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When Depression Doesn't Go Away
Created on 10/1/2010

B sent in a question about a family member with depression.

A relatively young woman, this person has been seeing a physician specialist for a few years and continues to take antidepressant medication. Her moods are better but still not as good as they once were. B asks what else can be done.

Depression is something that visits most all of us at one time or another.
 
The depression that occurs as a result of loss or grief is often referred to as situational depression, where the source is something external to us. This form of depression can linger but typically lightens over time as our coping skills restore balance, helping us to find joy again.

When there is no apparent circumstance triggering the blues the condition is called endogenous depression.

It's not unusual for a person who seems to have everything going for them - family, gainful employment, good physical health - to present with depression saying, "On paper everything looks so good - why do I feel so bad?"

We still don't understand all there is to know about depression, including what causes it. 

We do know that depression is an illness that requires treatment by a medical profession - it's not a personal weakness or flaw. It's a very common condition, and one that can usually be treated successfully.

There are a number of activities that can help keep depression away or at least improve our moods, such as:

- following a Mediterranean-style diet (research findings confirm that a healthy, anti-inflammatory diet lessens depression)
- regular physical activity (the single best antidepressant yet identified is exercise)
- getting adequate sleep (at least 7 hours each night)

If your loved one is taking medication for other problems their doctor should have already checked to see if side effects include depressed mood. In addition, disorders such as hypothyroidism often cause depression - again, the doctor can check for these types of health issues.

Antidepressant medications can be helpful for some if the depression is longstanding or severe, but should only be used under the guidance of a physician well-versed in their risks and benefits, such as a psychiatrist. The drugs prescribed are sometimes changed or combined to offer the best chance of overcoming depression.

Thankfully, most people with mild to moderate depression don't seem to require drug therapy. Many with more challenging forms of depression are able to discontinue the medication at some point under the direction of their doctors and be the happy, balanced person they always were. 

All, however, can benefit from exploring and using appropriate forms of stress management and coping that might include regular exercise, meditation, group support, and laughter.

Some people with resistant depression are later diagnosed to have bipolar disease, which requires a different treatment approach. Bipolar disease is now being recognized with greater frequency.
 
Fish oil supplements may be of benefit especially if the person in question has bipolar disorder.

Other potentially helpful agents include SAMe and St Johns wort, but always speak with your doctor first before you start taking them, and NEVER combine these types of remedies with prescription drug treatment for depression, or with other over-the-counter mood aids. 

If your loved one still isn't getting better, B, it might be time for a second opinion. Seek out another well-respected psychiatrist to consult with who can review the medications presently being used, and change them if need be. Bring up the possibility of bipolar disorder for discussion.

A doctor may also want to check vitamin B12 and vitamin D levels, as very low levels have been associated with depressed mood.

It might also be the right time to consider working with a well-trained practitioner of Chinese medicine. Acupuncture has shown promise in some studies against depression.

I do hope your loved one finds peace and happiness again soon, B, and I hope the information above is of help.

Be well.
Dr. Russ

** Information on this web site is provided for informational purposes only and is not intended as a substitute for the advice provided by your physician or other healthcare professional. You should not use the information on this web site for diagnosing or treating a health problem or disease, or prescribing any medication or other treatment. **



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