Depression

Depression is an extremely common problem that many people struggle with.  I hope that this article will be helpful and educational.

Introduction

It is estimated that in any given year, 6.7 percent of the U.S. population has Major Depressive Disorder (MDD), the clinical name for what people generally refer to as depression.  A medication used to treat depression is the third most prescribed medication in the U.S., behind only cholesterol-lowering medication and asthma medication.  Although everyone has ups and downs in their moods, people with MDD have such severe downs that it significantly affects their daily function.

Symptoms

The main symptom of MDD is depressed mood, plus additional common symptoms as described by the mnemonic SIGECAPS:

S: Sleep (decreased or increased)
I: Interest (decreased, also known as anhedonia)
G: Guilt (feeling worthless, hopeless, helpless)
E: Energy (decreased)
C: Concentration (decreased)
A: Appetite (decreased or increased)
P: Psychomotor retardation or activation (feeling slowed or feeling restless)
S: Suicidal thoughts

Diagnosis

As with most mood disorders, MDD is diagnosed clinically, based on history.  There is no blood test or imaging test that is diagnostic for MDD.  However, if there are clinical signs that suggest a medical problem may be contributing to your depression, your doctor may order blood tests to check for infections and check your thyroid, liver, kidneys, and vitamin B12 and folate levels to see if there are any other factors contributing to your depression.  At times, brain imaging may be helpful to make sure there are not any underlying brain abnormalities that are contributing to your depression.  Before initiating medication treatment of MDD, it is important that your doctor screen you for Bipolar Affective Disorder (BPAD), as many anti-depressant medications that can help people with MDD can actually make people with BPAD much more unstable.

Treatment

Treatment can involve psychotherapy, medications, or combined treatment, depending on patient preference and severity of symptoms.

  • Psychotherapy: Cognitive Behavioral Therapy (CBT) has been shown to be effective for Major Depressive Disorder. I recommend a CBT workbook to my depressed patients –  The Feeling Good Handbook by David D. Burns.   Many patients find it helpful to go through the workbook and suggested exercises with the guidance of a mental health professional, though the workbook is made to be self-guided.  Some patients find insight-oriented psychotherapy or supportive therapy to be more helpful types of therapy than CBT.
  • Medications: The most commonly used medications for treating Major Depressive Disorder are selective serotonin reuptake inhibitors (SSRI’s).  These medications can be prescribed by your primary care doctor, or by your psychiatrist.  If SSRI’s are not effective, serotoinin-norepinephrine reuptake inhibitors (SNRI’s), other anti-depressants such as bupropion (Wellbutrin), atypical antipsychotics, and other adjunctive medications can be effective.  Older medications such as monoamine oxidase inhibitors (MAOI’s) and tricyclic antidepressants (TCA’s) can also be alternatives if newer, safer medications are not effective.  The best predictor of your response to medications is how you have responded to medications in the past.   How blood-relatives have  responded to medications in the past can also help your doctor choose the best medication for you.
  • Combined Treatment: For many patients, the combination of psychotherapy and medications is the most effective form of treatment.

For Further Information

See the Wikipedia entry on MDD, a handout from the National Institute for Mental Health (NIMH), or contact a qualified mental health professional.

Article written 12/1/09 by Minyang Mao, M.D.  Revised 12/1/09 by Minyang Mao, M.D.

Disclaimer: This article is intended as an educational resource only, and is not intended to be a replacement for treatment. For evaluation and treatment, please contact a qualified mental health professional.

Content © 2009 Minyang Mao, M.D.  Image © 2009 Bob Lin.  All rights reserved.

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