Psychiatric Associates

Depression

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What is Depression?

       Everyone occasionally feels blue or sad, but these feelings are usually fleeting and pass within a couple of days. In contrast, a depressive disorder interferes with daily life and functioning and causes pain for both the depressed person and those around him. Depression is a common and serious illness and most who experience it need treatment to get better. Regrettably, many depressed people never seek treatment. However, the vast majority of depressed people, even those with the most serious depression, can get better with treatment.

One Person's Story:

        "It was really hard to get out of bed in the morning. I just wanted to hide under the covers and not talk to anyone. I didn't feel much like eating and I lost a lot of weight. Nothing seemed fun anymore. I was tired all the time, and I wasn't sleeping well at night. But I knew I had to keep going because I've got kids and a job. It just felt so impossible, like nothing was ever going to change or get better.

       "I started missing work, and a friend noticed that something wasn't right. She talked to me about the time that she'd been really depressed and had gotten help. She encouraged me to call my doctor, so I set up an appointment. It was hard to get myself to go, but I did. I talked to my doctor about how I was feeling. She checked me over and when she didn't find anything wrong she referred me to a therapist. I've been seeing my therapist every week for "talk" therapy, and I've learned ways to deal with how I feel. My therapist also consulted with my doctor, who prescribed medication for me. Everything hasn't gotten better yet, but I feel more able to deal with life and am starting to enjoy my family again. Things are just getting better and better." 

What types of Depression are there?

       The most common types of depression are Major Depressive Disorder and Dysthymic Disorder. Major Depressive Disorder, also called Major Depression or Clinical Depression, is comprised of symptoms that interfere with a person's ability to work, sleep, study, eat, and enjoy activities. Major Depressive Disorder can be disabling and can prevent the depressed person from functioning normally or feeling well. A Major Depressive Episode may occur once in a lifetime, but more often recurs throughout the person's life. Dysthymic Disorder, also called Dysthymia, is comprised of symptoms that last at least two years, aren't as severe or disabling as those of Major Depressive Disorder, but nonetheless can prevent the depressed person from functioning normally or feeling well. People who experience Dysthymic Disorder may also experience one or more Depressive Episodes.

       Other, less common types of depression are Psychotic Depression, Postpartum Depression, and Seasonal Affective Disorder (SAD). Psychotic Depression is comprised of a severe Major Depressive Disorder accompanied by psychotic symptoms, such as a break from reality with hallucinations, delusions, or illusions. Postpartum Depression is comprised of a Major Depressive Disorder which begins within a month after a woman has given birth. Between ten and 15 percent of new mothers experience Postpartum Depression. SAD is comprised of a Major Depressive Disorder which begins during the fall, typically between mid-October and mid-November, when there is less sunlight, and lifts during the spring, typically between mid-March and mid-April. Unique among the Depressive Disorders, SAD can be effectively treated with light therapy, although nearly half of those experiencing SAD don't respond to light therapy alone. 

Click HERE for an in-depth article on "Psychotic Depression" by Dr. Hranilovich.

Click HERE for an in-depth article on "Depression During and After Pregnancy" by Dr. Hranilovich.

Click HERE for an in-depth article on  "Seasonal Affective Disorder (SAD)" by Dr. Hranilovich.

What are the symptoms of Depression?

        Not everyone who experiences depression suffers the same symptoms. Each person's set of symptoms is unique in frequency, intensity/severity, duration, and pattern. However, everyone who's depressed experiences one or both of the following two symptoms:

  • depressed mood (feeling sad, blue, down in the dumps, empty, helpless, or hopeless);
  • anhedonia (an inability to experience pleasure, enjoyment, or happiness).

       He or she also experiences at least three of the following symptoms nearly every day:

  • decreased or increased appetite or significant weight loss or gain;
  • difficulty falling asleep or staying asleep, or waking up too early;
  • sleeping much longer at night, napping during the day, or fighting off falling asleep during the day;
  • mental and physical excitation, racing thoughts, flight of ideas, or restlessness;
  • thinking and moving as if you’re in slow motion;
  • fatigue or loss of energy;
  • feelings of worthlessness or guilt;
  • difficulty thinking, concentrating, or deciding;
  • and/or recurrent thoughts of death or suicide, a suicide plan, or a suicide attempt.

What disorders often accompany depression?

       Depressed people often experience other disorders at the same time. These disorders may precede the depression, cause it, and/or be caused by it.

       Anxiety Disorders, such as Posttraumatic Stress Disorder (PTSD), Obsessive-Compulsive Disorder (OCD), Panic Disorder, Social Phobia, and Generalized Anxiety Disorder (GAD) often accompany depression. People experiencing PTSD are especially prone to having an accompanying depression.

       Alcohol and other substance abuse disorders often accompany depression. In fact, research indicates that the combination of mood disorders such as depression and alcohol/substance abuse disorders is common among Americans.

       Serious medical illnesses such as heart disease, stroke, cancer, HIV/AIDS, diabetes, and Parkinson's Disease often accompany depression. Depressed people who also suffer a medical illness tend to have more severe symptoms of both and more difficulty adapting to their medical illnesses and to cost more to treat than depressed people without an accompanying medical illness. 

What causes Depression?

       There's no single cause for depression. Rather, it most likely results from a combination of genetic, biochemical, environmental, and psychological factors. Depression is a disorder of the brain. Brain-imaging scans such as magnetic resonance imaging (MRI) have shown that the parts of the brain responsible for regulating mood, thought, sleep, appetite, and behavior function abnormally in depressed people. In addition, important neurotransmitters (chemical messengers) are out of balance. This knowledge doesn't explain WHY people become depressed, however. 

