Depression: Your questions answered
A recent Gallup poll showed that 1 out of every 6 people in America are depressed or seeking treatment for depression. This is the highest figure ever in the United States.
Fifty thousand suicides happen each year in the U.S., and it is estimated one-quarter of the entire world suffers from depression.
Chronic diseases, abusive families, bullying, COVID-19 and poverty are a few of the risk factors. More women than men suffer from depression, and young adults and the elderly are particularly vulnerable. May is Mental Health Awareness Month, a time to focus on awareness and education about mental illness -- and to encourage support for those with mental illness.
Here are common questions I receive from patients about depression:
What is depression?
Depression is a chemical disorder where an individual is down for two weeks or more and has little or no interest in participating in social and enjoyable activities.
Am I depressed or do I have something else?
It is important to differentiate depression from bipolar depression as they are treated differently. Bipolar depression often begins at a younger age, there is often a family history, and the symptoms may include racing thoughts, reckless behavior, mood swings and poor judgment. This depression is often resistant to the usual medications.
Am I "crazy" if I have this disease?
Absolutely not. People with depression function at the level of heart failure. The brain can get sick just like the heart. This disease likely relates to a lack of serotonin plus inflammation of the brain. This "crazy" stigma myth is fortunately starting to wane. Sen. John Fetterman, Dwayne Johnson, Janet Jackson, John Lennon, Winston Churchill and Abraham Lincoln are just a few examples of people who have dealt with depression.
What happens if I am thinking about suicide?
Seventy percent of patients having depression will experience suicidal ideation, so this is not unusual. Suicidal thoughts with a plan is a medical emergency and 911 should be called. Depression with or without suicidal thoughts can be treated by a primary care physician, social worker, psychologist or a psychiatrist.
If you or someone you know needs help with depression, text "STRENGTH" to the Crisis Text Line at 741-741 to be connected to a certified crisis counselor.
How is depression treated?
Often psychotherapy is a good starting point because this treatment is equivalent to a medicine. Cognitive behavioral therapy is quite effective and has the patient test the reality of negative emotional thoughts.
Medications that increase serotonin, adrenalin and dopamine may be added such as sertraline, venlafaxine and bupropion, respectively.
Treatment with medicine should occur for nine months after a person is well or in remission.
But what if I don't get better?
Sometimes depression is resistant to standard medical treatment.
Transcranial magnetic stimulation (TMS) is a machine shaped like a shower head that delivers magnetic waves to the brain and is noninvasive. Typically, six weeks of treatment is required and results in a success rate around 80%. It is often covered by insurance.
IV Ketamine represents an anesthetic that can be used for depression or pain and is successful in about 70% of depressed individuals. Essentially this drug is infused over an hour and often treatment is repeated five to seven times. The medicine is a hallucinogen at lower dosages and many patients will describe odd experiences upon receiving this agent. It is relatively expensive and not often covered by insurance.
Are there other non-drug treatments besides therapy?
A modified Mediterranean diet may also improve mood. And, daily exercise is deemed to be beneficial as well.
What's on the horizon for depression treatment?
In 2022, a large study by King's College London found psilocybin, a psychedelic compound produced by 200 types of mushrooms, can improve severe depression in people who have not responded to antidepressants. Oregon has the approval to utilize these agents in clinics next year. Usually a social worker remains with the patient during the "trip."
Depression is a very common biochemical disorder of the brain that needs to be recognized as a real disease. Unfortunately, there is still a stigma attached to depression but it is improving. Hopefully with more research, the above newer treatments will result in much less mortality. Reducing the number of COVID cases along with isolation should also help reduce depression.
• Evan Lipkis is a physician, author and professor who practices in Glenview. He exclusively treats anxiety, depression and weight loss. To reach him, email firstname.lastname@example.org.