Ask Dr. Pat

Dr. Pat Consults: Lady Sings the Blues, but Is She Depressed?

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, she reaches out to Dr. Marianne Gillow, a board-certified psychiatrist in private practice in New York City, to discuss the difference between “the blues” and depression that may be ameliorated with medication.

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There are occasions when feeling sad is simply normal behavior: for instance, a romantic disappointment, a medical illness, or a trenchant note from the IRS.

And that’s just the point: Traumatic life-events are part of the human condition; they routinely cause malaise. But when does sadness, an appropriate response to difficult life events, turn into depression, a medically treatable syndrome?

“The blues” (sadness triggered by some sort of loss) used to be considered unresponsive to antidepressants, because the patient’s despair was “situational.” In the past, the mental health field considered medication useful only when a patient was assessed to have “biological” depression. (“Biological depression is a disorder of the brain,” notes MedlinePlus, the website of the National Institutes of Health. “There are a variety of causes, including genetic, environmental, psychological, and biochemical factors.”)

The view on so-called “situational” depression has changed in recent years. Some people with  “the blues” develop clinical symptoms that are actually medication-responsive.  More and more, depression is being viewed as a disorder of mood reactivity.  Anyone who notices profound changes in his/her thinking, feeling, or functioning should look into the possibility that he/she may have a treatment-responsive syndrome, even if the changes are due to a difficult situation.

Anyone in trouble should look at his/her constellation of symptoms.  If you have Target Symptoms that are medication-responsive, you stand a very good chance of receiving some benefit from antidepressants.

Below are listed some clusters of target symptoms that are particularly known to improve with medication.

1) Sleep and appetite can be very sensitive targets symptoms. A change in sleep or appetite in any direction can be indicative of depression. Early-morning awakenings are another clue that depression may be present. Sleep and appetite changes that persist for more than a month are classic indicators of biological depression.

2) The presence of “core depressive symptoms” for two weeks or longer can be a sign that it is time to look into antidepressant treatment. Core depressive symptoms can include crying spells, hopelessness, negativity, and ongoing sadness. If loved ones become concerned about you and report that they observe core depressive symptoms, looking into antidepressant medication may be a good step toward relief.

3) Changes in ability to function are key in identifying depression. Many people can feel great sadness, but are able to continue to work and carry on with day-to-day tasks. If depressive symptoms take over your ability to get things done, then it is highly likely that the level of despair is too high to get better without medical intervention. If you are unable to read or focus on what you need to do because of negative thinking, consider a medication evaluation.

4) An uncharacteristic preoccupation with death is also a sensitive indicator that depression is present. When depressed, it is normal to feel that life is not worth living. Many people report a sense of knowing the future—and knowing that everything WILL go wrong. Some people report an ongoing sense of impending doom. Others note that an increased preoccupation with mortality can hover over the day like a death star. And of course, feeling suicidal is absolutely one of the clearest signs that a medication evaluation for depression is essential.

I hope these parameters will be helpful to you in deciding if you have a level of depression that merits a look by a mental health professional. The above target symptoms are considered medication-responsive, and there is much to be gained by looking into medication—or, even better, a combination of medication and talk therapy, which has been clinically proven to be even better than medication alone.

There are downsides to antidepressant medication—possible weight gain and possible loss of the ability to feel sexual arousal among them. “Anyone taking antidepressants should be monitored closely, especially when they first start taking them, cautions the website of the National Institutes of Health.  “For most people, though, the risks of untreated depression far outweigh those of antidepressant medications when they are used under a doctor’s careful supervision.”

People by the millions find a way, during their lives, to endure humiliation, to deal with losing a job, to face the rejection or the dying of a loved one—but not all of them go through the pain of a major depressive episode. If you think depression is affecting you, educate yourself! (Dr. Cecilia Ford, a clinical psychologist who is a regular columnist for Women’s Voices, has written many articles for us  on depression.) In our modern times, there are many helpful options out there . . . and well-considered medication can help you get the best quality of life possible.

After you have educated yourself, speak out!  Ask for help . . . and ask around.  Your internist or gynecologist is likely to know some good mental health providers.  Your dermatologist, too, is likely to have good referrals, as are any other doctors who take care of you. Also, more friends than you may think are under a psychiatrist’s care: ask them about their experiences and who is good in your community.  In this age of PR and multi-media, old fashioned word of mouth from trusted friends and health care providers remains the best source of information. If that option is not available to you, websites by professional association, like the American Psychiatric Association of the American Psychological Association, are extremely useful.

Anyone who has depressive target symptoms deserves a good look by a qualified mental health professional.  It is reasonable for you to expect target symptoms to improve with treatment.  Be sure you are comfortable with the psychiatrist or psychopharmacologist you meet with.  Get a good explanation of what is recommended, what the side effects are, and engage in ongoing monitoring.  Even if your depression is situational, you can get a good result with treatment.  Then you can become the Lady Who Sings the Blues . . . not the Lady who has them!

 

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