Understanding Depression -- Diagnosis and Treatment
How Is Depression Diagnosed?
Although very common, depression is often ignored or misdiagnosed and left untreated. Such inattention can be life-threatening; major depression in particular has a high suicide rate.
Studies show that 74% of people seeking help for depression go to their primary care doctor, and that 50% of these cases are misdiagnosed. Of the cases that are correctly diagnosed by a primary care doctor, 80% are given too little medication for too short a time. Some of this mishandling may occur because patients seek a doctor's help with -- and physicians prescribe for -- physical symptoms, such as sleep problems, fatigue, or weight loss, without considering depression as a possible root cause.
Tests for depression should also be given to rule out any organic factors, such as nutrient deficiencies, underactive thyroid or hormone levels, reactions to drugs (either prescription or recreational), and/or alcohol, which all can produce similar symptoms.
Older adults are at greatest risk of being overlooked or misdiagnosed for depression. Frequently, primary care physicians, and older patients themselves, dismiss symptoms of depression as a part of growing old or categorize it as senile dementia -- an irreversible condition that causes loss of memory and concentration. Sometimes, both depression and dementia are part of the picture. But depression, unlike dementia, can be treated effectively and is reversible, so it is important to recognize depression in the older adult population.
For all of these reasons, it is important to be clear and honest with your health care provider about your symptoms and response to treatment. If symptoms do not improve within four to eight weeks of treatment, tell your doctor that you would like to see a psychiatrist for diagnosis and treatment. Clearly, for more severe symptoms -- and always if you have thoughts about death or hurting yourself or someone else -- you should see a psychiatrist.
What Are the Treatments for Depression?
The stigma depression carries drives many people to hide it, try to tough it out, or self-medicate with alcohol, drugs, or herbal remedies. To effectively treat depression, see a good mental health professional and get a correct diagnosis and treatment plan. Many treatments for depression are available that vary according to the cause of the depression and its severity.
Major depression and dysthymia are usually treated with a combination of psychotherapy and antidepressants. Psychotherapy aims to teach patients how to overcome negative attitudes and feelings and to encourage them to return to normal activities. Drug therapy is intended to moderate or correct chemical imbalances that affect moods.
Medication for Depression
The group of antidepressants most frequently prescribed today consists of drugs that regulate the chemical serotonin. Known as selective serotonin reuptake inhibitors (SSRIs), the group includes Paxil, Prozac, Celexa, Lexapro, Zoloft and Viibryd. Serotonin norepinephrine reuptake inhibitors (SNRIs) including Effexor, Pristiq, and Cymbalta, also act on serotonin and norepinephrine but in a different way than SSRIs. Other antidepressants include Wellbutrin, a drug that appears to affect dopamine regulation, and Remeron, which increases levels of serotonin and norepinephrine by a different mechanism than SNRIs. For children and adolescents, the SSRIs are among the best-studied and therefore often the drugs of choice.