Following New Year’s Day, many people will pursue changes in their life directed toward an improvement in the quality of their lives. Frequently, this includes health and finance. However, an often unrecognized and underappreciated issue is depression. One of the blessings of being in the clinical practice of psychiatry is hearing from people who are feeling better. Recently, a number of my patients have mentioned that they feel so much better than they did a year ago.
As I reflect on the folks that have mentioned their progress, these individuals are diverse and reflect different modalities of treatment for their depression, including psychotherapy, medications, Transcranial Magnetic Stimulation (TMS) Therapy, or Electroconvulsive Therapy (ECT) or a combination of these therapies. Their lives are not perfect, but they are more hopeful, optimistic and engaged. They feel better and can deal with the challenges in life and to celebrate the joys.
While there are commonalities in the pathophysiology of depression, everyone’s depression is unique to them. Some have a stronger genetic vulnerability. Some had a traumatic childhood. Some have a chronic physical illness. Some live without loving support. People’s clinical needs should be evaluated individually.
Depression is more than just feeling down or having the “blues.” Depression is a constellation of clinical symptoms that includes depressed mood, sadness, lack of interest, lack of motivation, difficulties with sleep and appetite, and thoughts of not wanting to live or suicide, and that continues over an extended period. About half all people that suffer from depression do not seek professional help. Of the people that do seek help, the majority have improvement of symptoms.
There continues to be an unfortunate stigma that is an obstacle in people getting help. Many organizations and people encourage people struggling with depression to get help, and I do think the stigma is decreasing as awareness and education surrounding depression grows.
Sometimes people have hesitancy about change. It is essential to realize that change may be hard, yet it can be worth it. The process can start with a meeting to talk about the feelings you have and how they fit in the context of your life. You can clarify what is going on and talk about options on how to address issues and symptoms.
The development of a therapeutic relationship is a fundamental element of treatment. Psychotherapy to continue to talk about issues and concerns and learn new tools, develop insight, and improve coping is a critical component and maybe the principle or only element for some people. Remember that while you are meeting someone as a potential therapist, the experience is a two-way street and that you are interviewing them to see if you are, in fact, comfortable working with them as well.
Depending on the symptoms and unique aspects of someone’s life, there are many treatment options to consider. For individuals with depression, I recommend maintaining necessary healthy activities such as proper nutrition, exercise, and sleep even though many times, people may be too depressed to take action on these activities.
For depression, there is a range of treatment options such as psychotherapy, medications, ketamine/esketamine, Vagal Nerve Stimulation (VNS), ECT or TMS Therapy. First-line treatment typically includes medications and/or psychotherapy. Currently, second-line treatment is considered to be TMS Therapy or augmentation with additional drugs. Each of these treatments has its pros and cons. We do know they can be effective, and this will depend on each person’s unique situation and should be discussed with the treatment provider.
The first step is to reach out for help and explore treatment options with a qualified professional. The patients I mentioned at the beginning of this article are more engaged with their families, better prepared to enjoy the holidays, and more present in their work efforts— sounds like they are on a path to a pretty good New Year’s resolution to me.