support groups such as Alcoholics Anonymous (www.aa.org) and medication. There are also many outpatient substance abuse programs and rehabilitation programs available.”
At a Glance: Possible Causes of Depression
According to Christopher B. French, PhD, licensed clinical psychologist and chief executive officer of Northside Psychological Services Inc., there appear to be multiple causes for depression, which include:
• Biology and genetics: Those who experience depression may have different brain structure than others who do not suffer from depressive symptoms, including altered levels of brain chemicals. In addition, depression is more likely to occur in those who have close family members who also experience depression.
• Neurotransmitters: Certain levels of brain chemicals have been linked to depression (either too much or not enough of certain neurotransmitters, such as serotonin).
• Early childhood trauma: Trauma experienced in early childhood (such as childhood abuse or death of a parent) may cause permanent changes in brain structure that may make you prone to experiencing depression.
• Life events: Stress experienced from major life events (such as divorce, death of a loved one or financial difficulties) can lead to depression.
• Hormones: Hormonal changes (such as can occur with menopause and thyroid conditions) have been linked to depression.