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What is depression?

Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. Also called major depressive disorder or clinical depression, it affects how you feel, think and behave and can lead to a variety of emotional and physical problems. You may have trouble doing normal day-to-day activities, and sometimes you may feel as if life isn’t worth living.

Depression isn’t a weakness, and you can’t simply “snap out” of it. Depression may require long-term treatment.

Most people with depression feel better with medication, psychotherapy or both. Research tells us the combination of these is the most effective way to treat depression. (SOURCE)

Types of depression include:

  • Major depressive disorder (MDD): Major depression (clinical depression) has intense or overwhelming symptoms that last longer than two weeks. These symptoms interfere with everyday life.
  • Bipolar depression: People with bipolar disorder have alternating periods of low mood and extremely high-energy (manic) periods. During the low period, they may have depression symptoms such as feeling sad or hopeless or lacking energy.
  • Persistent depressive disorder (PDD): PDD is also known as dysthymia. Symptoms of PDD are less severe than major depression.
  • Psychotic depression: People with psychotic depression have severe depressive symptoms and delusions or hallucinations. Delusions are beliefs in things that are not based in reality, while hallucinations involve seeing, hearing, or feeling touched by things that aren’t actually there.
  • Seasonal affective disorder (SAD): Seasonal depression, or seasonal affective disorder, usually starts in late fall and early winter. It often goes away during the spring and summer.

Symptoms of depression in older adults
Depression is not a normal part of growing older, and it should never be taken lightly. Oftentimes, depression goes undiagnosed and untreated in older adults, and they may feel reluctant to seek help. Symptoms of depression may be different or less obvious in older adults, such as:

  • Memory difficulties or personality changes
  • Physical aches or pain
  • Fatigue, loss of appetite, sleep problems or loss of interest in sex — not caused by a medical condition or medication
  • Often wanting to stay at home, rather than going out to socialize or doing new things
  • Suicidal thinking or feelings, especially in older men

General symptoms of depression
Although depression may occur only once during your life, people typically have multiple episodes. During these episodes, symptoms occur most of the day, nearly every day and may include:

  • Feelings of sadness, tearfulness, emptiness or hopelessness
  • Angry outbursts, irritability or frustration, even over small matters
  • Loss of interest or pleasure in most or all normal activities, such as sex, hobbies or sports
  • Sleep disturbances, including insomnia or sleeping too much
  • Tiredness and lack of energy, so even small tasks take extra effort
  • Reduced appetite and weight loss or increased cravings for food and weight gain
  • Anxiety, agitation or restlessness
  • Slowed thinking, speaking or body movements
  • Feelings of worthlessness or guilt, fixating on past failures or self-blame
  • Trouble thinking, concentrating, making decisions and remembering things
  • Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide
  • Unexplained physical problems, such as back pain or headaches

For many people with depression, symptoms are usually severe enough to cause noticeable problems in day-to-day activities, such as work, school, social activities or relationships with others. Some people may feel generally miserable or unhappy without really knowing why.

Causes of depression
It’s not known exactly what causes depression. As with many mental disorders, a variety of factors may be involved, such as:

  • Biological differences:People with depression appear to have physical changes in their brains. The significance of these changes is still uncertain but may eventually help pinpoint causes.
  • Brain chemistry:Neurotransmitters are naturally occurring brain chemicals that likely play a role in depression. Recent research indicates that changes in the function and effect of these neurotransmitters and how they interact with neurocircuits involved in maintaining mood stability may play a significant role in depression and its treatment.
  • Hormones:Changes in the body’s balance of hormones may be involved in causing or triggering depression. Hormone changes can result with pregnancy and during the weeks or months after delivery (postpartum) and from thyroid problems, menopause or a number of other conditions.
  • Inherited traits:Depression is more common in people whose blood relatives also have this condition. Researchers are trying to find genes that may be involved in causing depression.
  • Life events:Stress, the death of a loved one, upsetting events (trauma), isolation and lack of support can cause depression.
  • Medical conditions:Ongoing physical pain and illnesses can cause depression. People often have depression along with conditions like diabetes, cancer and Parkinson’s disease.
  • Medication:Some medications have depression as a side effect. Recreational drugs and alcohol can also cause depression or make it worse.
  • Personality:People who are easily overwhelmed or have trouble coping may be prone to depression.

