When a patient complains of physical symptoms such as chronic musculoskeletal pain without trauma, headaches, gastrointestinal symptoms, or difficulties with sleeping—and tests reveal no physical problem—Dr. Michael Stouder, of the Mission Heritage Medical Group Foothill, considers the possibility that depression may be the cause.
“That’s when I begin to ask what’s going on in their lives, when did these symptoms start?” he says, and adds that often patients shrug off the suggestion of depression.
“Some people think if you can’t diagnose a problem with a blood test or an X-ray, then it’s not real,” he says. “But depression is considered a medical disorder,” such as an imbalance of neurotransmitters—chemicals in the brain related to nervous system function—serotonin, dopamine, and norepinephrine. Other causes include alcoholism, chronic pain, chronic stress, past trauma, certain illnesses and medication.
Dr. Stouder sees more patients with depression, but suggests this may be because the stigma of admitting to depressed feelings is disappearing. Still, he wishes the public understood that depression does not have to be suffered through: treatments exist, both non-medical and medical.
Who gets depressed
Women are 70 percent more likely to experience depression than men, according to the National Institute of Mental Health (NIMH). Although African Americans are less likely than whites to experience a major depression, according to NIMH, when they do, their depression is more likely to be chronic and severe.
Dr. Stouder sees older patients with signs of depression. “Older people have a lot of losses, and may even be grieving the loss of their health. Their bodies are not what they used to be and sometimes they are lonely and their children or grandchildren live far away. Women tend to be more in touch with their feelings than men and may admit to sadness,” he says.
“Men will often say they’re angry, irritable, not sleeping well,” he adds, “or that they are so cranky their spouse doesn’t want to be around them.”
Causes are most likely a combination of psychological, environmental, genetic and biological, according to the NIMH.
Medical conditions such as thyroid problems, which can cause depression-like symptoms, as well as life-threatening illnesses like heart disease or cancer should be considered. A review of medications a patient is taking might reveal one or more that contribute to depressed feelings.
But when those causes are ruled out, then probing into emotions is in order. “When something happened, such as death of a family member, loss of job or getting divorced, then the cause of the depression has probably come from the outside,” says Dr. Stouder. Talking through feelings with a psychotherapist brings relief.
Getting treatment for alcoholism, exercising and/or seeing a psychotherapist can lift depression for some people.
Others, whose lives may seem to be fine, but feel depressed nonetheless, may benefit from antidepressant medication, says Dr. Stouder. “They may have a biochemical imbalance that is independent of what’s going on in their lives.”
Many people get relief with a combination of treatments.
Is it the blues or is it depression?
Feeling down or discouraged doesn’t necessarily mean that depression has set in. “The blues happens to all of us,” says Dr. Stouder, “and with temporary counseling, it will pass and I can reassure a patient that they’ll probably feel better soon.”
But one main sign of depression is bad feelings that don’t go away after several months. Here are some other signs of depression, according to the NIMH:
- Persistent sad, anxious, or “empty” feelings
- Feelings of hopelessness or pessimism
- Feelings of guilt or worthlessness
- Irritability, restlessness
- Loss of interest in activities once pleasurable, including sex
- Fatigue and decreased energy
- Difficulty concentrating, making decisions
- Insomnia, early-morning wakefulness, or excessive sleeping
- Overeating, or appetite loss
- Thoughts of suicide
- Aches, headaches, cramps, or digestive problems that do not ease even with treatment.
The topic of suicide should never be avoided, Dr. Stouder says. “Some people may think that if you bring it up, you might tip a person over the edge. But we always ask a person showing signs of depression, ‘Do you think about harming yourself?’ or ‘Do you feel that life is not worth living anymore?’ It’s OK for friends to ask that. And if a person says that life is not worth living, get that person in for help.”