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What we treat

Depression

Therapy & Medication for Depression

We all feel sad or irritable from time to time. Feelings of sadness are normal and may be an
indicator of a problem or issue that requires your attention. Don’t let your feelings define you, rather listen to your feelings to help discover the underlying issue, if one exists. However, these feelings usually pass after a few hours, days or weeks, or with the remedy of the underlying issue. Depression is different. Depression is a common medical illness and ranges from minor to severe. Depression causes feelings of persistent sadness that affects how we experience our lives. Depression can cause severe symptoms that interfere with all aspects of our lives including how we think, feel, and behave. Sometimes a person may have only one episode of depression during their lives, and others may have more than one. Fortunately, depression is treatable.

What is Major Depression?

In adults, major depression (clinical depression) is persistent sadness and loss of interest that affects how we think, feel and act and can lead to feelings of emptiness, and feelings that life is not worth living. When symptoms last more than two weeks and include a pervasive and persistent low mood accompanied by low self-esteem and a loss of interest or pleasure in life and normal activities plus other symptoms you may be depressed.

Young adults often report persistent feelings of sadness, irritability, frustration, negative selfesteem, worthlessness, anger, extreme sensitivity, sleeping too much, self-harm, avoidance of social interactions, peer and academic problems, problems at home and overeating.

What are the symptoms of major depression?

Characteristics include a distinct change in mood characterized by:

  • low or depressed mood most of the day, almost every day
  • an inability to enjoy life
  • loss of interest in the daily activities of life
  • loss of energy or increased fatigue
  • reduced interest in sexual desire or performance
  • physical aches and pains
  • feelings of worthlessness
  • anxiety, irritability, restlessness
  • persistent sadness
  • withdrawing from family and friends
  • isolation
  • reduced physical activity
  • feeling emptiness hopelessness, helplessness or worthlessness
  • irritability and restlessness
  • changes in sleep patterns including insomnia and sleeping too much
  • changes in appetite resulting in weight gain or loss
  • difficulty concentrating and making decisions
  • inappropriate guilt
  • negative thinking and pessimism
  • distorted thinking
  • suicidal thoughts and suicide attempts.

Depression symptoms and the differences between the sexes

Women are twice as likely to suffer depression as men, and their symptoms may be different
than men with depression. Generally, women report persistent sadness while men may feel
angry, irritable, and aggressive, lose interest in work and family, feel fatigue and have trouble
sleeping.

In men, physical symptoms like a racing heartbeat, tight chest, headaches and stomach
problems can signal depression. Men may also be more likely to engage in reckless behavior,
and drug and alcohol abuse in an attempt to cope with their feelings. Both sexes may think
about suicide. Women are more likely to attempt suicide than men, but men are more likely to succeed. Women are more likely to talk about their feelings and seek help than men.

How is it diagnosed?

The first step in diagnosis is to receive a medical evaluation. If you have not previously seen
your primary care provider, your Midtown therapist may refer you for a physical exam, and lab tests to assure that your depression is not related to an underlying physical condition.
Some medications and some medical conditions can cause depression symptoms. If found,
your primary care doctor can treat the medical condition and refer you to the mental health
professionals at The Midtown Practice as needed for therapy.

Depression is diagnosed based on your symptoms. There is no blood test to diagnose depression. Your Midtown therapist will evaluate your symptoms based on the well-established criteria for depression; and will ask you to answer questions about your thoughts and feelings as well as your behavior to help with the diagnosis. It is important to provide a complete history of your symptoms, when they started, how bad they are, whether you have a family history of depression or other mental problems, and whether you have been treated for depression or another mental problem before.

What causes major depression?

Research suggests a mixture of factors combine including genetics, environmental stress,
biological and psychological factors to cause depression. Environmental stress includes the loss of a loved one, financial problems, work problems, relationship problems and major life
changes. Biological factors include serious physical illnesses like heart disease, diabetes,
cancer and Parkinson’s disease; thyroid disorders, sleep apnea, and stroke. Chronic pain is
strongly associated with severe depression. Depression can make these illnesses worse, and
these illnesses can worsen depression as well. Medications for some illnesses can contribute to symptoms.

When should I seek the care?

If you have symptoms of depression daily that last more than two weeks you should see a
psychologist or psychiatrist for diagnosis. The earlier depression is identified the more quickly you can get the help you need.

What are the subtypes types of depression?

  • Persistent Depressive Disorder (Dysthymia)

A low-grade persistent depression that lasts for two years or longer, but symptoms are less
severe than in major depression. A person may have many episodes of dysthymia mixed
with one or more episodes of major depression.

  • Cyclothymic Disorder

Similar to but milder than bipolar disorder, this disorder involves highs and lows.

  • Perinatal depression (Postnatal Depression)

Severe depression during pregnancy and after delivery.

  • Premenstrual Dysphoric Disorder (PMDD)

More severe than PMS, PMDD symptoms include extreme moodiness, depression or
anxiety, sadness an irritability in the days before menstruation.

  • Seasonal Affective Disorder (SAD)

SAD is depressive symptoms that occur in the seasons when there is less natural light
usually in the fall and winter months and goes away in the spring and summer.

  • Manic depression

This type is one phase of bipolar depression

  • Minor depression

It is like major depression, but symptoms are less severe and don’t last as long.

If can be difficult asking for help but it is the best way to get relief. You don’t need to have all
the answers, but you do need to reach out to people you can trust. Talk with your family,
your doctor or trusted friends who can offer their support and help you find professional
assistance so that you receive the right treatment for you. At The Midtown Practice we work
with adults of all ages who are struggling with psychiatric and psychological problems. We
are confident that we can help you constructively work to personalized solutions based on
your goals and needs. We are here for you.

Resources

https://www.nimh.nih.gov/health/publications/men-and-depression/index.shtml

https://www.nimh.nih.gov/health/topics/depression/index.shtml

https://www.mayoclinic.org/diseases-conditions/depression/symptoms-causes/syc-20356007

https://www.womenshealth.gov/menstrual-cycle/premenstrual-syndrome/premenstrual-dysphoric-disorder-pmdd

Semenkovich K, Brown ME, Svrakic DM, Lustman PJ. Depression in type 2 diabetes mellitus: prevalence, impact, and treatment. Drugs. 2015 Apr;75(6):577-87. doi: 10.1007/s40265-015-0347-4. PMID: 25851098.

Zhang Y, Chen Y, Ma L. Depression and cardiovascular disease in elderly: Current understanding. J Clin Neurosci. 2018 Jan; 47:1-5. doi: 10.1016/j.jocn.2017.09.022. Epub 2017 Oct 21. PMID: 29066229.

Cui R. Editorial: A Systematic Review of Depression. Curr Neuropharmacol. 2015;13(4):480.
doi:10.2174/1570159×1304150831123535

Yang L, Zhao Y, Wang Y, et al. The Effects of Psychological Stress on Depression. Curr Neuropharmacol. 2015;13(4):494-504. doi:10.2174/1570159×1304150831150507

Salk RH, Hyde JS, Abramson LY. Gender differences in depression in representative national samples: Metaanalyses of diagnoses and symptoms. Psychol Bull. 2017;143(8):783-822. doi:10.1037/bul0000102


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