Clinical depression is a medical condition that goes beyond everyday sadness. It causes profound, long-lasting symptoms and often disrupts a person’s ability to perform routine tasks. A person’s vulnerability to developing this disorder is often related to many factors, including changes in brain function, genetics, and life stresses and circumstances.
Depression is the most common psychiatric disorder worldwide. In the United States, 17 percent of the population experiences a bout of clinical depression in their lifetime. Even so, very few people who have the disorder discuss their symptoms with a healthcare provider. Instead, two-thirds of people with depression who see a healthcare provider for routine care come in complaining of physical symptoms, such as headache, back problems, or chronic pain.
People are reluctant to discuss their depression symptoms for a number of reasons. Often they’re concerned about the stigma of mental illness; sometimes they worry that a primary care provider is not the appropriate health professional to enlist; some see their condition as a personal weakness rather than a “real” illness; and some are worried about the implications of having a psychiatric illness entered into their permanent record. The problem is, effective treatments do exist, and not treating depression can cause serious problems.
People with untreated depression have a lower quality of life, a higher risk of suicide, and worse physical prognoses if they have any medical conditions besides depression. In fact, people with depression are almost twice as likely to die as people without the condition. What’s more, depression affects not only the person with the disorder but also those around him or her.
That’s where we come in. We can help treat the underlying causes of depression. Call us at 802-368-1041 to speak to an admission specialist today.
DEFINITION OF DEPRESSION
When people talk about depression, they’re usually referring to what healthcare providers call unipolar major depression (or major depressive disorder). The diagnosis of unipolar major depression is discussed in detail elsewhere.
Briefly, to be diagnosed with unipolar major depression, a person must have five or more of the following symptoms present most of the day nearly every day for at least two consecutive weeks. For the diagnosis, at least one symptom must be either depressed mood or loss of interest or pleasure.
●Loss of interest or pleasure in most or all activities
●Change in appetite or weight
●Insomnia or hypersomnia (sleeping too little or too much)
●Psychomotor agitation or retardation (restlessness or sluggishness)
●Fatigue or loss of energy
●Feelings of worthlessness or excessive guilt
●Recurrent thoughts of death or suicide
For the purposes of this discussion, we will use depression to mean unipolar major depression. There are other subtypes of depression, as well, but those are beyond the scope of this article.
TREATMENT DEPENDENT ON DEPRESSION SEVERITY
Healthcare providers approach the treatment of depression differently depending on its severity. The following descriptions explain how the different severity levels are defined.
Mild to moderate depression — People with mild to moderate depression have the following characteristics:
●They do NOT have thoughts of or plans for suicide or homicide.
●They do NOT have psychotic symptoms, such as delusions or hallucinations.
●They have little to no aggressiveness.
●Their judgement is intact.
People with mild to moderate depression can generally be treated during routine visits with a healthcare provider; they do not typically need to be hospitalized.
Severe depression — People with severe major depression have one or more of the following characteristics:
●They DO have thoughts of and plans for suicide or homicide.
●They DO have psychotic symptoms, such as delusions or hallucinations.
●They have a condition called catatonia, which involves being unable to move or talk normally.
●Their judgement is impaired such that people (including themselves) may be at risk for harm.
●Their normal functioning is impaired. For example, they may refuse to eat or drink which may lead to malnourishment or dehydration.
People with severe major depression usually need to be seen by a psychiatrist and sometimes need to be hospitalized.
TREATMENT FOR MILD TO MODERATE DEPRESSION
For the initial treatment of mild to moderate depression, we suggest a combination of antidepressant medication and psychotherapy. Well-designed studies have shown that combination treatment is more effective than either treatment on its own. Nevertheless, either treatment can also be given alone, as studies have also shown that each is effective and comparable to the other.
Despite being comparably effective, one advantage of psychotherapy is that some of its benefits often persist even after active treatment ends. Psychotherapy may help people develop new coping skills as well as more adaptive ways of thinking about life problems. The same is not necessarily true of antidepressants; many who take antidepressants alone relapse after stopping them.
Treatment diagnosis however first starts with a call to our admissions. Please call 802-368-1041 Today.
TREATMENT FOR SEVERE MAJOR DEPRESSION
For people with severe depression, we suggest a combination of antidepressant medication and psychotherapy. It’s also reasonable to try antidepressants alone. (Psychotherapy is generally not used alone for patients with severe depression.) Another reasonable treatment for severe depression is electroconvulsive therapy (ECT), particularly in people who are actively thinking about suicide and who may be in danger of following through on their plans. ECT is discussed at elsewhere.
Choosing an antidepressant — For the initial treatment of severe depression, we use serotonin-norepinephrine reuptake inhibitors (SNRIs) or selective serotonin reuptake inhibitors (SSRIs). In people who have symptoms besides those of depression, additional medications such as atypical antipsychotics may be appropriate.
Some healthcare providers start with SNRIs because studies suggest that these medications are more likely than SSRIs to alleviate severe depression. A reasonable alternative to SNRIs or SSRIs is a medication called mirtazapine (brand name: Remeron). It, too, has been shown to be effective in treating severe depression.
Tricyclic antidepressants are another reasonable alternative for severe depression. However, tricyclics can be dangerous and cause serious side effects, so some healthcare providers prefer to avoid prescribing them until safer alternatives have been tried.