Dr. Most: Depression is an Illness AND Depression is Something We Can Treat

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Doctor Kevin Most joined us today to talk about depression. When we say “depression” we are referring to clinical and diagnosable depression, not how depression is commonly perceived and talked about in the media. Doctor Most, Steve, and Andrea all engaged in a passionate conversation about this subject, and we hope you take the time to listen to this podcast. His notes are below if you want to further your own education.

The tragedy in France is quite sad, but this individual is not the typical patient with depression. Depression is very common, each of us, have individuals we know and see daily that suffer from some spectrum of depression.  It should be our goal to understand that this is an illness that when identified and treated allows patients to lead normal lives. We need to help identify the patients that we know and encourage them to get help, be supportive, have knowledge. 

We often hear about the patient with depression that has an adverse event, but these are so very rare. Unfortunately we hear about them as they impact celebrities or media events.
  • Ignorance about the illness only leads to a terrible stigma that is unfounded and harmful. Our goal should be to know what to look for in ourselves and others for this illness, just like we do for stokes, heart attacks, and other illnesses. Be supportive, don’t shun these individuals, understand the illness and know what you can do to help. They may be your neighbor or even one of your children.
Depression is a medical condition. It is not just feeling down and you will get over it. We know there are chemical imbalances in the brain that lead to depression. It is no different than high blood pressure or thyroid disease. It is an illness that can be treated successfully if we can identify and get the patient in for treatment. Making a patient feel uncomfortable or shunning them will often lead to the patient not finding help. We need to change the social stigma associated with depression.
  •  The number of individuals with depression can be staggering. In 2012, there were an estimated 43.7 million adults aged 18 or older in the U.S. with some form of mental illness in the past year. This represented 18.6 percent of all U.S. Adults. This can affect children as well, 1 in 33 children have clinical depression and estimates have 1 in 8 adolescents suffer from depression at some time. Do the math, if you have an adolescent child, chances are 2-3 children in his or her class is suffering from depression. Think of all your friends, chances are you have a friend suffering from depression. It is very common.
  • Mental Illness can range in impact from no or mild impairment to significantly disabling impairment, such as in individuals with Major Depressive Disorder.
Lets Make sure we know what to look for, what symptoms might the untreated patient have, again think of this like we do stroke and heart attacks, look for the symptoms. Look for them in yourself and others around you.
Common symptoms 
  • Persistent sad, anxious, or “empty” feelings
  • Feelings of hopelessness or pessimism
  • Feelings of guilt, worthlessness, or helplessness
  • Irritability, restlessness
  • Loss of interest in activities or hobbies once pleasurable, ( The Blackhawk Fan who does not want to watch the games)
  • Fatigue and decreased energy ( your golf buddy who says he is too tired to go play golf)
  • Difficulty concentrating, remembering details, and making decisions
  • Insomnia, early-morning wakefulness, or excessive sleeping
  • Overeating, or appetite loss
  • Thoughts of suicide, suicide attempts
  • Aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment.

Depression, even the most severe cases, can be effectively treated. The earlier that treatment can begin, the more effective it is. Again we need to be identifying the symptoms in ourselves and seek out treatment. We should also be looking at our friends and if you see the symptoms  encouraging them to get help. The encouragement that  his can be treated, treatment helps, you can live a normal enjoyable life.

The first step to getting appropriate treatment is to visit a doctor to rule in or rule out other causes of the same symptoms. Certain medications, and some medical conditions such as viruses or a thyroid disorder, can cause the same symptoms as depression. A doctor can rule out these possibilities by doing a physical exam, interview, and lab tests. If the doctor can find no  other medical condition that may be causing the depression, the next step is a psychological evaluation

Depression also may occur with other serious medical illnesses such as heart disease, stroke, cancer, HIV/AIDS, diabetes, and Parkinson’s disease.  Think about your friends suffering from other illnesses are they showing signs of depression.People who have depression along with another medical illness tend to have more severe symptoms of both depression and the medical illness, more difficulty adapting to their medical condition. Treating the depression can also help improve the outcome of treating the co-occurring illness.

