Hi everyone. We’re back for this month’s originally-named “Monthly YMF Mental Health Column”. (Seriously. I’m notoriously uncreative.) Why this series? Mental health problems, especially depression, end up affecting roughly 6.7% of the U.S. population 18 or older in a given year. Statistically, you’re bound to know into someone — even if it’s not obvious — who has experienced this first-hand. And even if you are never afflicted with depression, it’s useful to know how to support a friend, or what not to do, or tactful ways to tell someone depression doesn’t come from sinning. (!) All of my statistics have come from the National Institute of Mental Health, which has excellent resources at nimh.gov.
I’m going to go through some common Q&A, with some official definitions taken from NIMH but with my own comments and experience woven in. This month I’ll cover depression and next month jump to another topic, likely anxiety.
Okay, I’ve heard a bunch about this, but what exactly is depression? Is it just feeling sad about something?
Depression, broadly speaking, is a period of time when feelings of sadness persist longer than two weeks. There are a number of specific common symptoms, but your specific diagnosis will depend on the severity of symptoms and potential causes. (For example, you wouldn’t have postpartum depression if you haven’t recently had a baby.) Not all of these symptoms need occur for a diagnosis of depression. Take a look:
- Persistent sad, anxious, or “empty” feelings
- Feelings of hopelessness or pessimism
- Feelings of guilt, worthlessness, or helplessness
- Irritability, restlessness
- Loss of interest in activities or hobbies once pleasurable, including sex
- Fatigue and decreased energy
- Difficulty concentrating, remembering details, and making decisions
- Insomnia, early-morning wakefulness, or excessive sleeping
- Overeating, or appetite loss
- Thoughts of suicide, suicide attempts
- Aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment.
If all of these continue for more than two weeks and/or start to interfere with your day-to-day life, especially if they happen with no apparent cause, it’s a good indication of depression.
Help! I’m looking at this list and I think I/my friend has depression! What can I do about this?
Depression, even the most severe cases, can be effectively treated. The earlier that treatment can begin, the more effective it is.
My own experience is a testament to this. My depression was bad. I started spending all my time in the basement, I didn’t go out, and essentially stopped eating — my transformation from a cheerful teenager to a reclusive, despondent, sad, individual happened within a couple months. It took a similar time frame to get back to being more functional, but with good doctors and support it can happen.
Usually, you don’t just wake up one morning feeling like you are worthless and life isn’t worth living. It happens gradually, and if you’ve already eating and sleeping well, exercising (see my previous post for more complete non-medication suggestions), and things aren’t getting better, it’s time to find a doctor. Depression is not something you can think or pray away, any more than you can think or pray away a broken arm.
Okay, I’m totally on board to get my friend to see a doctor. But there are so many types out there! Where do I start?
If you have a general practitioner or primary care physician (PCP), they are someone you could discuss your symptoms with. Your doctor may refer you to one of the following, or, if you don’t have a PCP, you would look for one or both kinds of doctors:
Psychologist: Psychologists are what we think of when we say “therapists”. They will have a PhD in psychology and will see patients (some do research as well). Good psychologists know a lot about the various mental illnesses and will have a number of strategies and ideas for actions you or others can take that do not involve medication. This is because psychologists cannot prescribe medication. For that, you need a psychiatrist.
Psychiatrists: Psychiatrists are MDs who can and do prescribe medication. They know the specifics about neurotransmitters, serotonin, and what chemically could be causing you to feel the way you do. (Short answer: your neurotransmitters aren’t working.) Psychiatrists can make a diagnosis about types of depression (major, post-tramatic, post-partum, or bipolar) and will meet with you over time to see how you respond to medication.
For me, when things started, I first met with a psychologist, but it pretty quickly became clear I would need a psychiatrist. I started spending more time with a psychiatrist — very begrudgingly at first. We tried one medication, it worked well, then it didn’t, and then tried another which was much more effective. Doctors should be your friends.
I’ve been prescribed some medication. What’s the history of anti-depressants and are they safe? I remember my grandmother took an antidepressant and she had horrible side effects. I don’t like drugs or medications. Convince me drugs today don’t make anything worse!
(Warning: this section gets super technical about types of medication and is less likely to be of interest to the general population.)
Some of the newest and most popular antidepressants are called selective serotonin reuptake inhibitors (SSRIs). Fluoxetine (Prozac), sertraline (Zoloft), escitalopram (Lexapro), paroxetine (Paxil), and citalopram (Celexa) are some of the most commonly prescribed SSRIs for depression. Most are available in generic versions. Serotonin and norepinephrine reuptake inhibitors (SNRIs) are similar to SSRIs and include venlafaxine (Effexor) and duloxetine (Cymbalta).
These are the most common types of antidepressants you would take nowadays.
SSRIs and SNRIs tend to have fewer side effects than older antidepressants, but they sometimes produce headaches, nausea, jitters, or insomnia when people first start to take them. These symptoms tend to fade with time. Some people also experience sexual problems with SSRIs or SNRIs, which may be helped by adjusting the dosage or switching to another medication.
One popular antidepressant that works on dopamine is bupropion (Wellbutrin). Bupropion tends to have similar side effects as SSRIs and SNRIs, but it is less likely to cause sexual side effects. However, it can increase a person’s risk for seizures.
