Depression (& Mania)

People who are depressed usually feel, well, depressed.  But sometimes they don’t recognize it, and may have a variety of physical symptoms like fatigue, headache, dizziness, tingling sensations, chest pains, virtually anything.  The more we try not to think about depression, the more we may suffer in other ways.

Depression can be “reactive,” occurring because of some event, usually a loss.  Most people are able to overcome grief, usually within a month.  When it lasts 6 months, it’s definitely abnormal.  That may only happen to people prone to depression, in the sense their genetics makes them so.  People can also become depressed when using alcohol or drugs (hard to treat until they stop).

“Endogenous Depression” means that the depression comes from within you, and is clearly genetic.  I had a 30-year-old patient once, new to my practice, who’d moved across country.  She’d been taking the anti-depressant Prozacยฎ for 10 years, feeling absolutely fine.  So she figured she likely didn’t need it any more, stopped it, and within a month was as depressed as ever.  Clearly, the chemicals in her brain were such that she had depression the same way somebody has diabetes or high blood pressure; she got all better when she went back on the medication.

The most serious kind is Psychotic Depression, when a person’s thoughts are altered such that they hallucinate (usually hearing voices), become paranoid, or have delusions. Some patients are diagnosed as having “Schizo-Affective Disorder,” which means it’s hard to tell if the primary condition is Schizophrenia with a component of depression (categorized as an “affective” disorder), or Depression with psychoses as in schizophrenia.  Bipolar Disorder, which used to be called Manic-Depressive, often involves psychosis.  Such persons alternate between depression and mania, when their mood swings to the other pole and they seem giddy and high (see symptoms below).  But it’s certainly no fun, and there’s high risk of suicide. Many people may also

We diagnose Depression if a patient (who hasn’t had a recent loss) experiences 5 of the following symptoms during a 2-week period (has to include at least 1 of the first 2 symptoms):

  • Depressed Mood most of the day (sad, tearful, hopeless)
  • No interest or pleasure in virtually any activities (often including sex) most of the day
  • Major weight loss or gain; major decreased or increased appetite
  • Insomnia, or sleeps all day
  • Other people note constant restlessness, or sluggishness
  • Fatigue or loss of energy (often doesn’t want to get out of bed)
  • Irrational feeling of worthlessness or guilt
  • Hard to concentrate or think
  • Persistent thoughts of death, or of suicide

We diagnose Bipolar Disorder if the depressed person had ever in the past experienced a week of feeling abnormally high, full of energy, or irritable, with at least 3 symptoms of:

  • Feeling more important or special than everyone else (grandiose)
  • Hardly sleeping, but not feeling tired
  • Talking constantly
  • Racing thoughts
  • Easily distracted
  • Bouncing around among countless activities or tasks, usually never completing any
  • Uncontrolled sprees of foolishly wasting money or of promiscuous sex

The feared complication of Depression or Bipolar Disorder is suicide.ย  Some people attempt suicide impulsively on the spur of the moment, especially teens, those acutely manic, or those psychotic.ย  But the chronically depressed often think & plan it.ย  Almost half approach the health care system the week before attempting, but this isn’t straight-forward.ย  They may seek care for a cold, some minor pain, or anything unrelated, and may not appear depressed at all (in fact, they may seem perfectly content, because they’ve finally made a decision).ย 

We need to be alert enough to ask how things are going, whether they feel depressed.  If so, we simply ask, “have you been so depressed that you’ve thought about killing yourself?”  Patients are always relieved to talk about it, since it’s often been on their mind for quite some time.

Treatment for Depression can be quite successful.  It can include medications, talk therapy (now called โ€œCognitive Behavioral Therapy,โ€ or CBT), or a combination.

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