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

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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