I am amazed at how many people don’t realize they are depressed when they come in complaining of “just feeling off.” I will ask, Do you have any stressors in your life right now? “Just the usual,” is a common but valuable response. What’s the usual? I ask. Then, my patient often replies with something distressing like, “Well, things are really tight financially and that’s causing a lot of friction between my spouse and I.”
Recently a man told me how he had bills to pay, but he didn’t know if would have a job tomorrow, because his company had been downsizing a lot of staff. Another woman told me, “I hate my job but can’t afford to leave it.” The numbers about depression are also astounding –nine percent of the population will struggle with severe depression at some point in their lives.
TRIGGERS & SYMPTOMS
People facing stressors, confronting chronic illness, living in an unstable environment, or who have a family history of depression are at the highest risk for developing severe depression. As physicians, when we discuss depression in the office with patients, we usually describe it as being on a spectrum, with the genetic element on one end, and the situational element on the other end.
We are all somewhere in the middle. Some people inherit a larger genetic component, and so it only takes a small trigger for depression to seep into their lives. Other people who have a smaller genetic component need one or more larger triggers to become depressed. Whatever genes we have, we play the hand we’ve been dealt. For some people depression will be something they deal with throughout their lives. Fortunately, there are many great strategies to cope with and treat it.
Some patient populations experience depression symptoms that are different from the norm. For example, with patients aged 60 or older, we often see anger or irritability as the main presenting symptom. These are people who have been kind and happy all their lives, but as their bodies stop behaving the way their minds feel, sometimes bitterness will start to emerge that was never there before.
“Among adolescents, distinguishing between normal teenage angst and depression can be challenging.”
Depression is not a normal part of aging. Chronic health issues and functional decline, which can be the cause of the depression, may also make it difficult to recognize the depression for what it is. Patients 60 years of age and older do not usually feel “depressed” in terms of feeling sad or blue. So, when the possibility of depression is brought up, it is quickly dismissed, even though the other symptoms are present, and the patient would likely have a much better quality of life with treatment.
AMONG ADOLESCENTS
Among adolescents, distinguishing between normal teenage angst and depression can be challenging. Many parents get concerned, but calm themselves down with justifications such as, “It’s just a phase, and he’ll grow out of it.” The safest course with teenagers is avoiding unnecessary risks. If a new pattern of behavior is persisting for more than two weeks or if your teenager seems withdrawn and less interactive, talk to him or her about it. If you discover a clear explanation, great. It gives you a concrete issue to deal with, and it offers you peace of mind that the issue is not something more severe. If a teen says he or she is feeling depressed or cannot put feelings into words, then come in to your physician so we can screen for depression.
TESTS & DIAGNOSES
The first thing a doctor will do in the office is ask a few questions about your mood. Our current diagnostic tools are based on the criteria for major depressive disorder. The next step, when making the diagnosis, is screening for other conditions that may appear like depression. Thyroid disorders often appear similar to depression, and a quick test at the doctor’s office can rule that out, if that’s the case. Anemia and electrolyte disorders can also cause you to feel sluggish and not yourself. We look for any problems related to alcohol or substance use, including prescription medications that can cause you to feel depressed.
MEDICATION
Many people can’t stand the idea of taking a medication for something they feel they should be able to “just snap out of.” If only it really were that easy! We don’t recommend taking pills for every up and down in your mood, but if it is affecting your functioning and it is lasting for more than two weeks, there are great treatments available. When the option is taking a pill so people can enjoy life and handle stressors and responsibilities, most people choose to take the pill. They want to stop suffering through their depression, dropping the ball, and watching things get worse.
Medication is only part of the treatment. For some people it is all that is needed, and after a few weeks they are functioning well and feeling like things are getting back to normal. Many people with severe depression, that is either recurring or that lasts longer than expected, will also do well with a counselor.
It is a good thing to have a professional, emotionally uninvolved person with whom to discuss what is going on and may be triggering the depression. It can be very difficult for people to have these discussions with their spouse or loved ones because the loved ones may feel defensive or thoughtlessly dismiss a depressed person’s experiences.
It is important to know that most medications take several weeks before the results are noticeable to the person taking them. There have been many times when I’ve had a husband and wife in the office talking about the depression, and the person on the medication says, “I really don’t feel any different. I don’t know if it’s working or not.” Immediately, the other spouse interjects, “This is a night and day difference! If they stop the pill, I’m leaving!”
The reason is, when an antidepressant works, you feel normal, and your body doesn’t really notice when you feel normal. Eventually you’ll realize that, “I’m waking up at a normal time, I’m sleeping okay, and I’m starting to enjoy life again.” But usually your family and close friends will notice those things way before you ever do. So, if you want to know if the medication is working, let a trusted person know you are starting to take the medication, and ask for feedback. If they can point out things with comments such as, “Yesterday when the kids started to get rambunctious, you took it in stride instead of flying off the handle,” you’ll start to realize that your depression symptoms are lifting.
Sometimes finding the right pill is a matter of trial and error, and this can be frustrating because each new pill will take several weeks before you can expect to see it work. Just keep in mind that there are plenty of good medication options. If you are patient, you and your doctor will find one that works well for you.
TALK TO YOUR DOCTOR
If you think you may have depression, let your doctor know. If your depression symptoms seem to last for more than two weeks, you can’t easily pinpoint a specific reason for them, or if your symptoms are affecting your functioning, see your doctor. We can help you get back to enjoying your life again.