What is Clinical Depression?
That is a frequently asked question. First of all, let’s define what we mean by clinical depression. A clinical depression presents with certain target symptoms. For example, disrupted sleep, change in appetite, low energy, hopelessness, helplessness, more frequent crying spells, anhedonia which is not enjoying activities that one used to enjoy, thoughts of suicide or thoughts that life is no longer worth living, and tendency to isolate can come in some combination representing depression for an individual. Some but not all of these symptoms tend to be present. These symptoms usually have to persist for a week or two to be considered a clinically significant depression.
Sometimes the starting point to treating depression is to enter into therapy/counseling. While in therapy, one can explore triggers or stressors that are fueling the depression. Coping skills can be developed or reinforced. One’s view of the world or paradigm can shift through work in therapy. Sometimes the depression can be situational. For example, a negative event can happen in one’s life and that can trigger a depression. At other times, an episode of depression can come out of the blue or seem to be there for no reason. It is not uncommon for people to stay “I have a good life, I don’t understand why I am going through a depression.” Depression, like many illnesses, can run in families. People can have a genetic predisposition that leaves them more prone to episodes of depression. A solid percentage of people who enter into counseling experience improvement in their depressive symptoms.
If progress is limited in counseling, it may be time to consider the addition of anti-depressant medication. Anti-depressant medication is not a happy pill. It does not make one happy. Instead antidepressant medication can be helpful in addressing presenting target symptoms such as the sleep disruption, change in appetite, low energy, hopelessness, negative outlook, thoughts of suicide, and anhedonia. It is definitely not a quick fix. Antidepressant medication typically takes 4 to 6 weeks to fully impact symptoms. Antidepressant medication will help a percentage of people who have depression. It is definitely not fool proof. It works for about 60 to 70% of patients with depression.
How does the medication work?
The theory behind the medication is that neurotransmitters in the brain are tied into mood and anxiety states. For example, neurons in the brain can release a neurotransmitter called serotonin which then communicates with the next neuron. In some areas of the brain, there may be a relative deficit of serotonin. A common class of antidepressant such as a serotonin reuptake inhibitor blocks the reuptake pump and can make more of one’s own serotonin available in the synapses. In other words, it boosts one’s own supply of serotonin which then, overtime, impacts the depressive presentation. There are a variety of different types of antidepressants which have different mechanisms of action. That is one example.
As with any medication, there can be side effects. Each medication has a list of possible side effects that certainly do not impact everyone. They are the long list that we hear at the end of commercials that sound very scary. Typically, if one is having a lot of side effects then one would move on to a different option. There are literally over 20 different antidepressants to choose from.
The Relationship with your Provider is key!
Your individual provider can look at pros and cons with you and best decide what option to potentially pursue. Keep in mind that these medications are very widely prescribed and obviously have to be reasonably and well tolerated to be used to such a great extent.
In summary, most data supports the combination of therapy and medication as being the treatment of choice for depression. Keep in mind that either therapy alone or medication alone can also be effective but the combination of both may be the most comprehensive way to approach treating clinical depression.
We are here to help you
If you or anyone in your family has questions or concerns, please call The Center for Collaborative Counseling and Psychiatry at 847-440-2281. We are here to support you.