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Depression

Depression Treatment in Salt Lake City

In any given one-year period, 9.5 percent of the population suffers from a depressive illness. That’s about 18.8 million American adults! The economic cost for this disorder is high, but the cost in human suffering cannot be underestimated. Depressive illnesses often interfere with normal functioning and cause pain and suffering not only to those who have a disorder, but also to those who care about them.


Depressive Disorder is Often Treatable


Serious depression can destroy lives and wreak havoc on families. Much of this suffering is unnecessary. Most people with a depressive illness do not seek treatment although a great majority- even those whose depression is extremely severe – can be helped.

Thanks to years of fruitful research, there are now psychosocial techniques such as cognitive/behavioral therapy, talk therapy, and interpersonal therapy that help ease the pain of depression. If you feel that you or someone you care about is one of the many undiagnosed depressed people in this country, the information presented here may help you take steps that may save a life.

For more information or to schedule an appointment for treatment, contact our Salt Lake City offices at (801) 261-3500.

Types of Depression


Depressive disorders come in different forms, just as is the case with other illnesses such as heart disease. Here we will briefly describe three of the most common types of depressive disorders. However, symptoms, their severity, and persistence vary for each individual.

Major depression is manifested by a combination of symptoms that interfere with one’s ability to work, study, sleep, eat, and enjoy once-pleasurable activities. Such a disabling episode of depression may occur only once but more commonly occurs several times in a lifetime.

Dysthymia, a less severe form of depression, involves long term, chronic symptoms that do not disable, but keep one from functioning and feeling well. Many people with dysthymia also experience major depressive episodes at some time in their lives.

Another form of depression is bipolar disorder, also called manic-depressive illness. Not nearly as prevalent as other forms of depressive disorders, bipolar disorder is characterized by cycling mood changes: severe highs (mania) and lows (depression). Sometimes the mood switches are dramatic and rapid, but most often they are gradual. When in the depressed cycle, an individual can have any or all of the symptoms of a depressive disorder. When in the manic cycle, the individual many be overactive, over-talkative, and have a great deal of energy. Mania often affects thinking, judgment, and social behavior in ways that causes serious problems and embarrassment. For example, the individual in a manic phase may feel elated and full of grand schemes that might range from unwise business decisions to romantic sprees. Mania, left untreated, may worsen to a psychotic state.

Symptoms of Depression and Mania


Not everyone who is depressed or manic experiences every symptom. Some people experience a few symptoms while some may experience many. Severity of symptoms varies with individuals and also varies over time.

Depression

  • Persistent sad, anxious, or “empty” mood
  • Feelings of hopelessness and pessimism
  • Feelings of guilt, worthlessness and/or helplessness
  • Loss of interest in pleasurable hobbies and activities that were once enjoyable, including sex
  • Decreased energy, fatigue and being “slowed down”
  • Difficulty concentrating, remembering and making decisions
  • Insomnia, early-morning awakening or oversleeping
  • Appetite and/or weight loss; overeating and weight gain
  • Thoughts of death or suicide; suicide attempts
  • Restlessness and irritability
  • Persistent physical symptoms that do not respond to treatment (such as headaches, digestive disorders and chronic pain)

Mania

  • Abnormal or excessive elation
  • Unusual irritability
  • Decreased need for sleep
  • Grandiose notions
  • Increased talking
  • Racing thoughts
  • Increased sexual desire
  • Markedly increased energy
  • Poor judgment
  • Inappropriate social behavior

Causes of Depression


Some types of depression run in families, suggesting that it can be inherited. This seems to be the case with bipolar disorder. Studies of families in which members of each generation develop bipolar disorder found that those with the illness have a somewhat different genetic makeup that those who do not get ill. However, the reverse is not true: not everyone with the genetic makeup that causes vulnerability to bipolar disorder will have the illness. Often, factors such as stresses in the home, at work, or in school, are involved in its onset.

In some families major depression also seems to occur generation after generation. However, it can also occur in people who have no family history of depression. Whether inherited or not, major depressive disorder is often associated with changes in the brain’s structure or function.

People who have low self-esteem and consistently view themselves and the world with pessimism are prone to depression. The same is true for people who are easily overwhelmed by stress. Whether this represents a psychological predisposition or an early form of the illness is not clear.

