3 Steps of Clinical Depression

How can you tell if you have clinical depression and what can be done about it?
• There’s always the self test on the Internet, but depending on the web site, you might conclude that you’re depressed and need to get your doctor to prescribe Pill XYZ (thank you pharmaceutical website!) We all have bad days. That’s not clinical depression.
• There’s always that friend, or bar buddy who denies that anyone needs treatment. “Just have another drink.”
• There’s your “granola head” friends who might have their own ideas, sometimes sounding bizarre: “You need to align your aura with the stars.”

But how much do we really understand about how biochemical imbalances and neurotransmitters work in our brain and what genetic factors are at play?
So let’s say you get past all that and you speak to your “doctor”. Symptoms can include any of the following and must persist for several weeks to be diagnostic of clinical depression:
• awakening during the night with problems getting back to sleep
• loss of interest in usual hobbies
• low energy or libido
• changes in appetite
• anxiety
• cannot see good things in life
• aches
• on the edge with emotions
… and note that feeling sad is not a necessary symptom.
Recently the American Family Physician medical journal published psychiatry guidelines. There is an emphasis on a proper plan for treatment and follow-up.

Prescription treatment is not the only thing available, as long as the depression is not severe. There is non-prescription treatment like talk therapy; this psychotherapy is with a counselor or psychologist. Also some people get results with St. Johns Wort herb or SAM-e supplement. Prescription meds are generally safe, non-addicting and usually give good results within a month or two. There are sometimes transient and minor side effects.

Step 1 is getting the right diagnosis and a treatment plan. Besides clinical depression, there could be a diagnosis such as bipolar (manic/depression), ADD (attention deficit), OCD (obsessive-compulsive); usually a MD psychiatrist treats these diagnoses. Next action is to develop a structured plan for treatment. Whether it is with meds and/or with psychotherapy, it is important to follow up in 1 to 2 months to be sure there is good improvement.
There are several classes of meds by prescription, but typically a serotonin med like prozac or zoloft is used. (See my blog for details of other examples and classes of antidepressants such as norepi and dopamine drugs.) You and the “health care provider” will work together to adjust the dosage for what’s right for you.

Step 2 is continuing on the full dose of medication for 4-9 months to prevent relapse. If depression-focused cognitive behavior therapy is being done, then continue this also.

Step 3 is when one has to know when and if they should get off of medication/treatment. If this is the first episode of depression, or even a second episode that did not come soon after the first, then you may be able to work with the “prescriber” to slowly taper off the med over at least several weeks.

The following situations may be problematic in terminating treatment: if the first episode happened in your youth, if there are on-going social stressors or if residual symptoms of depression linger. A rule of thumb is that second episodes need two years of meds and third episodes need lifelong medication. Step 3 is never ending for anyone who ever had clinical depression, because of the need to monitor for relapse.