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Depression blog

With Mayo Clinic psychiatrist Gabrielle J. Melin, M.D.

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May 30, 2008

Depression diagnosis is key

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By Gabrielle J. Melin, M.D.

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Everyone has ups and downs in life. When does feeling down, sad or depressed mean that you have a clinical depression that requires treatment? Does treatment always mean prescribing medication? Not always.

Depression can be mild, moderate or severe, just like other medical illnesses. It can be accompanied by other symptoms including anxiety, irritability, anger, agitation, ruminating (dwelling on one thing over and over), guilt, and shame.

As mentioned in previous entries, changes in sleep, appetite and ability to enjoy life can accompany depression. In general, depression requires treatment when it causes significant impairment in a person's ability to live their life in all areas.

Let's consider medically complicated obesity as being a severe medical condition. It is termed medically complicated when the obesity is accompanied by other conditions such as diabetes, hypertension, hyperlipidemia, and sleep apnea. A surgical procedure known as gastric bypass might be an option a person with medically complicated obesity. This is not an option for all patients with obesity and is not for patients that are only 20 pounds overweight.

Using the same logic, severe depression, diagnosed by a qualified provider, is a serious medical illness. Possible treatment options might include medications, therapy (group or individual) or a combination of these treatments. The blog entry on ECT predictably resulted in people expressing very strong opinions either for or against the procedure. It was not meant to imply that ECT is used in mild cases of depression. It is generally reserved for cases when nothing else has worked successfully to treating depression.

In summary, the correct diagnosis is the key. Making the diagnosis of depression is more than filling out a self-rated questionnaire, such as the depression self-assessment available in one of the links. Self-rating scales are helpful tools that assist in screening, but a professional needs to complete a full evaluation. Again, not everyone needs medication. Sometimes talk therapy alone is enough and has been shown in mild to moderate depression to be as effective as medication. The professional that you see will give you their best recommendation.

The choice is then yours whether or not to follow the recommendations. If you are having significant difficulty functioning at home, work, school, and in social situations, see someone for evaluation.

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8 comments posted

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August 24, 2008 7:42 p.m.

My daughter was diagnosed with depression and anxiety disorder. She had insomnia, anxiety attacks, trouble with her memory, anger and withdrawal from social life. She was prescribed Xanax and Clonazepam (sp?). These drugs made her more angry and aggressvie. To make a long story short, her psychiatrist ordered blood work and discovered that instead of a depression/anxiety disorder she has an overactive thyroid. Thyroid problems can cause the same symptoms as a depressive/anxiety disorder. Please have blood work done BEFORE accepting a diagnosis of depression or anxiety.

- Barbara

July 31, 2008 10:16 a.m.

My sister-in-law committed suicide 4 months ago. She did not show typical signs of depression. Very active and out going. She went to her doctor who prescibed effexor. She was having some difficulty with the side effects (dizziness). He spent alot of time talking with her and all seemed ok. She died a few days later. She shared with me she might be in premenopause. I would like to direct all these questions and feeling into something positive. She loved adventure racing, orienteering, caching. How do I go about getting sponsors for this and giving the income generated towards womans health issues. Thank you

- Lynne Miller

July 29, 2008 11:42 a.m.

My mother has suffered with anxiety/depression and finally when she was 36 she admitted to her doctor and is on effecor xr, and doing well. I suffered with dep/anx in younger yrs, but in college go worse and have been on the same meds. Moved to big city, have agreat job I love went off the meds slowly. Two months later I am back to being so depressed and Anxious,. Went to a General Doc, she had absolutely no sympathy, but gave me a prescrip. Where do I turn now, to have a professional to guide me if this is the right step. Being new here it is overwhelming just finding a profession group to inquire about. Any suggestions?

- No Name

July 22, 2008 4:16 p.m.

Your mind and body are one. Serotonin is involved in proper functioning of the GI tract. Serotonin is also involved in mood regulation- we do not know what a "normal" serotonin level is for individuals at this point in time, but will someday. Light therapy is frequently combined with antidepressant/anti-anxiety medications. One needs to use the two in combination with caution when bipolar affective disorder has been diagnosed. Mania (significantly elevated or irritable mood along with other symptoms) can occur. Antidepressant medications alone can cause mania too. Any supplement use should be discussed with your Doctor first. We do not recommend any serotonin supplements.

- MC.Com Staff

July 17, 2008 12:08 p.m.

I am told that antidepressants can increase the level of serotonin production. Could IBS or digestive dysfunction also have an effect on the Serotonin levels? Can anyone comment on treatment with digestive enzymes? Does light therapy stimulate serotonin production? If so, is there danger in combining antidepressants with light therapy? Do serotonin supplements provide balance?

- no name please

June 17, 2008 7:06 p.m.

When my first doctor prescribed anti depressents for me, I was upset because I didnt feel I was depressed. The symptons, such as anxiety, sleeplessness, extreme fatigue, nauseousness, was making me upset. Further research and questioning finally led to a diagnosis of PMDD, premenstrual dsyphoric disorder. But the treatment is the same, and what a difference it makes. The moods swings are better, the anxiety much less, and the ability to cope better because I know what is now happening to my body. Please, any female having symptons only at certain times of the month, start tracking and see if there is a pattern. It can help.

- Lyn Preston

June 6, 2008 11:45 a.m.

Many years ago, while working in a mental health office, I learned that what at times appears to be depression is actually a partial seizure or other organic problem in the brain. In those days patients of our clinic who appeared to be at risk for either partial seizure or organicity were further assessed with a neurological examination, including an EGG or CAT scan , if deemed necessary. When patients of that clinic were treated with anti depressants they actually got worse. What they actually needed, at times, was an anti-convulsant medication (or some other type of treatment.) When they were given this type of medication, seemingly depressed patients got better. Yet, despite this knowledge, today it is difficult for patients to get a good comprehensive assessment probably because of the way our health system works.

- Virginia Macias, LISW, MSW

June 4, 2008 7:26 a.m.

Remember that as a patient with any illness, including mental illness, it is your responsibility to educate yourself. Your doctor is there as a tool to tell you when the information you find is correct or incorrect and what treatments might work best for you. Because a psychiatrist's main job is to prescribe medication he/she may not be prepared to answer a lot of questions and hear your suggestions for your treatment. I find that if I insist that the doctor wait and listen to all my concerns, he/she is always willing to do so and can better understand me and my illness, as each mental illness diagnosis can vary greatly from one individual to the next. It is your right and responsibility to utilize the resources you have, including the expertise of your psychiatrist.

- Martha L. Cunningham