By Natasha Persaud
If you've been feeling down in the dumps, it may be time to get help. Here, we asked Lawson Wulsin, M.D., professor of psychiatry and family medicine at the University of Cincinnati to address some common questions about depression.
I’ve been feeling down lately. Am I depressed?
“For most people, the warning signs of depression involve two weeks or more of feeling depressed, down or hopeless—and feeling little interest or pleasure in things you ordinarily enjoy,” explains Dr. Wulsin. “You may have trouble with sleep, appetite, concentration, memory and energy, as well as thoughts about death.” If you have these feelings, see your primary-care doctor or a mental-health specialist for an evaluation.
What are the biggest risk factors?
The most useful ones to pay attention to include a family history of depression; previous episodes of major or minor depression; and persistent stressful conditions (such as a chronic illness, abuse or a second psychiatric illness). These conditions wear down your central nervous system, leaving you vulnerable to depression, says Dr. Wulsin.
Is age a risk factor?
No! The good news is, most seniors are not depressed—or not simply because they’re old. “What really adds to their risk of depression are sudden stressful events like retirement, drops in income and loss of loved ones,” Dr. Wulsin explains. “Depression makes it harder to see the grandkids or engage in hobbies. Unfortunately, when people feel depressed they’re often tempted to do nothing. Yet they should at least get evaluated by a physician.”
Careful retirement planning is a good buffer against the social toll of aging. Other tips: Stay physically active by walking, swimming and doing other forms of exercise. And nurture social ties. Take the initiative to make new friends, particularly when your social networks get disrupted with a change in location or with the passing of a loved one.
How can my doctor help me relieve my depression?
On the initial visit, your doctor will perform a careful interview and may ask you to answer a short questionnaire called the PHQ9. You’ll be asked whether you have certain symptoms and how long you’ve had them. This helps determine whether you have depression and, if so, its severity.
You’ll also be asked how these symptoms are limiting your activities. For example, are you skipping work? missing deadlines? avoiding family and friends? Are you still enjoying hobbies, such as sports? Further evaluation may lead to a diagnosis of a specific type of depression—dysthymia (a chronic sad mood), for example, or bipolar disorder (formerly known as manic depression).
Your doctor may then suggest psychotherapy and/or prescribe medication—often an antidepressant. “A person should take the antidepressant for at least six months. Stopping early puts you at high risk for relapse,” cautions Dr. Wulsin. But don’t rely solely on medication. In some cases, after an initial six-month period patients no longer need antidepressants.
“For many people, psychotherapy is as effective as medication—and, in fact, it may be more protective over the long-term,” explains Dr. Wulsin. There are two well-studied forms of psychotherapy for major depression: cognitive therapy and interpersonal therapy. Cognitive therapy focuses on managing the dysfunctional, automatic thoughts that contribute to a person’s depression. Interpersonal therapy centers on how relationships affect a person’s self-esteem and functioning, both positively and negatively. Sessions consist of about an hour a week for a minimum of 10 to 16 weeks. To start, the therapist focuses on reducing symptoms, improving the patient’s functioning and preventing relapse.
A person on medication or doing therapy should ideally check in with the primary-care doctor at least once a month for the first three months.