Depression: What Is It, Who Gets It, And How Is It Treated?
A psychiatrist provides a clinician’s view of debilitating depression: what it looks like, who’s likely to get it, and what are current treatment modalities
I am a board-certified psychiatrist and I have been providing treatment for depression to patients for over 10 years.
There is no doubt that one of the most common reasons people finally take the leap and see me is to help them with debilitating depression. I use the term “debilitating” very intentionally. This is because in these cases the symptoms of clinical depression are causing intense distress and dysfunction for the person more days than not.
I have taken care of people of all ages, backgrounds, and stages of life who are suffering from this disorder.
A common thread in depression is hopelessness
A common thread amongst all of these patients is the extreme hopelessness they experience. It feels like a black hole with no way out. Hopelessness is one of nine potential symptoms that paint the dark, muddied picture of depression.
Other symptoms of Major Depressive Disorder as defined by the DSM-V are:
- depressed mood
- sleep disturbances
- appetite changes
- loss of interest or pleasure in activities
- decreased energy
- difficulty concentrating
- observably either restless or slowed down, and finally
- recurrent thoughts of death.
If you have experienced 5 of 9 of these symptoms for 2 weeks or longer, then you, my friend, have had an episode of clinical depression. These are symptoms that I make sure to specifically ask about in my consultations with patients, no matter who the patient is: male, female, adult or child, teacher, lawyer, or CEO.
Major Depression can affect anyone
Major Depression does not care if you have a wonderful loving family, a stable job or good social support. It can still affect and impact you and everyone around you.
As I previously mentioned, depression can negatively affect all types of people. However, individuals might present to me differently depending on their age, gender, cultural background, and other factors. Let’s take a look at is likely to suffer from this disorder.
Who’s likely to suffer from depression?
Women are twice as likely to be diagnosed with depression as compared to men. Why? Historically, females consult a doctor for depression more than males. It seems that women are more inclined and more comfortable reporting their own feelings as compared to men. Women will get themselves help of some kind, whether a friend, counselor, a primary care doctor or psychiatrist.
Men are not protected by their Y chromosome in any way from developing depression. In fact, men are more likely to endure the depression for a long time. Typically, they are undeservedly ashamed of themselves and may not seek help until they spiral into a severely depressed state. Men are twice as likely to commit suicide as women.
In my discussions with all patients, I remind them that depression is not a weakness or a flaw. Depression is a condition that robs you of your ability to perform your usual tasks and engage in your usual activities, regardless of gender and regardless of age.
Depression by age group
Just as depression can affect both biological genders, it can also rear its ugly head at any age.
-Children and teens
As a child and adolescent psychiatrist, I have seen the different presentations of depression through the lifespan. From the frequent and extreme temper tantrums of a 6-year-old to the cutting behaviors of a teenager, depression typically presents as “irritable” mood with other warning signs.
Children should not have a care in the world, right? No real stress, right? That couldn’t be more wrong. More than 4 million children under the age of 18 suffer from clinical depression. It affects 2% of preschool and school-age children.
Genetics in combination with this new age of cyberbullying, easy access to illicit drugs, and other social changes contribute to making depression more prevalent than it ever has been in the past.
Once a minor has had a depressive episode, they are at increased risk for future episodes while on the path to adulthood. This can make the early 20s very tenuous.
-College students and young adults
Leaving home and heading off to college is welcomed by many students. Moving into the next chapter of life is very exciting but also quite intimidating. Many have never had the experience of being in a lecture hall with 150 other students all raising their hands to ask questions at the same time. It can be overwhelming.
Further, the pressure to figure out who you want to be when you grow up or even selecting your major can make a student feel like they are on a game show picking which door to open to get a prize. It’s scary to pick door number 1 when you are not sure if doors 2 or 3 are better. It is easy to feel like you will be stuck with the wrong choice forever.
And, then comes graduation and even more momentous decisions: choosing graduate school or entering the workforce, picking a career and getting the right job, and, for many, the biggest one of all, choosing a forever mate.
These challenges of these early years can be formidable. They can lay the groundwork for negative thoughts for some young adults and can set the stage for depression.
Your fifties can bring a sense of relief for some who can look back on what they have accomplished with satisfaction: a career established, young children raised, a marriage that survived the mid-life crisis of the 40's.
But, the fifties are stressful for many perhaps because they have not accomplished what they hoped for by this time of life. And they are worried about the future. Their retirement did not go as planned because of rising costs. They’ve already been working for 30 years but now understand that traveling to Europe (or anywhere else) is no longer feasible.
