Depression: A major health problem
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| Dr. Tim Hayden, far right, talks to patient Brad Browder. As a family practitioner, Dr. Hayden provides primary health care for all ages. |
Depression has become a major health problem, he says. “Statistics from the World Health Organization show that people have a one in six lifetime chance of getting depression. Estimates show that by the year 2020, depression will be the number two cause of disability. With women, it already is the number two cause of disability.”
Sometimes the cause of depression is genetic; it can run in families, Dr. Hayden says. But more and more often, he explains, “depression is caused by the society we live in. We’re stressed out by the life we live.” External factors, such as bankruptcy, death of a family member or divorce, also can cause depression, he says, “but the majority of people have no identifiable cause.”
Though being depressed is a natural reaction to sad events in our lives, at times depression becomes a medical condition that needs to be treated.
People with symptoms of depression find it hard to get out of bed and face the day, Dr. Hayden says. “They don’t want to be around people or go to work.” They may complain of many other things, such as lacking energy, having headaches every day, having an inability to find pleasure in things that were once enjoyable, feeling hopeless, having a hard time making decisions or finding they can’t get along with coworkers. Dr. Hayden explains that it is common to hear a depressed patient say, “I’m so tired, I can’t get through the day.”
Unfortunately, too many patients with depression don’t realize they have it or seek treatment for it, Dr. Hayden says.
The condition is so common that Dr. Hayden diagnoses and treats patients daily with the problem. As a primary care physician, patients often come to him first, seeking help. His first job is to listen, get a family medical history and do a physical exam. When he thinks the problem may be depression, he also does blood tests to help rule out any physical cause of the fatigue.
If it is not physical, Dr. Hayden then can get an idea of what medications to prescribe by listening to a patient’s complaints. “Part of what I prescribe depends on the symptoms, part of it is educated guesswork.”
In the brain, he explains, “we think with chemicals and electricity.” Stress or another cause of depression can cause an imbalance of one of the chemicals in the brain: serotonin, norepinephrine or dopamine.
Giving a patient an antidepressant that affects one or more of the chemicals can balance out the chemicals in the brain, he says.
For example, he says, a patient complaining of fatigue probably has a lack of norepinephrine. A patient with obsessive/compulsive feelings may need serotonin. A patient who cannot experience reward or pleasure may be lacking dopamine. There are many anti-depressants on the market today, such as Prozac, Zoloft, Paxil and Lexapro, and they are not addictive, he says. (Anti-anxiety medications, like Valium and Xanax, can be addictive.)
It takes about one to two weeks of medications to begin leveling out the chemicals in the brain, Dr. Hayden says. Unless the patient has deep depression, he sees the patient again in four weeks.
With about 70 percent of the patients, he will be correct with his first choice of which anti-depressant will work. Those patients come in after four weeks saying, “I don’t feel great, but I see a difference.” Dr. Hayden keeps them on their medications, knowing that it can take up to eight weeks before the medications have done their job.
With the remaining thirty percent who aren’t seeing positive results, Dr. Hayden will need to increase the dosage, change the medication or even add to it.
In each instance, it takes about one to two weeks of being on a medication for the patient to notice the difference. “Once we get the patient feeling better again, he or she will need to stay on the medications about six to 12 months.”
Prozac’s arrival in 1986 was the beginning of better medications to treat depression with fewer side effects, he says. “These medicines save lives.”
Occasionally, he also will send a patient to a psychologist for counseling. And if the patient seems suicidal, he will send them to an inpatient facility for inpatient care.
If you have depression, you have a 50 percent chance of getting it again, Dr. Hayden says. Those who have two major bouts of depression, have a 75 percent chance of needing treatment again. And those who have had depression three times have a 90 percent chance of needing treatment again.
Dr. Hayden is seeing depression in patients of all ages, from teen-agers through the elderly. “Young and middle-aged women in their 20s, 30s, 40s and 50s have the highest risk of depression.”
Not all fatigue is depression, and depression that lasts less than two weeks may not need treatment. “Everybody has bad days or down days,” he says. “That’s normal. That’s not depression. That’s life.”