Depression

By Gilda Morales, ANP, DC

Depression is a common condition that for years was misunderstood by not only family members, but by the medical community as well.  There used to be a stigma attached to depression, with patients constantly being told to “snap out of it, pull yourself up by your boot straps,” and “pray yourself out of it.”  I have even heard of instances where patients were told that if they were true Christians, they would rely on prayer instead of medication, sending a signal that depression is not a true medical condition, causing even more distress for the patient.

Having experienced the heartache and frustration of living with a depressed person, my mother, I can certainly empathize with others who are living with family members who suffer with depression.  It is sometimes easier for family to deal with physical illnesses, than with disorders like anxiety and depression.  I can remember my mom lying in her bed with all the curtains drawn, sobbing uncontrollably.  This was “normal” for the first 13 years of my life, until a doctor prescribed what I know now, was antidepressant medication, or what I called a magical pill at the time.  My mother made a complete turn-around, becoming virtually a new person who enjoyed life, was funny and sociable.  Through the years, she would stop taking her medication, and return to her depressed, miserable state until she could be convinced to resume her medications.

Unfortunately, depression affects every age, with the highest prevalence in teens and young adults.  There is also a predominance of females over females, 2 to 1.  The condition is thought to be caused as a result of a deficiency of certain neurotransmitters in the brain, including monoamine oxidase, serotonin, norepinephrine, which are the more common ones.

Symptoms can appear as a result of stressors, such as deaths of loved ones, unemployment, or problems in relationships. In many cases there is a history of substance abuse or dependence and domestic violence plays a large role in the onset of depression, and there is strong evidence that there may be a genetic component from generation to generation.

A diagnosis of depression requires that at least five or more of the following signs and symptoms be present almost every day for a two-week period:

1.  Depressed mood most of the day, as reported by the patient or as observed by other people.

2.  Diminished interest or pleasure in most activities.

3.  Decreased or increased appetite or losing weight unintentionally

4.  Sleeping too little or too much.

5.  Fatigue, or lack of energy.

6.  Restlessness or a need to be alone, preferring to not socialize.

7.  Poor memory, poor concentration, and an inability to make decisions.

8.  Guilt or a sense of worthlessness

9.  Recurrent thoughts of death or suicide, even without a specific plan.

In the elderly, depression may be difficult to diagnose because the symptoms

may be due to other conditions such as dementia, while in children, the symptoms may appear as anger or irritability.  Sudden substantial drops in school grades, or a failure to gain weight as well as unreasonable separation anxiety could signal depression.

There is also standardized testing available that can help your primary healthcare provider make a definitive diagnosis and provide appropriate care, and referrals to other specialists if necessary.  In many cases, patients see a noticeable improvement in their symptoms within 14 to 21 days, but finding the right medication and the right dosage may take some time, and your provider may recommend therapy along with medication management to get the best results possible.