What is depression and when does it become clinical?

Most of us feel sad or depressed at times as a result of life’s many challenges and struggles or due to loss. But being sad or grieving is not the same as depression. Depression does not necessarily require a difficult event or situation, a loss, or a change of circumstance as a trigger. People’s lives might seem fine from the outside, but they feel terrible.

A clinically depressed individual may feel overwhelmed with low mood and suffer impairment in daily life functioning. A person with clinical depression has low energy and motivation. This individual may feel excessive guilt and worthlessness along with feeling like a burden to friends and family. Their concentration becomes poor and impairs their ability to perform at work or school. People with major depression have changes in sleep and appetite; both may either decrease or increase. Weight may go up or down and a depressed person either sleeps too much or is not able to shut their mind off to fall and stay asleep. A person with depression may become overly irritable and agitated, further damaging their relationships at home, work or school.

Many of us may experience depression at some point in our lives. Major depression affects about 6.7% of American adults or about 16 million people. Depression is a medical disease and calls for professional care. It is not a sign of weakness or something that one can just snap out of. It is important to seek treatment right away so that symptoms do not worsen.

The good news is that there are effective treatments for clinical depression. One of the first steps is to address underlying stressors, learn coping mechanisms, address diet and sleep hygiene, and exercise. Many different medications are available for the treatment of clinical depression. Our brain produces chemicals for transmission of impulses. When these chemicals (serotonin, norepinephrine and dopamine) are imbalanced, people develop symptoms of depression and excessive worry. Antidepressant medications allow more of the neurochemicals that your own brain produces to remain available (they decrease the re-uptake of the neurochemicals in the brain). Studies show that antidepressants work about 60% of the time. However, when medications are used in combination with therapy and in concert with improvement of diet, sleep and exercise, benefit is significantly higher. In our clinical experience, antidepressants help people move on with their lives, rather than dwell and obsess over the things that we perceive as negative. Medications help people feel less gloom and doom.

Generally, symptoms of depression start improving soon after treatment is initiated, but maximum benefit may take six to eight weeks to achieve. Once depression is in complete remission, it is recommended that treatment continues for an additional six to eight months. Studies show that when people stop medications and psychotherapy prematurely, the likelihood of depression relapse is higher.
If you feel depressed, make an appointment to see your doctor or mental health provider as soon as you can. If you think you may hurt yourself or attempt suicide, call 911 or your local emergency number immediately. Other options available if you are having suicidal thoughts include:

1. Call your doctor, nurse or mental health provider and tell them it is urgent.
2. Go to your local emergency department.
3. Call a suicide hotline number (in the U.S., call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255). Use that same number and press “1” to reach the Veterans Crisis Line.)
4. Reach out to a close friend, loved one or spiritual leader.

ROLAND SEGAL, M.D., DFAPA
LYNSEY SEGAL, Pharm.D.