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Health: Clinical Depression Responds Well To Treatment
Author: Nasir A. Khan, MD 
     

Clinical depression is a common mood disorder characterized by persistent despondency that interferes with a person’s daily activities. Most people at some time in their life will experience some type of mild, or reactive, depression occurring as a natural reaction to life’s stressors, such as a death in the family or the end of a relationship. This type of depression usually gets better with talking, support and the passage of time. Clinical depression, or major depression, is a more serious form of the condition, has biological causes and generally requires mental health treatment and medication. Many people who suffer from depression may have a combination of both types of the disorder, making a multi-pronged treatment approach most effective.


The National Institute of Mental Health (NIMH) estimates that more than 20 million children and adults in the U.S. are affected by major depression. Further, depression does not discriminate by age, socioeconomic group or country. The prevalence of clinical depression over a lifetime is 20 percent for women and 10 percent for men. It is also more common in the elderly.

Despite the pervasive nature of clinical depression, the good news is that this illness responds well to the range of medical treatments now available, so it can be very effectively controlled with proper care.

Some common physical, psychological and physiological signs and symptoms of clinical depression include:

•    Sleep disorder, most commonly waking in the early morning
•    Appetite changes, either weight loss or gain
•    Poor concentration, including the inability to focus and forgetfulness
•    Decreased libido 
•    Inability to experience pleasure
•    Anxiety/despondency
•    Decreased self-esteem and self-worth
•    Hopelessness
•    Suicidal thoughts
•    Flat affect and slowness of mental capacity and movement

These and other depressive symptoms occur because of an imbalance in neurotransmitters, which are chemicals that enable a person’s nerve cells to communicate with each other. For example, the neuronal serotonin level may be low in depression and high in mania. Hormonal changes that occur with childbirth and with menopause can sometimes lead to depression.

Antidepressant medications like Prozac and Zoloft work to correct the imbalance. The enormous sales of these and other similar medications reveal that more patients are being diagnosed and treated earlier for this condition. About 70 to 80 percent of patients treated with antidepressants will respond to this intervention, which can take up to two or three weeks to take effect and usually needs to be taken for many months even after the remission of symptoms in order to prevent a relapse. Fortunately, these psychopharmacological interventions are safe and produce no tolerance over time.

For the 20 to 30 percent of patients who do not respond to the medications, they may need to undergo Electro Convulsive Therapy or ECT, which has proven to be another extremely effective treatment method. The side effects, which include forgetfulness, are very mild, temporary and quickly diminish, making this is an appropriate option for many patients.

Less severe cases of clinical depression can be treated in an outpatient setting, such as the office of a psychiatrist, psychologist, psychiatric nurse, social worker or other type of mental health counselor. More serious cases are addressed in an inpatient hospital setting. Patients requiring inpatient care can either admit themselves voluntarily or may be involuntarily committed if they pose a danger to themselves or others and refuse help. The average inpatient stay is 7 to 8 days, before a person “steps down” to a partial hospital or day program, or an outpatient office setting. 

If you suspect that you, or someone you know, may be suffering from depression, it is important to talk to your Primary Care Physician (PCP). These trained medical professionals can be an important referral source who can guide you to the most appropriate resources. There are also certain screening tools that can be helpful in diagnosing the problem. For example, National Depression Screening Day offers an important opportunity to identify people in need of further evaluation for this illness. For more information about upcoming screenings and support groups, visit www.mentalhealthscreening.org.

Depression, if left untreated, can be extremely disabling. It can also lead to early loss of life, since suicide and depression are closely related. In fact, NIMH findings show that nearly one in six people with severe, untreated depression will die by suicide. But with appropriate diagnosis and medication intervention, depression is easily controlled and the millions of people who suffer from this illness can go on to lead long and healthy lives. 

 

(Nasir A. Khan, MD, is the CEO and Chairman of the Board of Bournewood Health Systems in Brookline, Mass. He is certified by the American Board of Psychiatry and Neurology (ABPN) in psychiatry and geriatric psychiatry. He also serves as secretary and executive committee member of the Indian Medical Association of New England (IMANE). You can email Dr. Khan at Nkhan@bournewood.com. )

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