Medical City Healthcare - December 21, 2017

Netflix's popular spring 2017 show, "13 Reasons Why," highlighted the topics of depression and teen suicide. In a follow-up blog, we discussed the rising suicide rates among older adults. But there is still a lot of ground to cover before we have a common understanding of these mental health issues. To provide some answers, we went straight to the source.

Shanna Nasche, LPC, a counselor at Medical City Green Oaks Hospital, answers her patients' top 7 questions about depression and provides strategies for communicating and seeking treatment.

How can I tell if it's really depression or just a few bad days?

It's common to feel sad from time to time. But if feelings of sadness or hopelessness persist for two or more weeks coupled with any of these other symptoms, it might be depression.

  • Feelings of guilt or worthlessness.
  • Lack of interest or energy for everyday activities.
  • Loss of interest or pleasure for activities that used to be enjoyable.
  • Changes in weight or appetite.
  • Changes in sleep habits or energy level.
  • Difficulty concentrating.
  • Suicidal thoughts.

It's important to get help if you or someone you know is experiencing these symptoms. You can get 24-hour emergency psychiatric care at Medical City Green Oaks Hospital by coming in or calling (972) 770-0818. You can also reach the National Suicide Prevention Lifeline at 800-273-8255.

How much of depression is genetic?

Family history can play a role in depression, but it's not a direct one-to-one ratio, says Nasche. "It's not like 'if my mom is depressed then I will be, too.'" Researchers are still looking for the specific genetic changes that predispose someone to depression, but they have made some findings, including:

  • Likelihood to inherit depression is probably 40-50% and might be higher for severe depression. This could mean that in most cases of depression, roughly 50% of the cause is genetic and the other 50% is from psychological or physical factors.
  • Major depressive disorder will affect at least 10% of the U.S. population at some point in their lives.
  • Having a parent or sibling with depression could increase the risk of developing it by at least 2-3 times compared with the average person.
  • Twice as many women as men are diagnosed with major depression (but that may be because women are more likely to seek treatment).

Can depression affect anyone?

Depression can happen to anyone at any age. In addition to genetic factors, hormones, biological differences and brain chemistry may also influence who gets depression.

Factors that have been found to increase the risk of developing or triggering depression include:

  • Traumatic or stressful events, including the loss or death of loved ones, money problems or physical or sexual abuse.
  • Personal history of other mental health disorders, including eating disorders, anxiety disorder or PTSD.
  • Family history (blood relatives) of depression, bipolar disorder, alcoholism or suicide.
  • Substance abuse (alcohol or drugs).
  • Personality traits including low self-esteem, extreme dependence on others or being self-critical or pessimistic.
  • Having a serious or chronic illness.
  • Some medications.
  • Time of year, such as during the sunless winter months when people with seasonal affective disorder (SAD) typically feel blue.

How can depression affect someone physically?

Nasche says that depression can take a physical toll and worsen existing health issues. Since serious/chronic illness is a depression trigger, it's not hard to see how the physical and emotional symptoms of depression could influence each other.

Some of the ways depression takes a toll on the body include:

  • Appetite and nutrition issues, including eating too much, eating too little or binging on sweets and carbs, which can cause:
    • Stomachaches, cramps, constipation and malnutrition.
    • Eating disorders.
    • Obesity-related illnesses, such as type 2 diabetes.
  • Stress issues, which can lead to heart disease and heart attack.
  • Immune system issues, which can make you more vulnerable to infections and diseases

How can I tell a family member or friend that I have depression?

Remember that depression is a real illness that is treatable and affects people in different ways. Having the condition doesn't mean you are weak, but it can be very difficult to talk about. Tell your loved one you want to set up some time to chat and be prepared for questions.

Nasche says her patients report two types of reactions when they tell people they are depressed. Sometimes it's love and support; other times, people think depression is just laziness. "No matter how educated the person is, some people just don't believe in depression," Nasche said. She always gives her patients the option to bring their loved one into a therapy session. Ask your doctor about this if it seems like the right decision for you.

What treatments are available for depression?

There are a number of treatment options for depression, so speak with your mental health professional about which ones might be right for you. Depression treatments include:

  • Medications (antidepressants) that can help improve the way your brain uses certain chemicals that control mood or stress.
  • Talk therapies (psychotherapy), such as cognitive-behavioral therapy, which helps people change negative thinking, recognize things that may be contributing to the depression and change behaviors that may be worsening the depression.
  • A combination of the two.

Nasche says that if you're functioning well "” not feeling great but functioning "” you probably have a choice of treatments. "If it's pervasive," she said, "you would benefit from a combination of medication and therapy."

Things that can be done at home to help depression include:

  • Exercise, which can improve symptoms with just 20-30 minutes of activity several times per week.
    • Structured exercise (online yoga class or a short run outside).
    • Unstructured exercise (working in the garden or walking).
  • Adequate sleep.
  • A nutritious diet rich in fruits and veggies, whole grains, low-fat dairy, healthy fats and lean meats.
  • Support groups, which can be found locally and online. The Anxiety and Depression Association of America is a good place to begin your search.

How does therapy work?

The question Nasche gets asked most by her patients is how can I feel better? Her answer is to relate depression to other chronic diseases that must be managed, such as diabetes. Both conditions may require changes in behavior and lifestyle choices. Therapy can help identify and manage those changes.

Because depression thrives on under-stimulation, isolation and inertia, behavioral changes are crucial. Some therapists work with patients on developing interpersonal skills, which can help them integrate and communicate better. "We’ve got to consciously work on shifting the mood by finding ways to integrate these behavioral changes into their typical day or week," said Nasche.

However, the strategies patients use to manage their depression must be ones they can stick to. "I tell my patients that one of the first things that we are going to do is figure out a handful of tools that they are willing to use," Nasche said.

What to do if you think someone might be depressed.

Many times, people with depression might not realize that they are affected; they might think that their feelings of sadness are normal. "They don't realize that their functioning could notably improve," said Nasche.

Try talking to this person and encourage them to get help. Emphasize that depression is a medical condition. Explain that, just like going to the doctor for a physical every year, it's important to be assessed by a doctor for your mental health. Let them know that a mental health professional can talk with them about their emotions. While depression is serious, it's also treatable. With the help of loved ones, getting through it may be a little easier.

Get fast, emergency help in any crisis at one of our many Medical City ER locations across North Texas. With average wait times posted online, if you do have an emergency, you can spend less time waiting and more time on the moments that matter most.

Find a fast Medical City ER near you or call our free 24/7 Ask-A-Nurse hotline.

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