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5 Things to Know About Clinical Depression

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woman feeling depressed Google recently introduced an Artificial Intelligence platform, Gemini, to take over from its BARD system. Curious about its capabilities, I asked, “What health-related queries do people commonly search for on the web?” Gemini highlighted that inquiries about clinical depression rank among the most common health topics searched on the internet, closely following diet (specifically weight loss) and ahead of sexual performance. In our previous blog post focusing on medical concerns, we delved into weight loss challenges and the shortage of new weight-loss medications for shedding excess pounds swiftly and safely. In this post we tackle one of the most puzzling conditions that bring people into their doctors’ consulting rooms and to their computer screens more and more frequently these days, which is Clinical Depression.  CALL 988 LIFELINE FOR SUPPORT! If a person suspects they or someone they care about might be suffering from depression, it is essential to get professional help. This is especially important when a person is experiencing suicidal or self-harm thoughts. There is an easy-to-remember three-digit 988 Suicide & Crisis Lifeline, which operates 24/7, allowing people experiencing substance abuse, suicide, and/or mental health crises to connect with trained counselors. 

#1 Understanding what depression is not

One of the most challenging aspects of depression is that it cannot be pinpointed through blood tests or other tangible measurements, unlike many other medical conditions diagnosed by doctors. We often rely on our healthcare providers to identify the causes of our symptoms by conducting a series of tests. It’s natural to anticipate that a definitive treatment plan will follow once the causes are identified, even if complete cures are not always feasible. However, diagnosing depression is a matter of experienced guesswork on the part of the doctor. The battery of tests available can only rule out illnesses or conditions that might manifest the symptoms that a patient with depression is experiencing. Blood tests, X-rays, scans, and MRIs primarily focus on detecting changes in the body. Yet true depression originates in the mind. It isn’t coming from somewhere in the body that can be touched, felt, probed, or manipulated. It’s a realm beyond physical examination.

#2. Depression isn’t a transient emotion like sadness or anxiety

Another aspect to grasp is that many individuals mistakenly complain of depression when, in fact, they are experiencing transient feelings of sadness or anxiety. There’s a clear line between a long-lasting condition like clinical depression and temporarily feeling a bit blue or jumpy. The key difference between sadness or anxiety and actual clinical depression is how long these feelings last.  When a doctor diagnoses depression, it’s not just about feelings of sadness or anxiety. The patient must experience a sense of depression persistently for at least two weeks without a clear cause. This is crucial because certain emotions, like grief from losing a loved one or pet or anxiety about a possible major life-changing event in the future, can last for months but are distinct from depression.

#3 Depression can be overwhelming

Clinical depression can be all-consuming, causing a person to lose interest in activities they once enjoyed, such as eating, intimacy, or socializing. It can severely impact their work, relationships, and self-care. Clinical depression isolates individuals, leading to feelings of worthlessness and self-blame. They may struggle with decision-making and concentration while experiencing self-criticism. In more serious cases, individuals suffering from depression may experience thoughts of self-harm, which could potentially lead to suicidal tendencies. 

#4 What do doctors look for

Healthcare professionals often conduct evaluations through interviews, questionnaires, and conversations with the patient. Specialized mental health assessments by psychologists, psychiatrists, and psychoanalysts can provide an assessment of the severity and duration of symptoms. In addition, discussions with family members, colleagues, and friends can help uncover triggers for episodes of depression. However, this approach is primarily used to differentiate between sadness and depression caused by tangible factors. Sometimes, the root cause of depression may not be easily identifiable.

#5 What treatments are available for people suffering from clinical depression?

We have written a few blogs that deal with different aspects of diagnosis and treatment of clinical depression. The following is just a summary – read the full articles for more comprehensive information. Dealing with depression means understanding the causes of Major Depressive Disorder (MDD). The diagnostic manual that doctors use for diagnosing depression is the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.  Some biological factors can make a person more susceptible to depression, involving neurotransmitters, hormonal changes such as those occurring during puberty, pregnancy, or menopause, and differences in brain structure and function. Depression can run in families, and there is a degree of gender bias since evidence shows that women tend to be diagnosed with depression more frequently than men. This can be attributed to hormonal fluctuations during the menstrual cycle, pregnancy, postpartum period, and menopause. Older adults experience factors like physical health problems, declining sexual desire, chronic pain, loss of loved ones, and social isolation. All of these can increase the risk of depression. Medications for clinical depression and anxiety can come in many forms and are often combined with psychological and behavioral therapy. For those patients who are severely depressed or at risk of harming themselves or others, inpatient or outpatient day treatments might be necessary. Selective Serotonin Reuptake Inhibitors (SSRIs) work by increasing the levels of serotonin in the brain by blocking its reabsorption. They are considered safe, with fewer side effects than older antidepressants, and are effective for treating clinical depression as well as anxiety disorders. Examples are Prozac (fluoxetine), Celexa (citalopram), Paxil (paroxetine), or Zoloft/Lustral (sertraline). Serotonin-norepinephrine reuptake Inhibitors (SNRIs) increase the levels of both serotonin and norepinephrine in the brain by blocking their reuptake. They are effective for major depression and certain anxiety disorders and may relieve pain in some individuals. Examples are Cymbalta (duloxetine) and Effexor (venlafaxine). Atypical antipsychotics are primarily used to treat schizophrenia. Their exact mechanism for treating depression is presumed to be related to inhibiting receptors on the dopamine (DA) pathway in the prefrontal cortex and blockage of the norepinephrine transporter (NET). Examples are Seroquel (quetiapine), Wellbutrin (bupropion), and Zyprexa (olanzapine). Monoamine Oxidase Inhibitors (MAOIs) block the enzyme monoamine oxidase, which breaks down serotonin, norepinephrine, and dopamine. It can be effective for treating clinical depression in some people who don’t respond to other treatments. Examples are Abilify (aripiprazole) and Zebeta (bisoprolol fumarate). There are other non-medicinal treatments involving psychotherapeutic sessions, such as:
  • Cognitive Behavioral Therapy (CBT)
  • Interpersonal Therapy (IPT)
  • Psychodynamic Therapy
  • Dialectical Behavior Therapy (DBT)
  • Problem-Solving Therapy. 
Physical therapy can include electroconvulsive therapy (ECT), Repetitive Transcranial Magnetic Stimulation (rTMS), and Vagus Nerve Stimulation (VNS).  Many lifestyle changes along with any other recommended treatment are also recommended, involving diet, avoiding alcohol and recreational drugs, and ensuring adequate sleep.
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