Depression affects more than 18% of the American population. As a clinical psychiatrist, I’ve seen it all over the past 10+ years. Since so many people are affected with this illness, it’s important to better understand depression so we can start healing together.
Who gets depressed?
The ‘D’ word has long plagued humankind – across time and across cultures. From celebrities like Jim Carrey to Kristen Bell, Ellen DeGeneres, and many more, it becomes clear that major depressive disorder has no limitations in who it afflicts. The rich, the poor, the tall, the short, the CEOs, the teachers, the athletes, the architects, all can be potential prey to the clutches of depression. Swept under the rug, viewed as a weakness or a flaw, depression has been viewed as a taboo topic.
Why do people get depressed?
There are predictive factors that can at least shed some light on why some people are more susceptible to developing depression as compared to others.
First and foremost – genetics. Depression is inheritable as it can be passed through family members through generations. This speaks to the true biology of major depression: the chemical and physiological components of depression, hence where treatment targets come in to play.
Stress leads to depression
Some obvious risk factors for depression is stress, but not just any stress. Types of stress that lead commonly to depression include:
- Recent divorce
- Death of a spouse
- Loss of a job
- Chronic pain
- Insomnia are just a few.
However, any changes, even positive ones, can be unsettling and a potential trigger. A new job, a recent marriage, birth of a child and retirement can potentially cause palpitations for anyone, especially if they have the genetic predisposition for depression. Now that we have identified depression triggers, we need to focus on the symptoms of depression, some subtle and some flashing like a harshly glaring neon sign.
What are the signs of depression?
Imagine how difficult it is to keep a straight face when someone tells you a well-delivered classic joke or finds that one spot where you are extremely ticklish. How difficult is it to hold in the brewing guffaw? Extremely.
Now, instead someone playfully poking you, imagine a faceless foe gnawing at your psyche, your self-esteem, your soul, day to day, hour to hour. Would you be able to hold that it; keep it from your coworkers, family and friends? That is depression. That is the day to day hour to hour battle that someone suffering from depression has to keep contained.
Internally, which means only felt by the depressed person, they endure reoccurring intrusive negative thoughts, typically self-deprecating in nature. These thoughts will typically lead to changes in behaviour like the following.
Signs of depression
- Isolation and avoidance – People who are depressed will often isolate and avoid friends and even loved ones. These thoughts can be so intense that concentration is negatively affected, causing a decline in work productivity.
- Sick days – Depressed patients will often call out sick from work, as their motivation and energy are so depleted, they can’t muster the drive to even get out of bed.
- Stops feeling pleasure – People who suffer from depression often stop feeling the pleasure out of activities they used to enjoy, a symptom called anhedonia.
- Quits activities – Those enduring depression will stop cooking, painting, going to the gym, which then feeds the depression because people will often give in to the ‘why bother’ or ‘what’s the point’ thoughts related to depression.
So what now?
To the outside observer, they will likely begin to notice some of these changes, but often make the incorrect assumption that this person has now become lazy, or that they don’t like that person anymore because they continue to decline invitations to go out socially. Often the one closest to the depressed person will bear the brunt of irritability and a short fuse. The truth is, this is not a change in personality for the person with depression; this is not the new version of that person. These are symptoms that don’t belong to them; symptoms that are a direct result of a condition that is treatable.
How do we treat depression?
Treatment options come in many forms, and more modalities are being researched and added to the arsenal every decade. You can now choose from many proven treatments for depression that can change your life within one month.
Here are the most effective antidepressants:
- Antidepressant medications – Oftentimes you hear: ‘Everyone takes antidepressants’. That’s not at all true. No one takes antidepressants medications without serious consideration. If often takes years for patients to try them because no one like to rely on medication to feel better. With that said, antidepressants have been long viewed as the first line treatment for depression. As they have evolved over the years, there are many different classes of antidepressants which offers patients many options. However, not all medications work for everyone, and many find the side effects difficult to tolerate.
