Identifying & Treating Depression

Staying with the theme of depression, I thought it might be useful to review some aspects of depression pertinent to clinical practice. There are two different types of depression. Major depression is defined as having a depressed mood at least 2 weeks with at least 4 other symptoms: loss of pleasure, difficulty making decisions or concentrating, psychomotor changes, changes in sleep or appetite, guilt, thoughts of death or suicide. Dysthymia is having a depressed mood more days than not for at least 2 years. Some of the major risk factors for depression in women include: having a chronic medical condition or cancer diagnosis, having a personal or family history of depression, taking certain medications or hormonal treatments, and experiencing perinatal loss, infertility or death of a family member. Women may also experience depression during the luteal phase of the cycle (a severe form of PMS), during pregnancy, postpartum or during menopause. Here are 2 very helpful screening questions that can be easily incorporated into your women's health history:

During the past month have you been bothered by:

}  Little interest or pleasure in doing things?

}  Feeling down, depressed or hopeless?

If the answer is "no" to both, doubt depression. If answer is "yes" to either question, interview further or use a more in depth assessment tool. I like the HANDS Depression scale and use it as part of my intake. In the women's health setting, refer any patients with suicide ideation, severe depression, psychosis, substance abuse, or those who are at high risk for noncompliance. Treatment for depression should be holistic and include:

·    Antidepressants and/or psychological counseling. 40% of people will not respond to the first antidepressant they take. 60% will experience at least one side effect. Antidepressants and psychological counseling have about the same remission rates- a little higher than 50%. Medication with counseling has about an 85% remission rate.

·    St. John's Wort is effective for mild to moderate depression. Numerous clinical trials support its use. Be aware of multiple drug interactions including oral contraceptives.

·    Nutrition is important. Getting plenty of B vitamins and omega 3 fatty acids is critical. Avoiding the "white foods" I mention above can quell the ups and downs that come with eating simple carbohydrates.

·    Exercise makes all the difference. Write an exercise prescription for your patients. Encourage them to get moving, it has been shown to improve mood significantly.

·    Prescribe key vitamins and minerals. If your patients don't take a multivitamin, recommend a good quality one. Make sure that it has plenty of the essential B vitamins. Consider supplementing with a B complex and fish oil as well.

·    Pay attention to spiritual health. Our patients who are depressed need to care for their spirits. Encourage them to do so with some of my suggestions above.

·    Refer to alternative providers as appropriate. Modalities such as acupuncture, massage, aromatherapy and energy therapies can be very helpful for patients. You can collaborate with the alternative provider so that your patient receives the best of conventional and alternative medicine.

I hope this information about depression is useful to you. If I can help you with any of your patients with depression, please let me know.