The American Psychiatric Association has developed standard definitions for all mental disorders. The criteria for diagnosis of depression are very straightforward. First we must recognize that everyone has a bad day or week occasionally. Depression becomes a problem when it lasts longer than usual or is so severe that it affects our ability to function. Additionally, certain events cause justifiable and understandable feelings of depression. These events, including death of a loved one, often cause a depressed mood for a few months. A diagnosis of depression usually results if the depressed mood lasts beyond those few months. Finally, there are a number of medical conditions and medications that can cause or contribute to depression. A careful look at other possible causes or contributors is important to your doctor’s diagnosis.
A change in ability to function, which lasts more than two weeks and includes five of the nine symptoms listed below, indicates the possibility of depression. For a definite diagnosis, one of the symptoms must be depressed mood or loss of interest or pleasure.
- Depressed mood most of the time.
- Lack of interest or pleasure in most activities.
- A greater than 5% change in body weight or a long-term change in appetite.
- Excessive sleepiness OR inability to sleep nearly every day.
- Extreme restlessness OR extremely slow movement.
- Loss of energy daily.
- Daily feelings of worthlessness or guilt.
- Unable to concentrate, make decisions, or think clearly on a daily basis.
- Recurrent thoughts of death or suicide.
- Depression: Not a personal weakness!
There are many theories about what triggers depression. Clearly the end result of the trigger is a change in the balance of chemicals in the brain. Sometimes (in milder cases) a person’s chemical balance will normalize on its own over time. Often, the imbalance goes uncorrected for many years. The chemicals involved (called neurotransmitters) include several substances. This fact is important because different medications change levels of different neurotransmitters. Thus, if your imbalance is in one chemical and your medication affects levels of another chemical, the medication may not work as well for you. Some of the neurotransmitters include serotonin, norepinephrine, and dopamine.
Treatment: Points to consider
- There is no reason to be embarrassed about asking for treatment for depression. One person in five experiences the disorder at least once in a lifetime.
- Antidepressant medications work 90% of the time. You will probably be amazed at how much better you feel. It is easy to get used to not feeling happy and to expect to feel that way. The change is refreshing.
- Usually physicians start out on a low dose and increase it slowly as needed. The dose of your antidepressant does not reflect how severe the depression is. Everyone responds differently to these medications.
- It takes one to one and a half months to fully respond to the medication. Don’t give up on the medicine until you have given it a chance.
- Unfortunately, you see the side effects of these medications right away. As time goes by, if you take the medication daily, the side effects tend to go away.
- If this is the first time for treatment, you do not necessarily have to take the medication long term. If the depression subsides in a reasonable amount of time, many physicians will stop the drug after six months.
Michelle Herbert Thomas, PharmD, CDE
Clinical Director, Richmond Apothecaries, Inc.
Rev. 1/2010 MHT