In recent years, however, researchers have shown that physical changes in the body can be accompanied by mental changes. Medical illnesses such as stroke, heart attack, cancer, Parkinson’s disease, and hormonal disorders can cause depressive illness, making the sick person apathetic and unwilling to care for his or her physical needs. Also, a serious loss, difficult relationship, financial problems, or any stressful (unwelcome or welcome) change in life can trigger a depressive episode. Very often, a combination of genetic, psychological, and environmental factors is involved in the onset of a depressive disorder. Later episodes of illness typically are precipitated by only mild stress or none at all.

Depression in Women


Women experience depression almost twice as often as men. Many hormonal factors may contribute to this increased rate of depression, particularly menstrual changes, pregnancy, miscarriage, giving birth, pre-menopause and menopause. Many women also face additional stresses such as responsibilities both at work and at home, single parenthood and caring for children and aging parents.

A recent study by the National Institutes of Mental Health showed that in the case of severe premenstrual syndrome (PMS), women with a preexisting vulnerability to PMS experienced relief from mood and physical symptoms when their sex hormones were suppressed. Shortly after the hormones were re-introduced, they again developed symptoms of PMS. Women without a history of PMS reported no effects following the hormonal manipulation.

Many women are particularly vulnerable after the birth of a baby. The hormonal and physical changes, as well as the added responsibility of caring for a new life, can be factors that lead to postpartum depression. While transient “blues” are common in new mothers, a full-blown depressive episode is not a healthy and requires active intervention. Treatment by a sympathetic physician and emotional support from family and friends for the new mother can aid her physical and mental well-being and her ability to care for and enjoy her infant. Learn more about postpartum depression and treatment.

Depression in Men


Although men are less likely to suffer from depression than women, three to four million men in the United States are affected by the illness. What is more, men are less likely to admit to depression and doctors are less likely to suspect it. The rate of completed suicide in men is four times that of women, though more women attempt it. In fact, after age 70, the rate of men’s suicide rises, reaching a peak after age 85.

Depression can also affect the physical health in men differently than it does in women. A new study shows that although depression is associated with an increased risk of coronary heart disease in both men and women, only men suffer a high death rate.

Men’s depression is often masked by alcohol or drugs or by the socially acceptable habit of working excessively long hours. Depression typically shows up in men not as feelings of hopelessness and helplessness, but as being irritable, angry, and discouraged. That means it may be difficult to recognize. Even if a man realizes that he is depressed he may be less willing to seek help than a woman. Encouragement and support from concerned family members can make a difference. In the workplace, employee assistance professionals or work-site mental health programs can help men understand and accept depression as a real illness that needs treatment.

Depression in the Elderly


Some people have the mistaken idea that it is normal for the elderly to feel depressed. On the contrary, most people in their golden years feel satisfied with their lives. Sometimes though, when depression develops, it may be dismissed as a normal part of aging. Undiagnosed and untreated depression in the elderly causes needless suffering for the family and for the individual, who could otherwise live a fruitful life. When he or she does go to the doctor, the symptoms described are usually physical since an elderly person is often reluctant to discuss feelings of hopelessness, sadness or extremely prolonged grief after a loss.

Recognizing how depressive symptoms in older people are often missed, many health care professionals are learning to identify and treat the underlying depression. They recognize that some symptoms may be side effects of medication the older person is taking for physical ailments, or they may be caused by another illness. If a diagnosis of depression is made treatment with medication and/or psychotherapy may help the depressed person return to a happier, more fulfilling life. Short-term talk therapy may help a person in day-to-day relationships or in learning to counter the distorted negative thinking that commonly accompanies depression. This is effective in reducing symptoms in the short-term depression for older patients who cannot or will not take medication, recent studies show. Efficacy studies show that long-term psychotherapy can also help with late-life depression.

Improving recognition and treatment of depression in late life will make those years more enjoyable and fulfilling for the depressed elderly person, their family and their caretakers.