Other, older drugs you may have heard about that would likely require more frequent supervision with a doctor:
Tricyclics are older antidepressants. Tricyclics are powerful, but they are not used as much today because their potential side effects are more serious. They may affect the heart in people with heart conditions. They sometimes cause dizziness, especially in older adults. They also may cause drowsiness, dry mouth, and weight gain. These side effects can usually be corrected by changing the dosage or switching to another medication. However, tricyclics may be especially dangerous if taken in overdose. Tricyclics include imipramine and nortriptyline.
Monoamine oxidase inhibitors (MAOIs) are the oldest class of antidepressant medications. They can be especially effective in cases of “atypical” depression, such as when a person experiences increased appetite and the need for more sleep rather than decreased appetite and sleep. They also may help with anxious feelings or panic and other specific symptoms.
However, people who take MAOIs must avoid certain foods and beverages (including cheese and red wine) that contain a substance called tyramine. Certain medications, including some types of birth control pills, prescription pain relievers, cold and allergy medications, and herbal supplements, also should be avoided while taking an MAOI. These substances can interact with MAOIs to cause dangerous increases in blood pressure. The development of a new MAOI skin patch may help reduce these risks. If you are taking an MAOI, your doctor should give you a complete list of foods, medicines, and substances to avoid.
Okay, that’s great, you’ve talked me/my friend into it, I’m taking medication. When will I start to feel better?
All antidepressants must be taken for at least 4 to 6 weeks before they have a full effect. We’re all waiting for a magic pill, but science isn’t there yet.
Don’t stop taking your medication unless your doctor tells you! It increases your risk of depression coming back more frequently and with more intensity. Some medications need to be gradually stopped to give the body time to adjust. Although antidepressants are not habit-forming or addictive, suddenly ending an antidepressant can cause withdrawal symptoms or lead to a relapse of the depression. Keep taking your medications even if you are feeling better!
In addition, if one medication does not work, you should consider trying another. NIMH-funded research has shown that people who did not get well after taking a first medication increased their chances of beating the depression after they switched to a different medication or added another medication to their existing one. This is what happened with me — don’t give up hope! There has been a tremendous improvement in these fields even within the past 20 years.
It’s really important after you start a medication to keep in touch with your doctor. If you don’t trust your doctor, look for another one. Find someone who will help keep you honest about this if you think skipping doses will be an issue. These drugs can help but self-medicating is not the way to go. I promise. (I keep saying this because I have a testimony of this).
Okay, my friend is taking medication. It hasn’t been 4 – 6 weeks yet. What can I do to help her/myself until then?
- Try to be active and exercise. Go to a movie, a ballgame, or another event or activity that you once enjoyed. Go for a walk with someone. Tell yourself you can be sad for a bit until a specific time and then you have to go out, like, from 5pm to 6pm you have to do something fun.
- Set realistic goals for yourself.
- Break up large tasks into small ones, set some priorities and do what you can as you can.
- Try to spend time with other people and confide in a trusted friend or relative. Try not to isolate yourself, and let others help you. Things will slip through the cracks. That’s okay.
- Expect your mood to improve gradually, not immediately. Do not expect to suddenly “snap out of” your depression. Often during treatment for depression, sleep and appetite will begin to improve before your depressed mood lifts.
- Postpone important decisions, such as getting married or divorced or changing jobs, until you feel better. This is not a good idea. Again, having a support network here really helps.
- Remember that positive thinking will replace negative thoughts as your depression responds to treatment.
- Continue to educate yourself about depression.
Okay, that’s great. I’m taking medication and feeling slightly better. But why did I have to go to YMF to get this information? Isn’t depression a common illness?
Major depressive disorder is one of the most common mental disorders in the United States. Each year about 6.7% of U.S adults experience major depressive disorder. Women are 70% more likely than men to experience depression during their lifetime (though some say this is skewed because women are more likely to seek treatment). Non-Hispanic blacks are 40% less likely than non-Hispanic whites to experience depression during their lifetime. The average age of onset is 32 years old (though recent research has suggested that college age students are particularly at risk). Additionally, 3.3% of 13 to 18 year olds have experienced a seriously debilitating depressive disorder (I was in this category).
Depression and mental illness still have a stigma around them, so most people don’t talk about it like they do a broken leg or even cancer, which is why your neighbor or roommate or co-worker may not have mentioned it. Changing this stigma can be hard, but there are a number of organizations working on it. Glenn Close, the actress, recently received an award about her foundation, Bring Change 2 Mind, and the Mayo Clinic has a number of suggestions: http://www.mayoclinic.org/diseases-conditions/mental-illness/in-depth/mental-health/art-20046477 If it’s feasible, try being open about your experiences with others in appropriate contexts. (Ie, “last year was a rough year with my depression, but so far 2014 has been great!”)
What can I do for my friend who is suffering?
Be nice to them. Watch a movie with them, eat food with them, and call or text them to let them know what you appreciate about them. Go for a walk with them. Tell your friend you care about them. Don’t forget them.
Depression is treatable. It takes work, it’s miserable, but it is beatable. You can do it.