Doctor’s Tip: Depression is common and treatable
Everyone feels sad at times, especially following a loss. Depression is different — it lasts longer and is more disabling. It can occur in children, the elderly, and everyone in between. Depression is common, affecting 7 percent of Americans (15 million) at any given time. It is the most common cause of disability between the ages of 15 and 45.
The common symptoms of depression are: prolonged sadness; loss of energy; irritability; social withdrawal; loss of interest in activities that previously were pleasurable; early-morning awakening or other sleep disturbances including sleeping too much; loss of appetite; heightened sensitivity to pain; numb emotions; difficulty concentrating and making decisions; unwarranted feelings of guilt; and thoughts of dying. The one symptom that everyone with depression has is absence of “zest for life.” In children depression can manifest as behavioral problems at home and a drop in school performance. In the elderly, depression can mimic dementia. Today’s discussion is about unipolar depression, as opposed to bipolar depression, which is characterized by depressive lows alternating with abnormal highs.
A person with a family history of depression, anxiety or substance abuse is at higher risk for depression, so there can be a genetic component. Although the biology of depression is not completely understood, low levels of brain neurotransmitters such as serotonin, norepinephrine and dopamine seem to play a role. Anti-depressants boost levels of these neurotransmitters.
Depression can adversely affect other people, including co-workers, friends and family members. Clear thinking is hampered in depressed people, who often think they’d feel better if they just had a different job or a different spouse or if they moved to another location — depressed people should avoid making important, life-changing decisions. Depression can be deadly, and suicide affects those left behind for the rest of their lives. In 2014, 42,826 Americans lost their lives due to suicide, and firearms were used in half of these cases. Suicide is a permanent fix for a treatable, temporary problem, and what’s often forgotten in the gun debate is that if there is a gun handy, depressed people are more apt to make an impetuous decision to kill themselves than if they had to figure out another way.
Depression is treatable, through counseling and/or anti-depressants. Unfortunately, 80 percent of depressed people don’t seek help, especially macho men. Many people tolerate anti-depressants well, although some complain of side effects. However, the side effects are usually mild and beat having depression. Sleep apnea can cause depression and is common — treating it can improve and resolve depression. (The screening test for this is inexpensive and easy — wear an oximeter on your finger all night, which measures your oxygen level and pulse rate).
There is clear evidence that regular exercise — both aerobic and strength training — helps prevent and treat depression. An anti-inflammatory diet high in anti-oxidants also helps. This means plant-based, whole (unprocessed) food with no added oil, salt or sugar — as opposed to an animal-based diet, which causes inflammation. Specific foods that have been proven to help prevent and treat depression are nuts, seeds, legumes, greens, coffee, tomatoes, carrots, and several spices including saffron. A local psychiatrist told me recently that his patients respond better to anti-depressants if they are on a plant-based diet. Depressed people should also avoid alcohol, which worsens sleep problems and depression. For more details about nutrition and depression, search “depression” on Dr. Greger’s website nutritionfacts.org or read the chapter on depression in his book “How Not to Die.”
During my 42 years of family practice, I saw countless people with depression. When I saw them back for follow-up a week after starting them on an anti-depressant most felt much better. In summary, If you have symptoms of depression for more than a week or two, you don’t have to continue to suffer or make your co-workers or your loved ones suffer. Try the above lifestyle changes first, but if you aren’t feeling better within several days, see your primary care provider or a mental health expert. Psychologists and counselors can’t prescribe medication, but PCPs and psychiatrists can. Counseling plus anti-depressants have been shown to be the most effective, if lifestyle changes aren’t enough.
Dr. Feinsinger is available for free consultations about heart attack prevention and any other medical concerns. Call 970-379-5718 for an appointment. For questions about his columns, email him at email@example.com.