Depression in Children


Only in the past two decades has depression in children been taken very seriously. The depressed child may pretend to be sick, refuse to go to school, cling to a parent or worry that the parent may die. Older children may sulk, get into trouble at school, be negative, grouchy and feel misunderstood. Because normal behaviors vary from one childhood stage to another, it can be difficult to tell whether a child is just going through a temporary “phase” or is suffering from depression. Sometimes parents become worried about how the child’s behavior has changed, or a teacher mentions that “your child doesn’t seem to be himself.” In such a case, if a visit to the child’s pediatrician rules out physical symptoms, the doctor would probably suggest that the child be evaluated by a psychiatrist who specializes in the treatment of children. If treatment is needed, the doctor may suggest that another therapist, usually a social worker or a psychologist, provide therapy while the psychiatrist will oversee medication, if it is needed.

Parents should not be afraid to ask questions such as:

  • What are the therapist’s qualifications?
  • What kind of therapy will my child have?
  • Will the family as a whole participate in therapy?
  • Will my child’s therapy include an antidepressant? If so, what might the side effects be?

The National Institute of Mental Health (NIMH) has identified the use of medications for depression in children as an important area of research. The NIMH-supported Research Units on Pediatric Psychopharmacology (RUPPs) form a network of seven research sites where clinical studies on the effects of medications for mental disorders can be conducted in children and adolescents. Among the medications being studied are antidepressants, some of which have been found to be effective in treating children with depression if properly monitored by the child’s physician.

Diagnostic Evaluation and Treatment


The first step to getting appropriate treatment for depression is a physical examination by a physician. Certain medications as well as some medical conditions such as a viral infection can cause the same symptoms as depression, and a physician should rule out these possibilities through examination, interviews and lab tests. If a physical cause for the depression is ruled out, a psychological evaluation should be done by the physician or by referral to a psychiatrist or psychologist.

A good diagnostic evaluation will include a complete history of symptoms, i.e., when they started, how long they have lasted, how severe they are, whether the patient had them before and, if so, whether the symptoms were treated and what treatment was given. The doctor should ask about alcohol and drug use and whether the patient has thoughts about death or suicide. Further, a history should include questions about whether other family members have had a depressive illness and, if treated, what treatment they may have received and whether it was effective. Lastly, a diagnostic evaluation should include a mental status examination to determine whether speech, thought patterns or memory have been affected.

Treatment choice will depend on the outcome of the evaluation. There are a variety of antidepressant medications and psychotherapies that can be used to treat depressive disorders. Some people with milder forms may do well with psychotherapy alone. People with moderate to severe depression often benefit from antidepressants. Most do best with combined treatment: medication to gain relatively quick symptom relief and psychotherapy to learn more effective ways to deal with life’s problems. Depending on the patient’s diagnosis and severity of their symptoms, the therapist may prescribe medication and/or one of the several forms of psychotherapy that have been proven effective for depression.

Electroconvulsive therapy (ECT) is useful, particularly for individuals whose depression is severe, life threatening or who cannot take antidepressant medication. ECT is often effective in cases where antidepressant medications do not provide sufficient relief of symptoms. In recent years, ECT has been much improved. A muscle relaxant is given before treatment, which is done under brief anesthesia. Electrodes are then placed at precise locations on the head to deliver electrical impulses. The stimulation causes a brief (about 30 second) seizure within the brain. The person receiving ECT does not consciously experience the electrical stimulus. For full therapeutic benefit, at least several sessions of ECT, typically given at the rate of three per week, are required.

Medications


There are several types of medications used to treat depressive disorders. These include newer medications. The most common are selective serotonin reuptake inhibitors (SSRIs), tricyclics, and monoamine oxidase inhibitors (MAOIs). SSRIs and other newer medications that affect neurotransmitters such as dopamine or norepinephrine generally have fewer side effects than tricyclics. Sometimes a doctor will try a variety of antidepressants before finding the most effective medication or combination of medications. The dosage might also need to be increased to be effective. It’s important to remember that some improvements may not be seen for up to 8 weeks before the full therapeutic effect occurs.

