Treatment for chronic depression has improved as doctors better understand the illness

By Leslie Cardé | Contributing Writer

Clinical depression isn't the same as depression caused by a loss such as the death of a loved one, a divorce, or finding out you have a serious medical condition.

Also known as major depressive disorder, it's pervasive and all-encompassing. It causes symptoms that affect how you feel, think and handle regular activities such as eating, sleeping or working.

“It’s characterized by slow moves, loss of pleasure, low energy, change in appetite, concentration problems, pathological guilt, psychomotor slowing, inappropriate guilt and suicidal thoughts,” said Lochlann McGee, M.D., assistant professor of psychiatry at LSU Health.

“In order to be diagnosed with this disorder, a patient must have five or more of these symptoms for two weeks or more, and (it must) account for the majority of the person’s day.”

There are different types of depression. Persistent depressive disorder (also called dysthymia) often includes less severe symptoms, but they can last much longer, typically for at least two years.

Perinatal and postpartum depression occurs when a woman experiences major depression during pregnancy or after delivery. McGee, who staffs the high-risk OB clinic at UMC, says that when depressive symptoms last for at least six months, the woman should be diagnosed and treated.

“We should note that this is a depression based on a special circumstance," McGee said. "Rather than having a genetic component, hormonal fluxes can cause this sort of depression."

Though it's called depression and has the same symptoms, it’s a separate condition, McGee said. The medication that doctors prescribe for pregnancy-related depression doesn't help with other kinds of depression.

Risk factors

Risk factors for depression include a family history, major life changes that involve trauma or stress, or certain physical illnesses and medications.

Sometimes, medications taken for particular illnesses such as diabetes, cancer, heart disease and Parkinson’s may cause side effects that

Lift The Mood

Beyond medical therapies, including talk therapy, there are things people with depression can do to lift their mood.

Thirty minutes a day of simple walking boosts mood.

Maintaining regular routines helps with mood... maintain a regular bedtime and wake-up time.

Prioritize tasks, and do what you can, but let the less important things wait.

Try to connect with other people. A study out of Ohio University, released in January, showed that helping others promoted healing, and often gave those who felt hopeless a sense of purpose.

Hold off on important decisions like marriage, divorce, or job changes, until you feel better.

Address substance abuse. “Lots of insomnia and substance use is a bad contribute to depression, so it’s important that physicians work out the best treatment strategies.

Patients may need to try several antidepressant medications before landing on the one that relieves symptom with a minimum of side effects. These medications can take from four to eight weeks to take effect, and often symptoms such as sleep, appetite and concentration problems improve before one’s mood lifts, so patients must give medications time to fully take effect.

“I will tell you that SSRIs, the classification of drugs used for these patients, are not happy pills,” said McGee.

“My patients sometimes tell me that it gives them a thicker skin, so that the things that bothered them previously and interfered with their lives don’t stick with them any longer. That’s the ideal situation, but it may take some adjustment.

"Too high a dose, and patients say they feel blunted: They aren’t happy, they aren’t sad, they just are. No one likes this feeling.” combination.... impaired decision-making is a result,” McGee said. “Reach out to others and avoid isolation. Many connections were severed during the pandemic, and it’s important to get them back. Depressed people often don’t share their burdens, and don’t ask for help, often because they don’t think they deserve it.”

For those with major depressive disorders that aren't responding to medication, McGee says brain stimulation therapies work best. He also is a proponent of electroconvulsive therapy and believes that hands down, it works best for severe depression --- double the rate of remission as drug therapy.

Other brain stimulation therapies include transcranial magnetic stimulation and vagus nerve stimulation. Other forms of this treatment are currently being studied, because for those with suicidal thoughts, it’s critical to reverse the course of the disease.

McGee emphasizes that those with depression are not weak; they have a brain disorder. MRIs now show that parts of the brain that are illuminated in most people are "dark" in those who have chronic depression.

If you know someone who has suicidal thoughts, it’s important to provide help. The Suicide and Crisis Hotline at 9-8-8 provides trained crisis counselors who anonymously aid those in immediate need.

For more information about depression, go to the Depression and Bipolar Support Alliance at dbsallliance.org

--- Leslie Cardé