What I Wish My Patients Knew About Treating Depression
Major depressive disorder, also referred to as depression, is what I describe as a full body disease. It’s more than just feeling sad or blue. Depression is characterized by at least two weeks of persistent depressed mood and/or loss of interest in pleasurable activities. However, it also may cause marked impairment in sleep, concentration, focus, energy, and appetite. Depression is also associated with constipation, muscle pain, decreased sexual libido, and slowed motor movements. Many people struggle to recognize when they are depressed. Some people who are depressed resist treatment due to feelings of shame brought on by the stigma of mental illness in our society. Others are frightened by horror stories about old insane asylums, or other misguided information. The good thing about depression is that it is a treatable disease and many people respond to one or more forms of treatment. The first and most important step is to be properly diagnosed by a licensed professional.
How is depression diagnosed?
The diagnosis of depression can be as simple as filling out a questionnaire or rating tool that is specifically designed to identify depression. Because other diseases can mimic symptoms of depression, including neurological, metabolic, and endocrine disorders, your physician will also want to perform a physical exam, interview, and laboratory work up. Depending on your history, your doctor may also want you to get a CT scan or MRI. Once a proper diagnosis is made, your physician will discuss treatment options with you.
How is depression treated?
The gold standard of treatment for depression continues to be antidepressants. Antidepressants are medications that affect the neurotransmitters associated with depression—particularly serotonin, norepinephrine, and dopamine. The most popular antidepressants are called selective serotonin reuptake inhibitors (SSRIs); they prevent the amount of serotonin released in your body from being re-absorbed back into your system. Newer categories of medications include serotonin-norepinephrine reuptake inhibitors (SNRIs), which prevent serotonin and norepinephrine from being re-absorbed back into the body. More recent medications, called atypical antidepressants, also enhance serotonin availability but in a way that differs from SSRIs or SNRIs. Older classes of antidepressants include tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs), which are effective treatments for depression but have lost their popularity due to intolerable side effects. Each category of medications has different side effects. SSRIs are more likely to cause diarrhea, weight gain, and sexual side effects than other drug classes. Some side effects go away after a few days. Because of side effects, people commonly discontinue their medication before it has a chance to work. If side effects are intolerable, talk to your doctor about changing your medication. For mild depression, psychotherapy in combination with healthy lifestyle changes may be recommended.
What should I expect from treatment?
There are many factors that should be considered when deciding which medication is best. Every person responds to antidepressants differently. This includes how well they work for your depression as well as what side effects you may experience with them. Some people have to try a few medications before they find the right one. If you have a family history of depression, it may be helpful to find out what medication family members have responded to. We now know that there is a genetic relationship to the response to antidepressants. One humongous leap in the treatment of depression includes the introduction of genetic testing. This involves a simple cheek swab that can be sent to a lab to predict what antidepressants will work best for you based upon your gene profile. Once you have the discussion with your doctor and he or she prescribes a medication, you should expect to wait at least three weeks before seeing an improvement in symptoms. In some cases, an additional few more weeks are needed in order to start feeling like yourself again.
Some people do not want to take medications or cannot tolerate the side effects. A recent advancement in treatment includes Transcranial Magnetic Stimulation (TMS). This is a simple procedure in which a magnetic electrode is applied to the scalp. The magnet stimulates an area in the brain known to cause depression. This is an alternative treatment to medications that has very few side effects, with the most common being scalp tenderness. The most serious side effect, although rare, is seizures. If a seizure occurs during treatment, your doctor will recommend that the treatment stop.
We still use Electric Convulsive “Shock” Therapy (ECT) for very severe cases of depression. This is still the best treatment for people who are not eating, drinking, and cannot function on their own. Unlike the movies, we don’t strap people down and electrocute them. ECT is a brief procedure that causes a tiny seizure. In most cases, the seizure is not visible to the human eye. It is best thought of as sending a “jolt” to your nerve cells that are no longer functioning. ECT can cause memory issues that usually do not last long term. It is very effective for severe depression.
Where should I go for help?
If you are worried that you are suffering from depression, you should set up an appointment with a psychiatrist as soon as possible. Delaying treatment runs the risk of worsening symptoms and suffering longer.