  • Up to 80% of those treated for depression show an improvement in their symptoms generally within four to six weeks of beginning medication, psychotherapy, attending support groups or a combination of these treatments. 
  • Despite its high treatment success rate, nearly two out of three people suffering with depression do not actively seek nor receive proper treatment. Many of these patients stay away because of the fear of being labeled as depressed, we must get past this social stigma perception.
  • An estimated 50% of unsuccessful treatment for depression is due to medical non-compliance. Patients stop taking their medication too soon due to unacceptable side effects, financial factors, fears of addiction and/or short-term improvement of symptoms, leading them to believe that continuing treatment is unnecessary. 
  • Participation in a patient-to-patient support group improved treatment compliance by almost 86% and reduced in-patient hospitalization. Support group participants are 86% more willing to take medication and cope with side effects. 
As Physicians we need to be more in tune with this, the Electronic medical record will help with this. Medication compliance requires that the drug is tolerated and taken. If the patient can’t afford the medication or the side effects can’t be tolerated, we need to identify that. We do that with close follow up appts but also with the tracking of refills, this is much easier now in an electronic format versus the old paper chart world we used to live in. 

Treatments

Once diagnosed, a person with depression can be treated in several ways. The most common treatments are medication and psychotherapy. One of the main messages with these drugs is they don’t work like pain pills or antibiotics, the full affect of these drugs may take 4-6  weeks. The patient and the support team must be aware of this. Patients often want to stop the meds because” it is not working” and often this is after a few weeks on the medications, encourage the patient to stay on the meds, and have them discuss this with their doctor.

Medication

Antidepressants primarily work on brain chemicals called neurotransmitters, especially serotonin and norepinephrine. Other antidepressants work on the neurotransmitter dopamine. Scientists have found that these particular chemicals are involved in regulating mood, but they are unsure of the exact ways that they work.

Popular  antidepressants

Some of the newest and most popular antidepressants are called selective serotonin reuptake inhibitors (SSRIs). Fluoxetine (Prozac), sertraline (Zoloft), escitalopram (Lexapro), paroxetine (Paxil). Most are available in generic versions. Serotonin and norepinephrine reuptake inhibitors (SNRIs) are similar to SSRIs and include venlafaxine (Effexor) and duloxetine (Cymbalta).

SSRIs and SNRIs tend to have fewer side effects than older antidepressants, but they sometimes produce headaches, nausea, jitters, or insomnia when people first start to take them. These symptoms will fade over time but encouragement from friends to continue with the medication is very helpful.

MAOIs

Monoamine oxidase inhibitors (MAOIs) are the oldest class of antidepressant medications. They can be especially effective in cases of “atypical” depression, such as when a person experiences increased appetite and the need for more sleep rather than decreased appetite and sleep. They also may help with anxious feelings or panic and other specific symptoms.

MAOIs can also react with SSRIs to produce a serious condition called “serotonin syndrome,” which can cause confusion, hallucinations, increased sweating, muscle stiffness, seizures, changes in blood pressure or heart rhythm, and other potentially life-threatening conditions. MAOIs should not be taken with SSRIs.

Treatment for depression goes well beyond medication. Therapy sessions with psychiatrists and support groups can help as well.  In many cases this is the type of therapy that when coupled with medication lead to very successful outcomes.

  • Participation in a patient-to-patient support group improved treatment compliance by almost 86% and reduced in-patient hospitalization. Support group participants are 86% more willing to take medication and cope with side effects. 
Our collective goal should be to lead a healthy life as individuals and support those around us to lead healthy lives. Identifying illness or possible signs of illness in ourselves and others is important. Encouraging a friend to seek medical advice is something we should consider, but make sure you are educated somewhat in the illness. Telling someone they are depressed is often not helpful, encouraging that same individual to see a physician about their symptoms often is. Knowing a little bit can be helpful, discussing with that dear friend to continue their medication because taking it for 1 week is not long enough to see results. Personally if you are feeling any of these symptoms, see your doctor, it often is not something you will just “get over”.

Be supportive of individuals with mental illness and stop conversations lead by ignorance to the disease.
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