Depression is by no means a modern affliction. Over the past year, however, the disease has been on our collective minds more than ever as revered artists and respected celebrities have ended their lives after what, in most cases, those close to them have described as years of struggle and darkness. In honor of World Mental Health Day, we asked Beijing United Family Hospital (BJU) Psychiatrist Dr. Esperanza Salinas a few questions about this disease. Read on to learn what depression is and how you can begin to deal with it.
What is depression?
The Diagnostic and Statistical Manual of Mental Disorders (DSM) defines depression as having five out of nine criteria. These criteria include being in a bad mood most of the time, having decreased interest in most things, changes in sleep and appetite patterns, decreased concentration, no energy, and fatigue. These issues may affect your functioning, relationships, diet, or home life. The intensity may determine whether they call it mild, moderate, or severe, the most severe with psychotic symptoms. For the DSM, it requires a two-week period of having these symptoms more days than not.
The majority of people that I see have been struggling with depression much longer than that. Usually, we see patients who have had these symptoms for a month or two months and it’s significantly affecting them academically or at work. People come in when they have been struggling and they’re noticing that they’re just not happy anymore and they just can’t get themselves to go to work anymore. They think, “I’m miserable and nothing makes me happy.”
There are two different types of depression. One is an agitated depression, where they have a lot of restlessness and difficulty sitting still. Then, there’s another type of depression where it’s more psychomotor retardation and fatigue and increased need to sleep. Everything takes so much more energy. The ability to get up and out of the house and doing something would be beneficial, but connecting with friends, going to the gym, going for a walk, going to see a movie, these things are just so hard because, physically, the depression really weighs them down.
Depression is curable. Most depression will last anywhere from six months to two years, and so people go into depression and come out of it. When you’ve had one depressive episode, your risk of having a second episode goes up.
How do I know if I’m depressed?
There is a ton of rating scales online that people can use. There’s the Hamilton rating scale for depression, where people can get an indication of whether they’re depressed or not. The one that we tend to use clinically is the PHQ9. It helps us to see if they’re in a mild, moderate, or severe range. PHQ9 tends to be a clinician-administered test, but all these scales are available online.
What should I do if I’m depressed?
If you’re in a depressed state, then it’s probably better to see a doctor. If you’re in a funk or you’re headed in that direction, physical activity and reaching out to friends and family help. Staying connected, staying involved, that’s all going to help. When you’re in a depression, though, your interest in those kinds of things really wanes and finding the motivation to get out of the house and do stuff is really, really hard.
There are things you can do: eating right, exercising, staying connected to friends – you know, some basic stuff. But most people who have started to slide into a depression have tried that. They need to talk to somebody because their depression is severe.
When is it most critical to seek help?
I think if you’re having suicidal thoughts, you should go see somebody right away. The brain does what the brain does and sometimes people have fleeting thoughts from time to time but, if the thoughts start to become very persistent and you spend a lot of time during your week thinking about this or thinking, “What’s the point?”, you’re probably on a slippery slope of this being much more severe. If you’re having any suicidal thoughts, I think it’s important to go talk to somebody about it because a majority of people are not thinking that way.
What can I do if I think my child might be depressed?
We often have family members that call and say, “I’m worried about my son, he doesn’t leave the room anymore and he doesn’t want to have dinner with us anymore.” Then, you can gently say, “I need you to talk to somebody because I’m really worried about you, can you start doing therapy?” If it’s a younger child, you can also make the appointment for them.
It also depends on the relationship between the parent and the child. If the relationship is very conflicted, the adolescent may not necessarily take to that and fight against it. Say they have a special relationship with an older sibling, an aunt, a godparent, or a teacher – those are the ones they may respond to.
What can I do if I think my friend might be depressed?
You still express concern while also empathizing with them about what they’re going through. You can say, “I’m worried about you. When I was going through my divorce, I had a really hard time and I see you going through some of the things that I went through.” You can say, “I’m worried about you because I’ve experienced this too. Have you thought about talking to somebody? I’m here for you if you need me. You can talk to me.” You should also be aware that their problems may be more than you as their friend can handle. When that happens, you can tell your friend, “Maybe you should see someone who does this all the time because I don’t know how to help you at this point.”
What can I do if I feel I need to see a mental health professional urgently?
We have our Emergency Room, and it’s there 24 hours a day. A mental health professional is on-call all the time. Depending on what they come in for, it’s often enough for patients just to have come into the Emergency Room. They make an appointment that day or the next day to come see us. Sometimes, they call us in to come see the patient in the Emergency Room because they’re very distraught. If they’re suicidal, we usually get them to stay overnight or request that they stay in the hospital for a few days. If they stay in the hospital for a few days, they’ll see us for a few days twice a day.
If I do see the doctor for depression, how will they help me?
I do medication and I do therapy. If the patient is depressed at a certain level (at a moderate to severe range) then medication is the treatment of choice. If they’re in the mild to moderate range then it’s the patient and clinician’s decision to decide what the best course is. Usually, therapy would be the recommendation. For moderately severe patients, we tend to have a negotiation. We’ll try one thing for a little bit of time and go back to medication. We’ll go back and forth depending on what the patient wants to do. Therapy requires much more of a time commitment because you have to come in every week for a 50- to 60-minute session. Medication is less of a time commitment but it takes four to six weeks to work. For that first part, the doctor is going to want to see the patient very regularly until the medication starts kicking in.
If you know you’re not someone who wants to do medication, I think it’s fine to see a psychologist. Our psychologists here are savvy enough to be able to say, “I don’t think therapy is going to be enough, you should see the psychiatrist.”
Dr. Esperanza Salinas is an American board-certified child and adult psychiatrist. She speaks English and Spanish. To make an appointment with her, call the BJU Service Center at 4008-919191.
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