Patients often are tempted to stop medications too soon. They may feel better and think they no longer need the medication or they may think the medication isn’t helping at all. It is important to keep taking medication until it has a chance to work even though side effects may disappear before the prescription ends. Once the individual is feeling better, it is important to continue medication for 4 to 9 months to prevent a recurrence of the depression. Some medications must be stopped gradually to give the body time to adjust. NEVER stop taking an antidepressant without consulting your doctor for instructions on how to safely discontinue the medication. For individuals with bipolar disorder or chronic major depression, medication may have to be maintained indefinitely. Antidepressant drugs are not habit-forming. However, as is the case with any type of medication prescribed for more than a few days, antidepressants have to be carefully monitored to determine if the correct dosage was prescribed. Your doctor will check the dosage and its effectiveness regularly.

For the small number of people for whom MAOIs are the best treatment, it is necessary to avoid certain foods that contain high levels of tyramine such as many cheeses, wines, and pickles, as well as medications such as decongestants. The interaction of tyramine with MAOIs can bring on a sharp increase in blood pressure that can lead to a stroke. A doctor should furnish a complete list of prohibited foods that the patient should carry at all times. Other forms of antidepressants do not require food restrictions.

Medications of any kind – prescribed, over-the counter or borrowed – should never be mixed without consulting a doctor. Other health professionals who may prescribe a drug – such as a dentist or other medical specialist – should be told of the medications the patient is currently taking. Some drugs, such as alcohol or street drugs, may reduce the effectiveness of antidepressants and should be avoided. This includes wine, beer, and hard liquor. Some people who have not had a problem with alcohol may be permitted by their doctor to use a modest amount of while taking one of the newer antidepressants.

Anti-anxiety drugs or sedatives are not antidepressants. They are sometimes prescribed along with antidepressants; however, they are not effective when taken alone for a depressive disorder. Stimulants, such as amphetamines, are not effective antidepressants but are used occasionally under close supervision for medically ill depressed patients.

Side Effects


Antidepressants may cause mild and usually temporary side effects (sometimes referred to as adverse effects). Typically these are annoying but not serious. However, any unusual reactions or side effects such as those that interfere with functioning should be reported to a doctor immediately.

The most common side effects of tricyclic antidepressants, and ways to deal with them, are:

  • Dry Mouth: It is helpful to drink sips of water, chew sugarless gum and clean teeth daily.
  • Constipation: Bran cereals, prunes, fruit, and vegetables should be in the diet.
  • Bladder problems: Emptying the bladder may be troublesome, and the urine stream may not be as strong as usual. Notify a doctor if there is noticeable difficulty or pain.
  • Sexual problems: Sexual functioning may change. If it’s worrisome, discuss it with a doctor.
  • Blurred vision: This will pass soon and will not usually necessitate new glasses.
  • Dizziness: Rising from a bed or chair slowly is helpful.
  • Drowsiness: This usually passes soon. A person feeling drowsy or sedated should not drive or operate heavy equipment. The more sedating antidepressants are generally taken at bedtime to help sleep and minimize daytime drowsiness.

Newer antidepressants have different types of side effects:

  • Headaches: These usually go away.
  • Nausea: This is also temporary, but even when it occurs, it generally goes away after each dose.
  • Nervousness and Insomnia (trouble falling asleep and waking often during the night): This may occur during the first few weeks. Dosage reductions or time will usually resolve the problem.
  • Agitation (feeling jittery): This might happen for the first time after the drug is taken and isn’t usually something to worry about, but contact a doctor if it persists.
  • Sexual problems: Consult a doctor if the problem is persistent or worrisome.

Herbal Therapy


Herbal treatments for depression and anxiety have been increasingly popular in recent years. St. John’s Wort (Hypericum perforatium), an herb used extensively in the treatment of mild to moderate depression in Europe, has recently aroused interest in the United States. This attractive, bushy plant is covered with yellow flowers and has been used for centuries in many folk and herbal remedies. Today in Germany Hypericum is used in the treatment of depression more often than any other antidepressant. However, the scientific studies that have been conducted on its use have been short-term and have used several different doses.

Because of the widespread interest in St. John’s Wort, the National Institutes of Health (NIH) conducted a 3-year study, sponsored by the National Institute of Mental Health, the National Center for Complementary and Alternative Medicine, and the Office of Dietary Supplements. One third of the patients in the 8-week trial took a uniform dose of St. John’s Wort. Another third took a selective serotonin reuptake inhibitor commonly prescribed for depression. The last group took a placebo (a pill that looks exactly like the SSRI and the St. John’s Wort, but has no active ingredients). The study participants who responded positively were followed for an additional 18 weeks. Results found no statistical difference between the placebo for either the SSRI or for St. John’s Wort.

