Ask Dr. Pat

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

You mentioned that you have already spoken to your primary care doctor. This is an important first step, since a thorough workup is necessary to ensure that there are no health factors that may be contributing to your mental health: There are a number of physical issues that are associated with depressed mood. Once you have ruled these out, having the diagnosis of depression opens up the opportunity for treatment.

Your options include both pharmacological interventions and psychotherapy, which you can explore with your primary care doctor; she may, depending on her own comfort level and expertise, recommend following up with a psychiatrist. There are a number of antidepressants available, and you can work with your doctor to find the one that is right for you. It can be difficult to predict which medication will be most effective for an individual, so finding the right treatment can require some patience on your part.  

Another option is to start psychotherapy: Studies have shown that this is as effective as antidepressant medications. In studies, no particular form of therapy has been shown to be better than others, but both cognitive behavioral therapy (CBT) and interpersonal therapy (IPT) are effective. CBT focuses on replacing the often negative thought patterns that develop in depression with more positive, constructive ones. IPT works on the role of problematic interpersonal relationships in the perpetuation of depression. Both CBT and IPT are forms of time-limited psychotherapy, meaning the treatment is designed to be done over a certain number of sessions, rather than indefinitely. An added advantage of psychotherapy is that the positive effects last long after you have stopped therapy, since the skills you learn stick with you. Studies looking at the effect of therapy on brain function have found that psychotherapy causes actual changes in brain activity, somewhat similar to the changes seen in those who are taking antidepressants. For your best bet, consider combining therapy with medications; this strategy has been shown to be the most effective.

Please discuss your current symptoms with your doctor. There are many opportunities available to you for treatment. You deserve to feel better.

Megan Riddle, M.D.

 

For More Information:
National Institute of Mental Health: http://www.nimh.nih.gov/health/topics/depression/index.shtml
National Alliance of Mental Illness: http://www.nami.org/Learn-More/Mental-Health-Conditions/Depression

References
Katon W, Ciechanowski P. Unipolar major depression in adults: Choosing initial treatment. Uptodate.com. 2015. http://www.uptodate.com/contents/unipolar-major-depression-in-adults-choosing-initial-treatment

Pratt LA, Brody DJ. Depression in the U.S. household population, 2009–2012. http://www.cdc.gov/nchs/data/databriefs/db172.pdf NCHS data brief, no 172. Hyattsville, MD: National Center for Health Statistics. 2014.

 

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