Maintain Hope
MEDICAL AND MENTAL HEALTH UPDATE
“I’m so depressed” is such a common expression in everyday parlance that we can easily forget what it means.
I often hear it from my teenage kids during school exam periods. I said it myself last year when my hairdresser added “blonde” highlights that made me look like a tiger in the wild. It was a refrain, almost a badge of honor, from the mouths of fellow medical residents during our training, indicating one’s proximity to pain.
Indeed many of us during the pandemic are feeling blue, down, and sad. Are we depressed, or are we simply reacting to a depressing situation?
What is REAL or major depression? Not the “I-got-a-C+-on-my-math-exam” kind of depression, but the kind where we are actually sick? And how do we make the distinction? Furthermore, why does it matter to a medical doctor and how does depression affect health?
Situational depression often resolves in time, and talking about the problem can ease the recovery process. This is a short-term form of depression that occurs as the result of a traumatic event or change in a person’s life.
For example, following the death of a parent, it may take a while before a person can accept that a family member is no longer alive. Until acceptance, they may feel unable to move on with their life.
Major depression is one of the most common mental disorders in the US. It is a mood disorder usually caused by a combination of genetic, biological, environmental, and psychological factors. An increasing amount of research suggests these factors cause changes in brain function, including altered activity of certain neural circuits in the brain.
Depression is characterized by a persistently depressed mood or loss of interest in activities. It can lead to a range of behavioral and physical symptoms. It can affect how you feel, think, and handle daily activities such as sleeping, eating, or working.
Many of my patients with pre-existing depression have found that their symptoms have flared during the pandemic. It makes sense: we are experiencing trauma, and our normal coping mechanisms like social interaction, routine, and regular exercise have been pulled out from under us. And some of my other patients are experiencing symptoms of depression for the very first time.
For many people, it presents as fatigue, lethargy, and difficulty getting out of bed. For others it is experienced as loss of interest in activities, hopelessness, and joylessness. Depression can also be associated with thoughts of suicide.
And yet for others, depression can present with behavioral symptoms. Take, for example, my cohort of patients who have difficulty prioritizing self-care—from healthy eating to taking their daily medications—and who (often subconsciously) sabotage their own health. Quite often for these patients, self-harm comes in the form of binge eating, alcohol overuse, or avoidance behaviors—not because they don’t know better but because depression is telling them erroneous messages like “what’s the point” or “you are worthless, so why bother.”
For these patients, my job is not to lecture them on the benefits of healthy eating or shame them into changing their behaviors—indeed depression often brings plenty of self-loathing—but rather to identify a diagnosis of depression and treat it in tandem with all other medical issues.
The standard of care for treatment usually involves medication, talk therapy, or a combination of both. But, as with any medical condition, the precise treatment depends on the patient’s unique circumstances, symptom severity, potential triggers, other health conditions, and myriad other health factors that drive patient care.
Here are other tips that may help you or a loved one during treatment for depression:
Know that you are not alone, nor are you “going crazy.” Depression is a treatable medical illness.
Try not to isolate yourself, and be sure to ask for help.
Try to spend time with other people (even if only virtually at this time) and confide in a trusted friend or relative.
Expect your mood to improve gradually, not immediately.
Set realistic goals for yourself.
Try to get daily exercise and time in nature.
Have hope. When patients with depression ask for help and get appropriate treatment they are better off and healthier, mentally and physically.
Indeed one of the best parts of my job is witnessing people emerge from the darkness of depression, connect the dots between their emotional and physical health, and employ their new self-awareness for improved health from the inside out.
Pictured here is one of my favorite memoirs about depression, William Styron’s Darkness Visible. It is a deeply moving and honest account of his own illness. It provides hope for anyone struggling with depression and great insight for anyone trying to understand this all-too-common disease. I highly recommend it.
I will see you tomorrow. Until then, be well.
P.S. I hope you caught a glimpse of yesterday’s Facebook LIVE with Amanda Williams, MD. We talked about race, COVID-19, having difficult conversations, and what we can do to make changes for good—personally, professionally, and in your community. Here are the videos (in two parts!): PART ONE and PART TWO in case you missed us.