Depression is a challenging disease in many ways. It has numerous possible causes and symptoms that are often associated with other health problems. It's also quite likely that most people will be depressed about something at some point in their lives, but this can be considered normal given the circumstances behind those feelings and how long they last. It's natural, for instance, to feel depressed after the death of a loved one or a personal or professional hardship. But when do "normal" feelings of sadness cross over to clinical depression? An accurate diagnosis is key.
Feeling sad, anxious or "empty."Feeling hopeless or pessimistic.Feelings of guilt, worthlessness or helplessness.Losing interest or pleasure in favorite hobbies and activities.Lower energy or persistent fatigue.Problems concentrating, remembering or making decisions.Sleep problems, including oversleeping.Changes in appetite or weight.Thoughts of death or suicide.Feeling restless and irritable.Constant physical ailments.
Again, many of these feelings may come and go over the course of one's life. But if these symptoms are present for more than two weeks, it's critical to get a professional diagnosis as quickly as possible. A depressive disorder , like most diseases, is best treated when diagnosed early, before it progresses.
Primary care doctors are usually well-equipped to do a preliminary screening. "It makes sense to see a general practitioner first," says Dr. Maria Oquendo, chairman of psychiatry in the Perelman School of Medicine at the University of Pennsylvania and president of the American Psychiatric Association. But she adds that patients have an obligation to be honest and forthright with their doctor. "If you suspect you have depression, it is very important to bring it up to your doctor directly," she says. "Many doctors are under tremendous time pressure to see many patients, and it is not uncommon for psychological conditions not to be addressed. So make a point of telling the doctor."
Having an open and honest relationship with your doctor is a must, says Dr. Drew Ramsey, assistant clinical professor of psychiatry at Columbia University in New York. "The best way to get an accurate diagnosis and, more important, to get treatment, is to find a mental health professional you feel a good fit with," he says. "My patients don't get better because I teach at Columbia, they get better because we have a good working alliance in how we treat it." By "good fit," he means finding a clinician you trust and can work with when challenged. "This is a voluntary system. You are allowed to find the clinician you like working with," he says.
Even in such a relationship, talking about a depressive disorder isn't easy. The NIMH suggests that the conversation can begin simply, by saying something like, "I haven't been myself lately," or "I think I might have depression, and I'd like some help." It also recommends coming to your appointment with a list of prepared information, including:
Any symptoms you've had, such as those that may seem unrelated to depression.When those symptoms started and how severe they are.Whether these symptoms occurred before, and if so, how they were treated.Personal information, including major stressful events in your life or recent changes in professional or personal relationships.Every prescription and over-the-counter medication you take, including vitamins and supplements.
The first step in diagnosing depression is usually determining if there's a physical cause for your symptoms, of which there are many possibilities. "Many symptoms of depression are consonant with illness, such as being tired, hungry or apathetic," Oquendo says. "It is critical that symptoms be considered in the context of other medical conditions," and to rule out if something else could possibly be going on. Problems with the thyroid gland, for example, can cause symptoms that look like depression. And many medications used to treat other illnesses can cause these symptoms as well. Your doctor will try to eliminate these other possible causes through a comprehensive physical exam, personal interview questions and lab tests.
If no physical cause is found, many primary care doctors prescribe antidepressant medication. While medications can be helpful, many mental health experts believe they are overprescribed. "Unfortunately, given our current health care system, primary care doctors don't have enough time, through no fault of their own, and may just prescribe antidepressants, because it is an easier fix," says Arthur Nezu, professor of psychology at Drexel University in Philadelphia.
A better choice might be to seek a professional with more expertise in depression, he says. There are many such specialists, including psychiatrists, psychologists, social workers or mental health counselors. The NIMH says that if your doctor does not refer you to such a provider, or if you feel your doctor is not taking your concerns seriously, you should contact your health insurance provider and ask for the name of a mental health specialist in your plan. You can also ask friends and family for recommendations.
By David Levine
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