By Dr Yan Baum, MD, Kaiser Permanente
When we returned from my first winter break at medical school, we were told one of my classmates had committed suicide. Everyone was shocked and sad for the loss. The student made an impression on everyone as upbeat and got very good grades. The parents later disclosed he had significant depression and had been secretly receiving treatment. However, he felt better after two months of treatment then abruptly stopped the prescription by himself and did not let his doctor know – no follow up.
That was 30 years ago. I still cannot forget what happened; each detail is a haunting memory that will not fade away. This tragedy is the price of uncontrolled depression – suicide – whose effects ripple out over time to the family, friends and even bystanders of the person who chose to take their own life.
Depression needs to be screened
Depression is not uncommon. Both men and women suffer from depression, worldwide, though it is not always formally diagnosed. People with serious chronic illness may be affected more. Sometimes, it can be hidden for different reasons.
Depression, a state of low mood and avoidance of activity, can affect a person’s thoughts, behavior, feelings and sense of well-being. Symptoms include sadness, fatigue, inactivity, difficulty in thinking and concentration, and a significant increase/decrease in appetite and time spent sleeping. Many depressed people have feelings of dejection, hopelessness and pain – and sometimes suicidal thoughts. A temporary depressed mood can be a normal reaction to traumatic life events, such as the loss of a loved one, divorce or financial hardship.
Not only can it cause suicide, depression can also significantly affect health by increasing death rates after complicated surgery and making chronic illness harder to control. Depression is fairly common and can result in serious health consequences.
At Kaiser Permanente, we screen every patient for depression that comes in to the clinic for any reason. I have identified some depressed patients that had been concealing their mood disorder – as my former classmate had – but this time there was an intervention, and they are now working with a Kaiser Permanente team to successfully help themselves feel better.
Today with diagnosis of depression and other mood disorders (like anxiety) becoming much more common, patients naturally look for a simple cure. Ads on TV have conditioned patients to seek “a pill for every ill.”
Clinically, depression is best treated not with a single “silver bullet” drug, but an integrated approach from a support team including which could include family doctor, a therapist, social worker, resource specialist, pharmacist, nutritionist or other specialists. Something as simple as attitude or mindset – how one thinks about your situation and future – can have a major impact on how you feel. Such integrative care, treating the whole person from several different angles at once, is the most effective.
In the process, we must make sure depression is not due to something else – like an untreated (or poorly treated) thyroid condition, or a prescription side effect. You need to sit down with your physician to discuss.
The “best treatment” for depression varies with the patient, however as I mentioned in my first column, a trusted relationship between the patient and physician is a good place to start. An open an honest conversation with your primary care doctor is a necessary starting point on a journey of recovery and creation of an effective treatment plan. The plan should be comprehensive, and can include diet, exercise, a diary, counseling, medication, and more.
Depression treatment quality control
Is there a quality measurement regarding the depression treatment? Yes, there is. Depression is like other chronic illnesses, we measure it and track progress.
Depression treatment fails for some patients because of lack of follow up and inconsistency. Patients start to feel better and then they stop taking the medication and/or following up, or they feel the medication is not working fast enough – no improvement after a week or two, so they abruptly stop (which can be dangerous).
A depression treatment plan needs to be clearly presented to the patient, and patients need to understand that it will take time. Medication may help within a week, but it can take a month or more to see the full benefit. During the first week or so, the side effects can seem bigger than the benefits.
Clinically, we consider the follow up rate regarding the depression treatment of patient, one of the quality measurements of depression. With a good follow up plan, usually depression will be much better controlled than without treatment.
When you want to come in to see your doctor, we can offer a well thought out integrated care plan to help you get through difficult times. If you think you may be feeling depressed, know you are not alone; we are here and can supply a team of caring professionals to assist you.