Understanding and Recognizing Depression

If you are considering suicide, seek help immediately. Call 911 or the National Suicide Prevention Lifeline at 1-800-273-TALK (8255). There is also a Crisis Text Line: Text HOME to 741741. For crisis support in Spanish, call 1-888-628-9454.

Do you wonder if you are depressed?

Over the past two weeks, have you:

• Experienced little interest or pleasure in doing things?
• Felt down, blue, or hopeless?
• Had trouble falling or staying asleep, or been sleeping too much?
• Felt tired or had little energy?
• Had a poor appetite, or been overeating?
• Felt bad about yourself, or that you are a failure or have let yourself or your family down?
• Had trouble concentrating on things, such as reading or watching TV?
• Been moving so slowly that other people have noticed, or the opposite—been so fidgety or restless that you have been moving around a lot more than usual?
• Had thoughts that you would be better off dead, or of hurting yourself?
• If you answered yes to any of the above questions, you may be experiencing a depressive disorder.

Major depression is one of the most common mental health disorders in the United States.  It’s estimated that approx. 17.3  million adults in the United States will experience a depressive episode in their lifetime. That is approximately 7.3% of the US adult population. And since the pandemic started, we are seeing a rise in the incidence of many mental health disorders, depression included. For example, one study found that following COVID-19 infection, 31% of patients screened positive for depression.  That number does not even include the depression brought on by isolation, loneliness, and worry related to the pandemic. Although identifying and treating depression is always important, right now it is critical.

A major depressive episode is diagnosed when a person experiences five or more of the following symptoms nearly every day over a two-week period:

Emotional Symptoms:

              *Depressed mood most of the day, nearly daily

              *Diminished interest or pleasure

              Feelings of worthlessness

Cognitive Symptoms:

              Thoughts about death, or suicidal thoughts or behaviors

Neurovegetative symptoms:

              Significant weight loss (5% of body weight in one month)

              Insomnia (difficulty sleeping) or hypersomnia (sleeping too much)

              Psychomotor agitation (movements that serve no purpose such as pacing)  or psychomotor retardation (visible slowing of physical and emotional actions, including speech)

              Fatigue

              Difficulty concentrating

One of the five symptoms must include one of the two symptoms marked with a star (*).

There are many other depressive disorders as well, including persistent depressive disorder (> 2 years of depressed symptoms), premenstrual dysphoric disorder (depression that occurs in the week prior to the onset of menses), and disruptive mood dysregulation disorder (diagnosed in children ages 6-18 and marked by severe recurrent temper tantrums). There is also a type of depression that is part of bipolar disorder. Each type of depression has its own criteria as well as effective treatments.

There are also “secondary causes of depression.” This is when depression is caused by another factor. This is the type of depression that no physician wants to miss. There are generally three categories of secondary causes.

The first category is when a medical condition causes the depression. It is important to note that this is not stress about a medical diagnosis leading to depression, but rather the actual medical condition itself causing depression. There are several different medical conditions that can lead to depression. Some of the most common are cancers (especially pancreatic cancer), cardiac causes (such as stroke and heart attacks), endocrine disorders (such as thyroid disorders), and neurological disorders (such as MS, epilepsy and TBI). Even obstructive sleep apnea can cause to depression.

The second category is depression caused by substance use. Alcohol use can cause depression, as can opioids, sedatives, cocaine, and amphetamines. Benzodiazepines and sleeping pills are on the list as well.

The third category of secondary causes includes commonly prescribed medications that can cause depression. This list is very long, but common offenders include steroids, ACE inhibitors, beta-blockers, and interferon. The antibiotics ciprofloxacin and metronidazole are also on the list, as are baclofen and estrogen.

Because the types and causes of depression are so varied, it is absolutely critical that you see a physician if you are experiencing the symptoms of depression listed above. Your primary care provider is a good starting place. You should have a full physical exam, lab work, honest discussion about substance use and review all of your current medications. There may well be a secondary cause for your depression that can be addressed. And if it is major depression, there are many treatment options available.

No one needs to suffer alone and hopeless in the darkness. There is help readily available.

The Rev. Suzanne Watson, M.D.  came to medicine as a second career after 10+ years of ordained ministry in the Episcopal Church where she served in congregations in California, New Zealand, and Connecticut, as well as on the staff of the Presiding Bishop in New York. She was also a candidate for Bishop of Alaska.

She attended medical school in her 20s, but left to devote time to raising her family. However, her dream of practicing medicine never died, and at the age of 50 she embarked on this vocational change. Part of her motivation was the loss of her physician husband to suicide. She is strongly committed to mental health advocacy, the reduction of stigma, and suicide prevention

She is currently in her last year of residency in  Psychiatry at the University of Nevada, Reno. She is returning to San Diego this Summer and will be working at the VA hospital in La Jolla.