Sadness vs. Depression

[MUSIC PLAYING] Welcome, everyone. I'm Dr. John Whyte, the chief medical officer at WebMD. Major depressive disorder is a mental health disorder characterized by persistently depressed mood or loss of interest in activities that causes significant impairment in daily life. It is a serious but treatable illness with several therapeutic options, including medications, psychotherapy, and talk therapy. Major depressive disorder is potentially a long-term or even lifelong illness for many patients, and maintenance therapy is often necessary to prevent relapse in patients with recurrent depression.

Joining me today to discuss the importance of diagnosis is Dr. Joseph Strand, an instructor of psychiatry at Harvard Medical School and adjunct faculty member on the medical staff of Cambridge Health Alliance, and Dr. Ludmila de Faria, associate professor, University of Florida College of Medicine, and chair of the APA Committee on Women's Mental Health. Doctors, thanks for joining me.

It is a pleasure.

Thank you for having me.

Now, let's be realistic. There are times when we all feel sad. So how do we know if we're experiencing major depression or perhaps a loved one or friend might be experiencing it? How do we sort that out?

Well, I always tell my patients that the difference between being a little sad and having major depressive disorder is the impact on your ability to function every day. If you suddenly can no longer perform your usual activities or if you have a lot of-- it's an ordeal to perform those activities, then you should consider that there is a clinical process going on.

So what are those criteria for MDD?

When you have a difficult time concentrating, where you are having a hard time sleeping, where maybe your appetite has changed, where you're just feeling hopeless, helpless, worthless, sometimes it turns into a position where you don't think you can go on anymore, where all you think about in the future is the same thing that's happening now, like nothing will change. You may become suicidal. These things are absolutely a time to come and talk with a physician, because you're not alone in this.

So we do a lot of surveys, even in my own clinical practice. Should patients be doing their own PHQ-9 or PHQ-2? These are simple surveys that people can administer themselves. Typically, it's done in the doctor's office. But that might be able to help us diagnose symptoms earlier on. What's your thoughts about using those at home?

So I am particularly fond of the questionnaires. The PHQ-2 questionnaire is a screening, very simple screening, that is just an indication that you might need to talk to somebody a little bit more about what are you feeling. So it's basically, have you been experiencing little pleasure or little interest in things for over a two-week period of time, and are you feeling down and in the dumps or blue?

And if you are unable to experience pleasure and feeling sad and depressed for a two-week period or longer, you need to talk to your doctor. And then they might have you answer a PHQ-9, which is a little bit more detailed, and then can also gauge the severity of the clinical process.

And I want to come to this point that sometimes, depression is episodic. But there is also recurrent depression or persistent depressive disorder. How do we distinguish in terms of whether it's major depressive disorder or we're talking about criteria for persistent depressive disorder or recurrent depression?

So the two-- recurrent depression is the episodic type that comes in. I see it in waves in my head. It's this big wave that swells and then decreases. And it might go dormant for a while, and the whole process my resolve before you experience another episode. On persistent depressive disorder, you feel sad for most of the day for most days of the week, and that lasts a very long time. Normally, people who have undergone a lot of trauma and have a sustained stress in their life, starting in childhood and moving into adulthood, tend to experience persistent depressive disorder.

JOSEPH STRAND: And because of that, it's affecting part of your brain that also is involved in memory and also being able to execute a task and finish it. So just imagine what happens when you start thinking, I can't finish this task. You then begin to feel even more depressed, and you begin actually compounding the very feelings that are happening. That's part of why it can last for so long.

When we see people with depression-- I'm just going to use that broad term-- for most people, is it episodic, it comes and goes? Or is it mostly something like other health conditions-- diabetes, high blood pressure-- once you're diagnosed, it lasts for a lifetime?

I love your question because I tell-- the population that I see tend to be young. It's the college age, transitional age youth population. And I often tell them depression and anxiety are potentially curable diseases. If you catch them early, then there is a significant chance that you're going to get medication and therapy, and you can completely reverse the process. And if you learn enough skills in therapy, might not have another episode because you know how to pace yourself and how to handle stress before you get there.

However, a lot of the time, especially for underrepresented populations and minorities who never had access to a mental health provider in their lifetime, by the time they get to me in their mid 20s or early 30s, the process is so advanced, so to speak, that it takes many years to reverse that process.

Joe, do you agree with that, that some depression might be curable?

Absolutely. I think it's important, again, to understand what's really happening in the brain. If you begin to think that depression will never go away, you will begin convincing yourself depression will never go away. What you think affects what you feel.

And some of the combination of your limbic system, which is this ancient emotional, irrational, impulsive part of the brain, takes over the prefrontal cortex, that part of the brain right behind your forehead. It's responsible for thinking, for anticipating a problem, and for solving a problem and what will happen next.

Now, imagine if your limbic system takes over your prefrontal cortex. How many times have you done something impulsively and slapped your forehead? What was I thinking? You're trying to jumpstart your prefrontal cortex.

Is that what I'm doing?

That's it. That's exactly it.

Sure.

What was I thinking? So what you can do is this. Look, everybody feels sad. It's part of who we are as human beings. But not everybody goes all that way on that transition to depression. But what you can do is recognize it. Recognition is prefrontal cortex. It's thinking. Whoa. I know what I'm feeling, but I don't need to succumb to this.

And recognition is that first step. And we're going to cover, in our next episode, once we get that diagnosis, then what are our treatment options. Doctors, I want to thank you both for joining me and helping us understand some of the signs and symptoms of major depressive disorder as well as episodic versus persistent and how we effectively diagnose it. So thank you.

Thank you.

Thank you.

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