The Black Dog of Depression

            “I am the most miserable man living.  If what I feel were equally distributed to the whole human family there would not be one cheerful face on the earth.  Whether I shall ever be better, I cannot tell.  I awfully forebode I shall not.  To remain as I am is impossible.  I must die or be better.”  That quote is by none other than Abraham Lincoln.  Likewise, Winston Churchill referred to his depression as his “black dog.”  Most depressed patients aren’t quite so striking in their descriptions.  They may complain of a loss of interest in things that used to seem important to them, or a general fatigue, or frequent tearfulness, or just a persistent irritability.

Depression may be the 3rd most common psychiatric disorder behind anxiety and phobias, with approximately 15 million Americans experiencing a depression each year. So, since we can all have some bad days or a period of sadness, what, from a medical perspective, defines an actual depression?  According to the most common psychiatric definition, as contained in something called DSM 5, a major depression involves: A depressed mood or a loss of interest or pleasure in daily activities consistently for at least a 2 week period.   Overall functioning must also be impaired by the change in mood.  In addition, at least 5 of the following symptoms must be present:

  • Depressed mood
  • Decreased interest or pleasure
  • Weight change of 5% or more (up or down)
  • Sleep disturbance
  • Psychomotor agitation or retardation – consistently slowed movements or agitated movements
  • Fatigue
  • Feelings of worthlessness or excessive or inappropriate guilt
  • Diminished ability to think or concentrate, or indecisiveness
  • Recurrent thoughts of death and/or suicide

As you read through that list, some of you may be seeing a description of yourself or someone you love.  Before we take a moment to look at what can be done about it, let’s first ask how does someone get here – what causes someone to get depressed?  That can be a complicated question as depression is often the result of any combination of several factors.  Everything from genetics to circumstances and how we think about those circumstances can play a role.  Sometimes chronic stress and anxiety or even physical illness or loss can trigger a depression.

The wide range of causes of depression plays into the several kinds of treatment that are employed.  Primary care doctors are sometimes called the psychiatrists of the masses since the majority of depression treated medically is carried out in primary care offices.  When seeing your primary care physician for possible depression, a number of physical contributors such as hypothyroidism , low testosterone, or medication side effects can be ruled in or out.

If these physical causes are not a significant factor and a major depression is diagnosed, several treatments can be considered.  Starting with simple approaches, regular exercise such as a brisk walk has been shown in studies to sometimes help as much as a prescription antidepressant.  Likewise, informal counsel with any mature friends or family can be helpful.  Pastoral counsel from a trusted pastor is often a further aid in working through a depression.

Beyond these helps, specific medical interventions can be considered.  Formal counsel can often provide further tools to battle depression.  Finally, prescription meds can have their place as well.  These are far from 100% effective and it can sometimes take time to find the one that is most effective for a given individual, but at times they can be enormously helpful.

Depression, as Lincoln said, can be absolutely miserable, both for the individual, and for those around them.  Ideally, it should be responded to as aggressively and directly as a heart attack, since in its own way it can be just as devastating.  So if you suspect the black dog of depression is sinking its teeth into you, get it checked out.

Andrew Smith, MD is board-certified in Family Medicine and practices at 1503 East Lamar Alexander Parkway, Maryville. He is contracted with some commercial insurance carriers and sees Direct Primary Care patients who do not have insurance, who belong to a cost sharing ministry, or who are on Medicare. He is accepting new patients. You may contact him at 982-0835

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