Depression: Diagnosis, treatment and beyond

I have been diagnosing and treating depression for over 35 years and it continues to increasingly fascinate me. It is one of the more common problems with which patients of all ages present in family practice. Overall, between five and 40 percent of the population has serious clinical depression, some milder than others.

The common symptoms of depression might include abnormal sleep, abnormal appetite, increased weight, irritability, low energy and often low self-esteem. Depression can be a chameleon presenting differently in women, men, children and the elderly. Suicide can be a serious consequence.

Women are more often treated for depression but this is due to the increased difficulty of diagnosing and recognizing depression in men and the adolescent population. Six million American men will be diagnosed with depression this year, but millions more are either unaware that their problem has a name or are unwilling to seek treatment.

Instead of talking about their feelings, men often mask the symptoms of depression with alcohol, drug abuse, becoming a workaholic or even gambling. This creates a hidden epidemic of despair that can destroy marriages, ruin successful careers and certainly burden society with unnecessary healthcare costs and lost productivity.

Similarly, winter blues may not be easy to recognize. Medically, we call this seasonal affective disorder, abbreviated as S.A.D. This is simply a form of recurring depression that typically starts in the fall and is due to light deprivation. In our northern climate the chance of having winter blues is higher the farther north you live and less hours of daylight you get. This is a significant issue this time of year and I was happy to see recently at 5 p.m. in the Adirondacks it was still not yet dark.

For winter blues, an effective treatment can be light therapy in patients who are not suicidal and would not benefit equally or more from depression medication such as Prozac. The treatment involves a special light box that might cost $200 or more and is used for 30 minutes once or twice a day with improvement often seen within 2-4 days. When medication is used, counseling is also of benefit. Even daily walks outside or increasing the amount of indoor lighting can be helpful. In cases of severe (major) depression, both medication and psychotherapy are indicated.

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