The following information to be used for educational purposes only, and is not intended to serve as treatment or a substitute for mental health services:
What is Depression?
Depression is a condition of consistently poor mood with other symptoms of low motivation, loss of enjoyment in activities, and poor energy, appetite and concentration.
What causes it?
Depression can have many different causes, and can appear and feel different in everyone. Some patients are vulnerable to having depression because it runs in the family. Other people have trauma during their childhoods that make it more likely for them to develop depression over their lifetimes. It is also possible for a patient to encounter a tragedy and be unable to recover and feel like their normal selves again. All of these examples are common reasons for depression, and treating depression in each of these cases involves a similar approach.
One exception is a medical cause for depression, such as a hormone imbalance, substance use or dementia (decline of memory and thought processing with old age). Depression from these direct physical causes should be addressed by treating the underlying causes of depression, but oftentimes the depression is still treated to relieve distress the patient may be experiencing.
Keep in mind that depression does not have to be purely biological. So even if depression does not run in your family, or there is no medical explanation for your depression, that does not make it any less serious or less necessary to treat. A patient who feels depressed from external circumstances, such as financial worries, interpersonal conflicts, dissatisfied living situation or caregiving for family members with terminal disease, should be treated early and adequately.
What’s the difference between being depressed, and just ‘being sad?’ Isn’t it normal to be sad during a sad situation?
Although it is completely natural to feel sad during difficult moments in life, mental health treatment should be considered if feelings of poor mood are lasting longer than what is expected for the patient. For example, when a family member dies, treatment may be recommended if a patient is disproportionately distressed, or does not show any signs of improvement, even after several months have passed.
How severe does depression need to be in order to start treating it?
In general, it is up to the patient, but major indications to start treating depression includes 1) If symptoms are so severe it impacts a patient’s functioning in life, for example; interferes with their work, relationships and general health, and 2) If the patient is having frequent thoughts of death and suicide.
Is my depression just in my head?
Many people who experience depression are often told to “snap out of it,” by their friends and family. While most of the time, their loved ones have good intentions, it is often an oversimplification to assume that a patient can overcome depression by “thinking positive.”
Depression has physical effects on the body and brain.
Studies have shown that brain images of depressed patients have lower activity in some areas, and high activity in others. The good news is, that once a patient receives treatment for their depression, the brain often reverts back to resemble that of a non-depressed patient. [1]
Medications alone AND talk therapy alone have been shown to make these changes in the brain, but the best results are most often observed when BOTH are used at the same time.
How do the medications work?
Each medication works in a different way, and your doctor can explain how your recommended medications interact with your brain. Most medications work by altering or blocking the effect of certain neurotransmitters, which are molecules that brain cells use to communicate with each other.
For example, many antidepressants work by gradually increasing the production of a neurotransmitter called serotonin. It is thought that low levels of serotonin can contribute to depression and anxiety, and studies have shown that suicide victims often have low levels of serotonin in their cerebrospinal fluid. [3]
Are there side effects?
All medications have the potential to cause side effects, but many times you will need to trial the medicine to find out how you respond to it. Many of our patients experience none or only few tolerable side effects. Every patient is unique, and everyone has different medications that do and do not work for them!
Will I be on this medication forever?
It will always be up to the patient to decide if they want to continue medications after they feel better. Some patients feel comfortable taking medications indefinitely, because they are enjoying their lives and do not want to risk feeling worse, and are not experiencing any side effects. If a patient is interested in stopping medications after their depression subsides, it is recommended they stay on medications for an entire year of remission before discontinuing medications. If they do decide to stop medications, they should gradually lower their medications under the supervision of a psychiatrist.
Are there any alternative treatments?
In addition to the standard treatment of common antidepressants and cognitive behavioral therapy (CBT), there are multiple other modes of treatment including: different combinations of medications, other types therapy modalities, Ketamine infusions, Transcranial Magnetic Stimulation (TMS), and for severe cases, Electroconvulsive therapy (ECT). Patients are always encouraged to try non-medical approaches in addition to medical treatment, such as yoga, regular exercise, meditation, getting involved in a spiritual community, etc. If you are experimenting with herbal remedies or alternative medicines, make sure to tell your psychiatrist to ensure there are no dangerous interactions between those remedies and your prescribed medications.
Depression is often a complicated, multifaceted problem, with several causes that span over the course of many years. Sometimes it may require a multifaceted solution; for example, a patient with a particularly difficult to treat case of depression may not respond to an antidepressant alone, but if he also takes an as needed anxiety medication, goes to therapy regularly, and makes lifestyle changes of having a routine of exercising and volunteering at a pet shelter every weekend, he may see improvement that makes his condition more tolerable. The important thing is that the patient keeps trying to find their solution; If one medication does not work- try another one. If one therapist does not help, try a different type of therapy or a different therapist. The patients that tend to get the results they want, are usually the ones that don’t give up!
1. Brain metabolic changes in major depressive disorder from pre- to post-treatment with paroxetine, Arthur L. Brody et al.
2. Regional Brain Metabolic Changes in Patients With Major Depression Treated With Either Paroxetine or Interpersonal Therapy Preliminary Findings Arthur L. Brody, et al
3. Aggression, suicide, and serotonin: Relationships of CSF amine metabolites. G.L. Brown et al
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