Q: Is there a real increase in the occurrence of depression over the past years or are we just getting better at diagnosing and treating it?
A: We've become much more attuned to asking the right questions and picking up on the symptoms, and there is less of a stigma about it. The medications are better, easier to use, and a lot of people can get treatment from their family doctor and don't have to go to a psychiatrist. That's also probably led to a lot of people being treated who don't need to be treated.
Q: Are we overmedicating people for depression? Are there things people can do to alleviate symptoms without taking anti-depressants and psychotropic drugs?
A: I think we are (overmedicating) at times. I think the family doctors don't use the same criteria as psychiatrists, and when their patients feel sad, [the family doctor] may treat them with medication (instead of referring them to therapy). Insurance also has made it harder to access therapy, so people who are good candidates for therapy get medicated instead. It's cheaper; therapy is expensive. All the studies that have been done show that in true depression, therapy and medication both are helpful, but they are much more helpful together than alone.
Q: Are therapy and medication forever?
A: Therapy has moved into a much more problem-focused than open-ended program than before. And medication's not forever usually. About 50 percent of people who have a depressive episode will never have another one. Generally, we recommend they stay on medication for six months to a year and then discontinue it. About half will be OK. Generally, if someone presents (with symptoms), is diagnosed, starts treatment and gets better, we'll follow them for six months to a year and try together to take them off their medication if it's their first episode. For psychiatrists (treatment and discontinuing medication) is all symptom based, not just whether the patient feels better.
Q: Do these drugs pose any dangers over time such as damage to body organs?
A: The anti-depressants ... the newer ones that have been around for about 15 years ... have not been shown to have any long-term problems.
Q: Do they cure the disease?
A: In some cases they do cure the disease. About half the patients who have a one-time episode have never had another one. That means about half the patients have a recurrent illness that comes back and they may have a need to stay on medication or in therapy indefinitely.
Q: What about adolescents and depression?
A: Adolescents have always been at a high risk for depression. The other high-risk peak is in the geriatric population. The suicide risk with adolescents is really high. I think most adolescent psychiatrists will tell you the risks are too high not to treat them (for depression). Whether we're overmedicating for depression, the meds are very safe and the risks of not treating them are very high. Untreated kids are more likely to use drugs, develop problems with the law; you have to have a careful analysis of what the risks are if you don't treat the kid.
Q: What are the signs of untreated depression and what should friends and family do about it?
A: They are very simple: sleep disturbance, sleeping too much or not able to sleep; appetite disturbance, overeating or under-eating with significant weight change; low energy and lack of motivation; difficulty concentrating; there's a symptom called anhedonia, which means loss of pleasure in usual activities; crying spells for no reason; and hopelessness or suicidal thoughts. They should probably talk to their primary-care physician first, and if it's pretty straightforward, their primary-care physician should help with medication and referral to a therapist. If it's not straightforward, then they need a psychiatrist. For people who are feeling suicidal, they should go to an emergency room or call a crisis line. Depression feels like you'll never get out, but you do; almost everybody does. (She suggests that families contact the Louisiana Alliance for the Mentally Ill, which offers support services.)
Q: What's the difference between depression and bipolar disorder?
A: Bipolar is a mood disorder where you have both depression and ... then you feel just the opposite: on top of the world, you don't need to sleep, you have loads of energy. Those episodes can become very severe and (the person can) become very dangerous to themselves. They tend to do drugs and drink more when they are in manic stages, go places they shouldn't, spend excessive amounts of money. That requires a totally different kind of treatment and is probably not one your family doctor can treat.
Q: Is there something environmental, nutritional or lifestyle wise that we can change to make depression less prevalent?
A: You place yourself more at risk for depression if you don't take care of yourself; (you need to) exercise, eat well. Alcohol certainly makes it worse. But even if you take care of yourself, you can get depression, especially if you are biologically predisposed, but you're more likely to get it if you don't take care of yourself.