As colder weather rapidly approaches, many health practitioners are keenly aware that the "winter blues" is more than just an expression.
In winter, the incidence of depression significantly increases. So, when the American Psychiatric Association recently updated their guidelines on the management of depression, it couldn't have come at a better time.
The most striking recommendation is the emphasis on psychotherapy as a critical component of treatment. Therapy not only improves the symptoms of depression but also helps patients build the coping skills necessary to deal with many of the root causes of the condition. Frequently, patients ask me to prescribe antidepressants yet resist seeing a qualified therapist.
While antidepressants are valuable tools in treating depression, these medications work best when taken in combination with ongoing psychotherapy. This may be done by psychiatrists occasionally, but more frequently, behavioral therapists see depressed patients either alone, with a spouse or a family member and, occasionally, in groups. The therapeutic value of talking with an expert, also referred to as cognitive behavioral therapy, is an essential element of treatment.
The association does recommend using a rating scale to accurately diagnose and define the psychiatric symptoms and severity of depression. As a general rule, depression is usually defined as minor or major. A patient with minor depression feels glum or sad, experiences frequent fatigue, has difficulty sleeping and may either gain or lose weight. Importantly, the patient is not suicidal and is able to function adequately at home or at work. The condition can persist for years and is often referred to as dysthymia. Minor depression can often be helped significantly with psychotherapy alone.
According to the Centers for Disease Control and Prevention, major depression occurs in 3.4 percent of the population. It affects people of all ages, ethnic groups, sex and socioeconomic status. To diagnose a major depression, a patient must have a significantly depressed mood or loss of interest or pleasure for most of the day for at least two weeks. Weight loss, insomnia, fatigue or loss of energy, a feeling of worthlessness and excessive guilt, a reduced ability to concentrate, and recurrent thoughts of death or suicide are common symptoms. These patients usually find it impossible to function in the community, and those deemed to be at risk for suicide should be admitted to a facility for observation and intensive treatment.
The association's recommendations focus primarily on major depression, an illness that must be taken very seriously. On occasion, the cause of major depression may be the presence of an illness, an adverse effect of a drug or may have been precipitated by a major psychological stress. It is important to determine if the patient has turned to drugs or alcohol or if substance abuse is a cause of the problem. Family and social issues must be carefully assessed. Dysfunctional relationships and physical or emotional abuse could be the root cause of a major depressive episode.
Mostly, depression occurs for no good reason and is associated with declines in serotonin and noradrenaline concentrations in the brain, which can lead to all of the disease's symptoms. Antidepressants aim to increase the concentration of serotonin, noradrenaline or both. Responses to individual antidepressants vary from patient to patient, and multiple trials of different medications may be needed before symptomatic relief occurs. Anyone who remains chronically depressed or has had three or more episodes of major depression should be maintained on antidepressants indefinitely.
When neither psychotherapy nor medications eliminate the symptoms of major depression, electroconvulsive therapy should be considered. In this procedure, electric currents are passed through the brain of sedated patients. Although the mechanism is ill understood, it is highly effective in improving symptoms.
Approximately 10 percent of Americans are depressed. It is a true epidemic that is frequently ignored, inadequately treated and often misunderstood. If you or someone you love suffers from depression, do not wait to seek help. Psychotherapy with or without the addition of medications can prove to be life changing.
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Dr. David Lipschitz is the author of the books, "Breaking the Rules of Aging" and "Dr. David's First Health Book of More Not Less."
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