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Depression complicates other illnesses

Donald J. Curran, D.O.

In any given one-year period, 9.5 percent of the population, or approximately 18.8 million American adults suffer from a depressive disorder. A depressive disorder is an illness that involves the body, mood, and thoughts. It affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things.

A depressive disorder is not the same as a passing mood, and it is not a sign of personal weakness or a condition that can be willed or wished away. Depression often interferes with normal functioning, causing pain and suffering, not only to those who have depression, but also to those who care about them. Most people with a depressive illness do not seek treatment, although the great majority can be helped.

It is not unusual for patients with high blood pressure, high cholesterol, diabetes, cancer and sleep disorders (the big five illness categories) also to consult their physicians for symptoms of depression. Many of these individuals do so because of pressure from family and friends – not because of referral from their primary care physician. Physicians often do not evaluate for a diagnosis of depression because of their focused attention to signs and symptoms of the other illnesses. Proper diagnosis of depression is important because this treatable illness can be attributed to the worsening of the big five, reducing not only quality of life, but also length of life.

There are many symptoms of depression, which vary with each individual. Some people experience a few symptoms, others many. Severity of symptoms varies with individuals and also over time.

One common symptom of depression is difficulty initiating and maintaining sleep. Other sleep problems such as sleep apnea and restless legs syndrome are complicated by clinical depression.

Besides the common sign of a depressed mood, less common signs of fatigue and chronic pain can be subtle but significant signs, for a person suffering from clinical depression. A complaint of excessive daytime sleepiness needs to be comprehensively evaluated by the physician as possibility of a hidden primary sleep disorder as well as a primary mood disorder such as major depression.

Other symptoms of depression may include:
• Persistent sad, anxious, or “empty” mood
• Feelings of hopelessness, pessimism
• Feelings of guilt, worthlessness, helplessness
• Loss of interest or pleasure in hobbies and activities once enjoyed, including sex
• Decreased energy, fatigue, being “slowed down”
• Difficulty concentrating, remembering, making decisions
• Insomnia, early-morning awakening, or oversleeping
• Loss of appetite and weight loss, or overeating and weight gain
• Restlessness, irritability
• Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain
• Thoughts of death or suicide; suicide attempts

Treatment for depression will depend on the outcome of a physician evaluation. There is a variety of antidepressant medications and psychotherapies (talk therapies) which can be used to treat depressive disorders. Some people with milder forms of depression may do well with psychotherapy alone. People with moderate to severe depression most often benefit from antidepressants. Use of medication can vary from one medication over a few months to the use of two or more medications over a year or two. Most individuals do best with a combined treatment of medication and therapy. The medication provides relatively quick symptom relief, and the psychotherapy teaches more effective ways to deal with life’s problems, including clinical depression.

Patients often are tempted to stop treatment too soon. They may feel better and think they no longer need the medication and/or therapy, or may think the treatment isn’t helping at all. More time in aggressive treatment makes for a better outcome for the depression and, in turn, for other illnesses such as the big five. Combining treatments leads to a synchronous response with remarkably improved happiness and well being for the patient.

If you or someone you care about seems to be experiencing a symptom(s) of depression, a visit to a physician is recommended. Other people and places that will make a referral to, or provide, diagnostic and treatment services include:
• Mental health specialists, such as psychiatrists, psychologists, social workers, or mental health counselors
• Health maintenance organizations (HMOs)
• Mental health centers
• Hospital psychiatry departments and outpatient clinics
• State hospital outpatient clinics
• Family service, social agencies or clergy
• Private clinics and facilities
• Employee assistance programs

Donald J. Curran, D.O., is board certified in Family Medicine, Geriatrics, Psychiatry and Sleep Medicine, and is the psychiatric director of Verde Valley Medical Center’s Senior Lifestyles Behavioral Health Unit. Dr. Curran has been practicing medicine and psychiatry for more than 30 years. He may be reached at 928 639-6450.