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Dr. Patricia Yarberry Allen is a collaborative physician who writes a weekly Medical Monday” column for Women’s Voices for Change.  (Search our archives for her posts, calling on the expertise of medical specialists, on topics from angiography to vulvar melanoma.)

This week, Dr. Pat has asked Megan Riddle, M.D./Ph.D. — a psychiatry resident at the University of Washington and a graduate of the Weill Cornell/Rockefeller/Sloan-Kettering Tri-Institutional M.D.-Ph.D. Program — to answer the questions of a woman seeking advice about therapy and treatment options for a niece with depression.


Dear Dr. Riddle:

I am an emergency room nurse in the New York area. I have a 28-year-old niece who seems stuck. Her parents were never married and she was brought up by my sister simply because her mother wasn’t able to care for her because of an addiction to pills and alcohol. My niece was always treated as well as my sister’s two other children, who were five years older and accepted their “adopted sister” as a real member of the family. These two children are older now and have decent jobs, are married and have families. My niece went to college sort of aimlessly and has a degree in business and lots of student debt. She works in a low-level position in publishing that seems to have no future. She is a pretty young woman but is overweight and doesn’t really date or go out much. My sister who raised her is unwell now and my niece is the one who gets the calls at work and manages middle-of-the-night emergency room visits. My sister has a rent-stabilized apartment and my niece lives with her and pays half the rent. She seems more withdrawn each time I see her. Pleasant and helpful but it seems she has to make an effort. I mentioned that she might like to see someone to see if she needed some medication for her sad mood and she was adamant that she would never take drugs. There is depression in the family but she said she did not want to be like her mother: addicted to pills. She really does not have the money or time for old-fashioned talk therapy. Are there other options for her?  Would a visit with a kind psychiatrist help her understand if she needs medication? Is cognitive behavioral therapy a possibility? I can pay for a visit to a psychiatrist and could help with short-term therapy, but I don’t have the ability to do more than that.



Dr. Riddle Responds:

Dear Jill,

I share your concern about your niece. It sounds as though she has been through quite a bit and has been struggling for some time. From your description, it sounds like she may be experiencing some form of depression. While the classic depression, officially called Major Depressive Disorder (MDD), gets the most attention, there are actually different kinds of depressive disorders. As your letter suggests, this has gone on for an extended period of time, so your niece may be experiencing what’s called Persistent Depressive Disorder (PDD), also known as dysthymia. With PDD, the depression itself may be less severe than seen in Major Depressive Disorder, but it lasts much longer — at least two years to meet the formal diagnostic criteria.  In addition to low mood, these individuals experience poor appetite or overeating, difficulty with sleep (sleeping either too much or too little), fatigue, poor self-esteem, trouble with concentration and in making decisions and a sense of hopelessness. People can experience both PDD with worsening periods of MDD as well, a so called “double depression.” From your description, this sounds very much like your niece. If she is willing, seeing a psychiatrist could offer more clarity regarding her diagnosis, which will help to guide treatment.  

RELATED: Depression—the Symptoms Are Not Always What You Expect

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  • Dr. Margaret Rutherford March 29, 2016 at 7:02 am

    I am a clinical psychologist and have been practicing for over 20 years. I agree with Dr. Riddle that medication could be helpful for this more long-term state of depression. But I would further suggest that there are many therapies that are brief in nature, CBT being only one of them. This young woman might benefit greatly from a relationship with a therapist who could act as a guide and support, while having a more objective view than family members. Talk therapy doesn’t have to be long-term to be highly effective.