Ask Dr. Pat

Dr. Pat Consults: Depression—the Symptoms Are Not Always What You Expect

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 MD-PhD Program, to address the concerns of a woman who has lost energy and the desire to do the things she once enjoyed doing. But can such mild symptoms spell depression?

 3 amImage by Mark Menzies via Flickr (Creative Commons License)

Dear Dr. Pat:

I am 56 years old and five years past an uneventful menopause. I have been struggling with low energy. I just don’t feel like doing the things I once enjoyed doing. It’s been going on for a while now—hard to say how long, since it has been rather gradual. Part of it may be related to my sleep, since I tend to wake up early in the morning—about 3 a.m.— and then lie awake, unable to fall back to sleep. I’ve been to my primary care doctor, and she says I’m healthy. One of my friends suggested that I might be depressed, but I’m not sure I feel bad enough to be depressed.  My mother had depression, and she barely got out of bed and was perpetually threatening suicide. I’ve never so much as considered harming myself, and I get up every morning to go to work and take care of my family, although I feel guilty because I haven’t been as involved in my children’s activities as I was in the past. I am still able to force myself to do all the basics of parenting, so no one is neglected. Work hasn’t been any more stressful than normal, although I do find I have some trouble concentrating and completing tasks. Overall, my life has been going well and I don’t have a reason to be depressed. What do you think? Could this be depression?  What can I do to function and feel better?

Thanks,
Marion

 

Dr. Pat Responds:

Dear Marion:

Your question is an important one. Mental health care providers and patients have strong opinions about the under- or over-diagnosis of depression and the options for symptom management for improvement in the quality of life of those who are suffering. It would make sense that you would be more concerned than many women who are mothers if you felt that you were developing an illness that so affected your own mother—and, consequently, you, her child. But the goal is to get a sound diagnosis and try various forms of treatment until you recover your energy, improve your sleep, understand the psychological basis of your current symptoms, and, with treatment, find a way to function with the joy you once experienced in daily life. You may recover with some form of psychotherapy or you may need a combination of medication and therapy. There is no quick or easy answer. The most important step is the one that you are now taking: asking the question, “Could this be depression?”  

Dr. Pat

 

Dr. Riddle Responds:

Dear Marion:

Yes, this absolutely could be depression. You describe many of the classic symptoms. These include changes in sleep, losing interest in things you once enjoyed, and trouble concentrating. Those who are depressed also tend to feel guilty. People can also experience changes in appetite—eating a lot more or a lot less than usual— as well as feeling either agitated or sluggish. Some people also have thoughts of suicide. It is not uncommon for someone to think, I’m not suicidal, so this can’t be depression, but you do not need to experience all of these things to be diagnosed as having depression (see box, “Could It Be Depression?”). A diagnosis of major depressive disorder requires five or more symptoms for a period of at least two weeks. If you are experiencing fewer symptoms for a longer period of time (at least two symptoms for at least two years), this is called persistent depressive disorder, or dysthymia. Both major depressive disorder and persistent depressive disorder can respond to treatment.  

You state that you don’t feel as if you have a “reason” to be depressed. The development of depression is related to a combination of components, and although it does include things like your current life stressors, it is also influenced by other factors like genetics, personality traits, childhood experiences, and even your current physical health. You mention that your mother struggled with depression. That must have been difficult to witness. In addition to being stressful, having an immediate family member with depression results in a two- to-threefold increase in the likelihood that you will also develop this illness.

Depression is very common, and often goes untreated. Lifetime rates of depression are between 10 and 15 percent for the population as a whole, with higher rates seen in women. A recent study released by the Centers for Disease Control showed that you are in a particularly high-risk age group: Women between the ages of 40 and 59 had the highest rates of depression. Many people suffering from depression don’t seek treatment: Only about 1 in 5 individuals with moderate depression report having seen a mental health professional in the past year. Only about a third of those with severe depression seek the care they deserve.

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