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by Katrina Christie MeD, LCPC
and Ric Saguil,MD, FAAFP

Feeling sad or down once in a while is perfectly normal. We all experience it. There aredepression1_1.jpg physical and mental reasons for temporary depression. Experiencing a short-lived blue-funk gives your body and mind a chance to re-energize. It also allows you to better understand and appreciate the good days, which for most people are frequent.

So what happens when that blue- funk doesn't go away? What happens when the "bad days" multiply into bad weeks or worse bad months? What makes us so sad that we don't want to get out of bed in the morning? What does it mean when the things we loved in life are no longer important? What's going on when our purpose in life is gone, when life itself has little meaning?

If life has lost its luster and you find happiness is no longer a part of your makeup, you're not alone. Depression affects 9.5% or 18.8 million Americans over the age of 18 every year.  Over 15% of depressed patients go on to commit suicide. Even more shocking is the fastest growing population of depressed Americans is preschoolers according to a 2004 study published in Psychiatric Services. With the rate of childhood depression increasing by 23%, it's no longer uncommon to read about teen suicide.

While the increase in the rates of depressed Americans is disturbing, the true sadness comes from the lack of understanding of its victims, their family and friends. The truth is Depression is a highly treatable affliction yet 80% of depressed people are not seeking treatment. According to a study by the National Mental Health Association over half of people surveyed believe depression is a personal weakness and as a result are too embarrassed to seek treatment. While the depressed patient knows something is wrong the tendency for their partners and friends is to minimize its affects and assume an attitude of "snap out of it", something analogous to a piece of lint that can simply be brushed off.

depression2.jpgSo what causes depression? There is no clear answer to this question. In general researchers believe that depression stems from physical or emotional issues that manifest itself as chemical imbalance. The chemical is called serotonin and is secreted by nerves in response to good feelings. Once the stimulus (good feeling) is gone the chemical is reabsorbed and stored for the next good feeling. Anti-depressant medications don't manufacture serotonin they simply block its re-absorption. This could explain the reason why anti-depressant medications are effective in severely depressed patients but fail in the mild to moderately depressed.

We know and it's easy to recognize loss or extreme trauma as a reason for short-term depression. Things like the death of a family member, job changes, personal injury, family issues and abuse or bullying are readily apparent. Long-term or lifelong depression can have its roots from a myriad of psychological or genetic issues. Childhood issues often can be buried only to surface years later. Other triggers can be chronic illnesses that drain our energy and which over time affect our lifestyle and lead to depression. Put enough bad days together and soon life looks bad. Conditions we often see that when not properly treated can set the stage for depression are: hypothyroidism, diabetes, menopause, insomnia, various nutritional deficiencies and food allergies.

Depression is an extremely treatable affliction and it's important that we abandon the idea that somehow the victim can and should just "brush it off". The six-minute medical visit and anti-depressant prescription routine is highly ineffective. Yet it's the common approach to medical management of a truly devastating ailment. Studies have shown that for the mildly to moderately depressed patient anti-depressant medications work no better than a placebo.depression5.jpg

Sadness is typically short-lived and after a reasonable period of grief should go away. Depression on the other hand, isn't simple, doesn't happen overnight and recovery takes guidance, support and time. In our practice we work with a team of providers who understand the role of sequencing medications, counseling, diet and exercise. All play a vital role in recovery. Ruling out health issues is first. Next comes evaluating the cause and third structuring a recovery plan that is comfortably paced but progressive.

Sarah was a good example. Sarah was a 61 year old female suffering from severe depression that had progressed to anxiety. Her issue had gradually worsened over a 4-5 year period. When we saw her for the first time she was unwilling to leave her bedroom. This vibrant career woman who loved her family and her life was now almost a complete recluse. She cried at the drop of a hat and lost all interest in the things and people she loved. When we first saw her she was taking Celexa (an anti-depressant) and synthroid  (a thyroid replacement hormone) with minimal positive affect, the fact is she was getting worse. We diagnosed her as moderately to severely depressed with underlying hypothyroidism and food allergies.  After a thorough examination and review of our thoughts by our physician, we changed her medications, began counseling, referred her to an anxiety clinic and our dietitian, who found out she was also gluten intolerant.  Changes were gradual but impressive. After a few weeks she was able to leave her house. Shortly thereafter she was able to start an easy exercise routine with the guidance of our exercise physiologist. Exercise releases feel good chemicals in the brain. Although she was barely able to complete 15 minutes of extremely low level exercise at first, she now works out vigorously 3 days weekly.  Things are different now.  Sarah gardens, plays with her grandchildren and now happily states, "she has her life back".

Depression is a downward spiraling cycle. Left untreated it typically gets worse. Understand that depression is a medical issue that can't be "brushed off". The best news is that with proper guidance and support depression is reversible.