        Some depressions appear to run in families, suggesting a genetic component. Depression also occurs in people without family histories of depression, however. Research indicates that the probability that any individual will experience depression results from the interaction between multiple genes and environmental or other factors. In addition, trauma, the loss of a loved one, a difficult relationship, or any other significantly stressful situation may trigger a depressive episode. Subsequent depressive episodes may occur with or without an identifiable trigger.

How is Depression diagnosed?

       Even the most severe depressions are highly treatable. As is true of most medical and psychological disorders, the earlier that treatment begins the more effective it is and the higher the likelihood that recurrences can be prevented.

        The first step toward getting help is to see your Primary Care Provider (PCP), the medical provider whom you see for other disorders. Certain medications and medical conditions can cause the same symptoms as depression. Your PCP can rule out these conditions by conducting a physical examination, asking questions, and/or ordering lab tests. If medications and medical conditions can be ruled out, your PCP will then either administer a brief depression questionnaire or refer you to a mental health professional for further evaluation.

        A mental health professional will conduct a complete diagnostic evaluation, including a discussion of any family history of depression and other psychological disorders and a complete history of symptoms. This history will include when your depression started; how long you've been depressed; how severely you're depressed; whether or not you've been depressed before; if so whether or not you received treatment and how successful that treatment was; whether or not alcohol and/or substance abuse are involved; and whether or not you feel suicidal and/or are planning to harm or kill yourself.   

How is Depression treated?

       Once diagnosed, a depressed person can be treated with a variety of methods. The most common treatments are medication and psychotherapy. 

       Medication: Antidepressant medications normalize the functioning of neurotransmitters (chemical messengers), primarily serotonin and norepinephrine. These particular chemical messengers are involved in regulating mood, although there's still no complete understanding of how this occurs. These medications include newer types, such selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs), and older types, such as tricyclics/tetracyclics (TCAs) and monoamine oxidase inhibitors (MAOIs). The SSRIs include Prozac (fluoxetine), Celexa (citalopram), Zoloft (sertraline), and others; the SNRIs include Effexor (venlafaxine) and Cymbalta (duloxetine); the TCAs include Tofranil (imipramine), Elavil (amitriptyline), Anafranil (clomipramine), and others; the MAOIs include Nardil (phenelzine), Marplan (isocarboxazid), Parnate (tranylcypromine), and others.

       Regardless of which medication might be prescribed, it takes two to four weeks to begin experiencing any effect and four to eight weeks to experience the full therapeutic effect. DO NOT stop taking the medication unless you and the prescribing provider have agreed that it's appropriate for you to do so, even if you feel better. Most depressed people who take a medication do so for between six months and a year, some for two or three years, and a small minority for longer. This is necessary so that the changes in neurotransmitter functioning which occur in your brain as a result of taking the medication become permanent. In addition, abruptly stopping an antidepressant medication can cause unpleasant withdrawal symptoms and/or a relapse.

       If one medication doesn't work, be open to trying another. Depressed people who don't improve after taking one medication increase their chances of getting better by switching to a different medication or adding a second medication. 

       Psychotherapy: Several types of psychotherapy (the "talking cure") can help depressed people. Some are short-term (10 to 20 weeks) and others are long-term (more than 20 weeks). Which might be suitable for you can be determined between you and the mental health professional whom you see. There are many types of psychotherapy, all of which can be effective in treating depression, but two types, Cognitive-Behavioral Therapy (CBT) and Interpersonal Therapy (IPT), have well-established histories of being effective. CBT helps people change negative and self-critical styles of thinking and behaving that contribute to or worsen depression, replacing them with more positive, functional, and adaptive ways. IPT helps people understand and work through dysfunctional and/or maladaptive relationships that contribute to or worsen depression.

       For those who are mildly or moderately depressed, psychotherapy alone is often the best treatment option. However, for certain people, especially those who are severely depressed, a combination of psychotherapy and medication may be necessary. Adolescents, for example, respond best and are least likely to experience a recurrence of depression if treated with psychotherapy and a medication. Similarly, older adults are less likely to experience a recurrence of depression if treated for at least two years with psychotherapy and a medication.

How can you help someone who is depressed?

       If you know someone who is depressed, odds are that his or her depression affects you, too. The first and most important thing that you can do to help a friend, family member, or coworker who is depressed is to help him or her get diagnosed and treated. You might have to schedule an appointment on behalf of the person or even go with him or her to see a provider. Encourage him or her to stay in treatment or to seek different treatment if no improvement occurs after six to eight weeks of medication or eight to 12 weeks of psychotherapy.

  • Offer emotional support, understanding, patience, and encouragement.
  • Engage the person in conversation and, most importantly, listen nonjudgmentally.
  • Never criticize or belittle feelings the person expresses, but rather point out realities and offer hope.
  • Never ignore comments about suicide. Encourage the person to share these thoughts with his or her provider and/or mental health professional, and report them yourself if you believe the person won't do so.
  • Invite the person to participate in walks, outings, and other activities. Keep trying even if he or she declines, but don't push him or her to do too much too soon. Making the person feel as if you have too many expectations of him or her may inadvertently result in feelings of failure.
  • Remind the person that with time and treatment the depression will inevitably improve.

© 2010
Dr. Thomas E. Hranilovich
Licensed Psychologist

Psychiatric Associates / 4084 Okemos Rd. / Suite A / Okemos, MI 48864
Phone: (517) 347-4848 / Fax: (517) 347-4844