The Food and Drug Administration issued a Public Health Advisory on February 10, 2000. It said that St. John’s Wort appears to affect an important metabolic pathway used by many drugs prescribed to treat conditions such as heart disease, depression, seizures, certain cancers, and rejection of transplants. Therefore, health care providers should alert their patients about these potential drug interactions. Any herbal supplement should be taken only after consultation with a doctor or other health care provider.

Psychotherapies


Many forms of psychotherapy, including some short-term (10-20 week) therapies, can help depressed individuals. Talking therapies help patients gain insight into and resolve their problems through verbal exchange with the therapist, sometimes combined with “homework” assignments between sessions. Behavioral therapists can help patients learn how to obtain more satisfaction and rewards through their own actions and unlearn the behavioral patterns that contribute to or result from their depression.

Two of the short-term psychotherapies that research has shown to be helpful for some forms of depression are interpersonal and cognitive/behavioral therapies. Interpersonal therapists focus on a patient’s disturbed personal relationships that both cause and exacerbate (or increase) depression. Cognitive/behavioral therapists help patients change the negative styles of thinking and behaving that are often associated with depression.

Psycho-dynamic therapies, which are sometimes used to treat depressed persons, focus on resolving the patient’s conflicted feelings. These therapies are often reserved until the depressive symptoms are significantly improved. In general, several depressive illnesses, particularly those that are recurrent, will require medication (or ECT under special conditions) along with, or preceding, psychotherapy for the best outcome.

How to Help Yourself if you Are Depressed


Depressive disorders make one feel exhausted, worthless, helpless and hopeless. Such negative thoughts and feelings make some people feel like giving up. It is important to realize that these negative views are part of depression and typically do not accurately reflect one’s actual circumstances. Negative thinking fades as treatment begins to take effect. In the meantime:

  • Set realistic goals in light of the depression and assume a reasonable amount of responsibility.
  • Break large tasks into smaller ones, set priorities, and do what you can as you can.
  • Try to be with other people and to confide in someone; it is usually better than being alone and secretive.
  • Participate in activities that make you feel better.
  • Mild exercise, going to a movie, a ballgame, or participating in religious, social, or other activities may help.
  • Expect your mood to improve gradually – not immediately. Feeling better takes time.
  • It is advisable to postpone important decisions until depression has lifted. Before deciding to make a significant transition – changing jobs, getting married or divorced – discuss it with others who know you well and have a more objective view of your situation.
  • People rarely “snap out of” a depression. But they can feel a little better day-by-day.
  • Remember, positive thinking will replace the negative thinking that is part of depression, and these negative thought patterns may disappear as your depression responds to treatment.
  • Let your family and friends help you.

How Family and Friends Can Help the Depressed Person


The most important thing anyone can do for a depressed person is to help him or her get an appropriate diagnosis and treatment. This may involve encouraging the individual to stick with treatment until symptoms begin to abate (several weeks), or to seek different treatment if no improvement occurs. On occasion, it may require making an appointment and accompanying the depressed person to the doctor. It may also mean monitoring whether the depressed person is taking medication. The depressed person should be encouraged to obey the doctor’s orders about the use of alcoholic products while on medication.

The second most important thing is to offer emotional support. This involves understanding, patience, affection and encouragement. Engage the depressed person in conversation and listen carefully. Do not disparage feelings expressed, but point out realities and offer hope. Do not ignore remarks about suicide. Report them to the depressed person’s therapist. Invite the depressed person for walks, outings, to the movies and other activities. Be gently insistent if your invitation is refused. Encourage participation in some activities that once gave pleasure such as hobbies, sports, religious or cultural activities but do not push the depressed person to undertake too much too soon. The depressed person needs diversion and company, but too many demands can increase feelings of failure.

Do not accuse the depressed person of faking illness or of laziness, or expect him of her “to snap out of it.” Eventually, with treatment, most people do get better. Keep that in mind, and keep reassuring the depressed person that, with time and help, he or she will feel better.