- Electroconvulsive therapy – In the past and currently utilised, when medications have failed, electroconvulsive therapy or ECT was the alternative recommended to patients. Though very effective, it is a highly invasive procedure conducted in a hospital under anaesthesia and can cause severe headache and memory loss, as it uses an electrical current to induce a seizure. However, no matter what, medications and ECT are not ever the only piece of the puzzle to treatment.
- Talk therapy – Psychotherapy or ‘talk therapy”’ is also a very well-accepted treatment for depression. It often specifically identifies possible triggers of depression for that person and providing them with various coping strategies to deal with stressors in their lives. However, even therapy now comes in many forms: Gestalt, psychodrama, cognitive, behavioural, psychodynamic psychotherapy, among others. Much of the results depends on the skills of the therapist and the ability to develop a trusting rapport with the patient.
- Diet and exercise – Depression also responds well to a healthy diet and exercise. We are biological entities, it makes sense that the food you eat and the physical conditioning you’re in would affect your ability to function ‘normally’. The powerful combination of diet and exercise uses healthy nutrients and vitamins to provide the brain power to fight depression. It also helps provide the stamina to continue fighting depressive thoughts. Both help increase the utilisation of important neurotransmitters in the brain.
- Better sleep – In addition, maintaining a healthy sleep pattern can combat depression. The brain functions best when it is awake during the day and shut down at night. This improves energy, concentration and mood in general. Protecting sleep is important and can be achieved with good sleep hygiene on a consistent basis.
All these treatment concepts have been well-established as excellent options to battle depression, especially in combination with each other.
Latest innovations in fighting depression
Now there are some newer interventions for depression, such as ketamine infusion and CBD oil. Even more readily accepted is Transcranial Magnetic Stimulation or TMS which uses magnetic pulses to retrain the brain how to modulate itself and minimise and mitigate the symptoms of depression. It highly effective and FDA-approved. You’re looking at a 45% complete remission rate from depression with TMS therapy.
Where to get help for depression?
So, where do you go to get help for your depression? With all of these treatment options, it can be very difficult to navigate the mental health provider world. In essence, it can take a team of people to help one person with depression.
Here are some people you can turn to for help:
- Psychiatrists – Board-certified psychiatrists are medically-trained mental health professionals who are well-versed in psychopharmacology as well as all of the other treatment modalities. A psychiatrist can conduct a detailed evaluation and formulate a diagnosis and treatment plan, and refer patients to the other professionals who can offer other useful treatments.
- Therapists – A therapist, either a master’s level or with a doctorate can offer individual, one-on-one psychotherapy to help process with the patient on typically a weekly or biweekly basis.
- Support groups – There are also many support groups out there, either self-lead or lead by a professional. Group therapy can be very useful, though initially intimidating, as this allows for an exchange of ideas among people with a common struggle and serves as a reminder that people with depression are not alone.
Useful resources
A great resource to search for groups or any kind of information is the National Alliance of Mental Illness. There are local chapters of NAMI all over the US. There website is
Finally, key members of the team can always be friends and family. Depressed patients often worry that they are a burden to their loved ones, but this is the irrational thought of depression.
The only burden is for friends and family to witness their loved ones suffering from depression and can always be there to listen and guide and help their wife, son, daughter, cousin, coworker, or roommate heal.
They can help research; they can drive to appointments. They can reach out their hand and remind those struggling with depression that they are loved and cared for and worth fighting for, and get them to join in the fight against their own depression.
Final thoughts
We are all susceptible to depression, however, one of our greatest attributes as humans is our will to survive. This innate drive that binds us all together is what pushes us to continue to learn more about this foe we know as depression and develop new and innovative treatments to combat this debilitating condition.
We no longer have to sweep it under the rug; we can face and fight depression head on, and find strength together as humans with this common goal.
Dr Lindsay Israel is a board certified psychiatrist in Florida. She writes for a number of publications about anxiety and depression.