How to treat depression
Depression can be serious, but it’s also treatable. Treatment for depression includes:

  • Self-help:Regular exercise, getting enough sleep, and spending time with people you care about can improve depression symptoms.
  • Counseling:Counseling or psychotherapy is talking with a mental health professional. Your counselor helps you address your problems and develop coping skills. Brief therapy may be all one needs, while others may continue therapy for longer periods of time. Some people participate in therapy off and on as symptoms improve or worsen.
  • Alternative medicine:People with mild depression or ongoing symptoms can improve their well-being with complementary therapy. Therapy may include massage, acupuncture, hypnosis and biofeedback.
  • Medication:Prescription medicine called antidepressants can help change brain chemistry that causes depression. Antidepressants can take a few weeks to have an effect. Some antidepressants have side effects, which often improve with time. Always consult with a healthcare provider before taking any medications to treat your mood whether prescribed or over the counter.

Medications and psychotherapy are effective for most people with depression. Your primary care doctor or psychiatrist can prescribe medications to relieve symptoms. However, many people with depression also benefit from seeing a psychiatrist, psychologist or other mental health professional.

If you have severe depression, you may need a hospital stay, or you may need to participate in an outpatient treatment program until your symptoms improve.

Psychotherapy is a general term for treating depression by talking about your condition and related issues with a mental health professional. Psychotherapy is also known as talk therapy or psychological therapy.

Different types of psychotherapy can be effective for depression, such as cognitive behavioral therapy or interpersonal therapy. Your mental health professional may also recommend other types of therapies. Psychotherapy can help you:

  • Adjust to a crisis or other current difficulty
  • Identify negative beliefs and behaviors and replace them with healthy, positive ones
  • Explore relationships and experiences, and develop positive interactions with others
  • Find better ways to cope and solve problems
  • Identify issues that contribute to your depression and change behaviors that make it worse
  • Regain a sense of satisfaction and control in your life and help ease depression symptoms, such as hopelessness and anger
  • Learn to set realistic goals for your life
  • Develop the ability to tolerate and accept distress using healthier behaviors

Telehealth opens the door to better treatment
Telehealth may be the perfect solution for the older population that may be restricted by quarantine in a nursing home, health issues or transportation issues. Additionally, telemedicine may be the most viable option for care for people who are struggling with depression and experiencing apathy or amotivation which can make it especially difficult to pursue care in the community.Also called telemedicine, there are several ways that people with depression may benefit from telehealth.

Telehealth is Convenient
Telemedicine eliminates the hassles of securing transportation and traveling to the doctor’s office. This works because your appointment is made on your smartphone or laptop, so you can be anywhere in the world and still see your doctor. It also frees up more time to take care of other daily tasks and duties.

Telemedicine Increases Accessibility
Many people who are depressed must travel more than 10 miles to see their health care provider. This can be especially difficult for those who do not have a car as riding public transportation can be very time-consuming. Furthermore, those with mobility challenges do not have to worry about if the doctor’s office is accessible.

Telepsychiatry Offers More Privacy
Making your appointments online means more privacy because you can easily do them from the comfort of your home or workplace.

Insurance Should Cover the Cost
One of the positive outcomes of the pandemic is that insurance companies have been forced to cover the cost of telehealth appointments. If you are on Medicaid or Medicare, there is much more flexibility in getting your appointments covered than at any time in the past. Additionally, if you do not have access to insurance, you may find more opportunities to work with a clinic that has a sliding fee scale.

Telehealth Is More Comfortable
Most patients with depression report that they feel more comfortable seeing the doctor online because they are surrounded by their things and in their own space. This may help you dive deeper into the challenges you are facing to find workable solutions sooner.

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