This phase of life is a time when I see patients for depression. They typically have a melancholy mood, low energy, and feelings of being burnt out. This is especially true when their jobs are no longer satisfying and they may begin losing interest in activities that they used to enjoy. They wonder what will the next decade bring, assuming their only relief will come from retirement.
Depression in the sixties
The sixies bring the opportunity for retirement, however, this is can be a double-edged sword. Yes, the grind of work is over. There are no more bosses to report to, no more employees to manage. However, when you have identified yourself with your career or role as a homemaker for 40 years, the shift in your day to day activities can be very unsettling. In my practice, I see a peak of new-onset depression amongst people in this phase of their lives.
Further, if you have had depressive episodes all throughout your life, by this point you have learned all too well about the kindling effect of depression. Each episode of depression begets the next episode, and each one increasing in intensity and duration. And more difficult to recover from each time. Difficult, but not impossible.
Single or married: does it make a difference?
An instinctive assumption is that married people are happy people. You might also think that single people are more prone to depression. Not true. This is an oversimplification of a very complicated disease state and here’s why.
Married people who are suffering from depression often still feel “alone.” There might be an initial bump in mood early on in a marriage. This is often termed the “honeymoon period.” However, genetic factors and/or environmental factors, that person is ripe for the depression once the honeymoon is over.
As for the single life, one might think this lifestyle to be instinctively protective against depression as there are no pressures of taking care of a spouse. You are free as a bird and independent. However, the lack of inherent and unconditional support can make you that much more susceptible to depression.
How Psychiatrists Treat Depression
Over the years, treatment modalities have remained relatively stagnant. All are potentially effective in their own ways.
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Cognitive Behavioral Therapy has been the gold-standard type of talk therapy. It has been shown to be most helpful with targeting the automatic negative thoughts of depression and replacing those thoughts with more rational positive affirmations.
A healthy diet and exercise have can be helpful in dealing with the mood fluctuations and energy struggles associated with depression. Plus, it is good for your cardiovascular system, so just do it!
High carb loads can lead to low carb crashes, causing irritability and lethargy. A well-balanced diet with low impact, sustained exercise can only help. However, this is not the end all be all treatment for depression by any means.
Medications have been utilized to manage depression for decades. They have taken on different forms from different classes over the years. Some of the older medications were notorious for causing potentially lethal side effects, such as cardiotoxicity. They have been replaced with newer ones, but even these are not side-effect-free.
The newer classes of medications, those that I was trained to utilize, have persistent reputations for causing weight gain, GI upset and sexual side effects, just to name a few. The good news is more and more medications are being studied and may eventually increase the arsenal of medication options.
When first-line interventions fail, what else is available?
Sometimes our patients’ depression is either non-responsive or intolerant to the medication options available. What then?
For decades until recently, the only alternative was Electroconvulsive Therapy or ECT. Though effective, this treatment which uses an electrical current to induce a controlled seizure is highly invasive and can cause memory loss and headache.
Finally, with the persistent push to fight the stigma of mental illness and the vast need to fill a void in mental health research, we now have a relatively new treatment modality for depression: brain stimulation therapy.
The best-studied of these therapies is Transcranial Magnetic Stimulation or TMS. This advanced therapy uses the latest technology harnessing the benefits of magnetic pulses to provide very targeted treatment for depression without the side effects. For many, TMS treatment can bring much-welcomed relief to their symptoms with little to no side effects.
Related content: How Genetic Testing Will Transform Mental Health Care
Looking back on my years practicing psychiatry, I remember feeling such relief every time a new treatment option became available for me to provide to my depressed patients.
Looking forward into the future of psychiatric care, I am hopeful that we as a medical community will continue to demand more and more attention be paid to mental health research. We will no longer settle for the status quo of treatments available.
As the secrets of the physiology of depression reveal themselves, we need to continue to add more non-invasive treatments to our relatively short but growing list of therapies that can mitigate and even eradicate depression for our patients.
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Dr. Lindsay Israel is a board-certified psychiatrist. Her goal is to help patients feel empowered because their symptoms can leave them feeling powerless. She specializes in Transcranial Magnetic Stimulation (TMS) therapy for the treatment of various psychiatric disorders. TMS is FDA-approved for depression and is a non-invasive, non-medication alternative to traditional treatments. Dr. Israel’s depression treatment center, Success TMS, focuses on this advanced therapy which allows patients to achieve remission from depression and return back to their best lives. For more information on TMS go to How TMS works and TMS vs ECT.”
Originally published at https://thedoctorweighsin.com on August 7, 2019.