DEAR DR. ROACH: Could you say something about depression? What can it do to you in the long run if it isn’t treated? – Anon.
ANSWER: Depression is a huge topic. There are many types of depression, and the effects of depression on a person depend in large part on age, sex, pregnancy status and many other unique characteristics of a person.
Depression is one of the most important conditions that doctors diagnose and treat. Major depression is the second leading cause of disability among all diseases and injuries. Nonetheless, many people are embarrassed to talk about it, tell their doctors about it or get treatment. Short screening tests for depression are available, and people at risk for depression can use a longer instrument, the PHQ-9, widely available to help diagnose and monitor treatment for depression.
Treatment for depression is pretty effective. Initial treatment of people with mild to moderate depression is effective (resulting in response or remission) in about 60% of people affected. Most primary care doctors, including family doctors and internists, are comfortable treating their patients with mild or moderate depression. Some people will need additional treatment, and those with severe depression or who do not respond to initial therapies will benefit from seeing an expert, such as a psychiatrist. Treatment is more effective when begun promptly after symptoms begin. However, some people have difficulty recognizing their symptoms as being due to depression, in addition to the barriers to treatment I mentioned above.
The official diagnosis of depression requires five of these nine symptoms, as obtained during a medical history by an expert.
• Feeling depressed: “sad,” “hopeless” and “down” are some common terms.
• Loss of interest or pleasure in activities the person used to enjoy.
• Significant change in appetite or weight.
• Change in sleeping habits: too much or too little.
• Physical restlessness, or its opposite, slowing of physical movement.
• Fatigue or loss of energy.
• Feelings of worthlessness or guilt.
• Poor ability to think or concentrate.
• Recurrent thoughts of death, which may or may not include a plan to hurt oneself.
I am sure there are people who will read today’s column and realize for the first time that their symptoms may be due to depression.
Prognosis of untreated depression is not as good. While death by suicide is a tragic outcome, there are many other bad outcomes that people with untreated depression may suffer. Damage to relationships with family and friends, poor work performance, alcohol and substance abuse are known common outcomes of untreated or poorly treated depression.
In my career I have treated hundreds of patients for depression. One frequent barrier to treatment is that many people feel that they can overcome depression by willpower alone. Well-meaning friends may give advice on diet treatment, exercise or supplements. Any of these may be helpful, but they are very rarely curative by themselves. You would never expect to get over appendicitis or diabetes by wishing it away. Depression needs treatment, and both medication treatment and psychological treatments are effective. Ideally, a person receives both.
Very often, the hardest steps in overcoming depression are the first ones: recognizing you have a problem and making an appointment to talk about it. One way to start – today – is by contacting U.S. Substance Abuse and Mental Health Services Administration’s national helpline at 800-662-4357 or at samhsa.gov, which can refer you to someone near you.