Do I have the Blahs or am I Depressed?

Recuperating from my concussion (see last blog) has certainly had an effect on my mood.  And for lack of a better description, I feel really blah!

Now, as a Psychiatrist whose primary role is to conduct mental assessments on my patients, you better be darn sure that I am paying close attention to my perceptions, my feelings and my behavior.  I have come up with a diagnosis of the BLAHS secondary to my injury.  It has left me with feeling B-lue - a sadness that has me lying on the couch a bit more than usual; L-ittle changes are noted in my energy, concentration, appetite, and sleep pattern; A-ware of the change, linking it to a recent event and in my case, dealing with symptoms of my concussion, not working and feeling unproductive; H-ourly changes, i.e., it does not persist for days or worsen, but rather fluctuates with visits from family, emails, and listening to my favorite music; S-hort lived -as in, this, too, shall pass.

Even though I have the knowledge to explain the recent change in my feelings and behavior, I am also wise enough to talk about this with my primary care physician. Most individuals do not.  Some episodes of feeling BLAH actually evolve into a depression.  I may be sitting at home today, but I am motivated to get the word out!

So - my goal today is to provide some information on depression.  I have decided to resurrect a previous blog on the topic.  Here goes!

What is depression? If you were to ask your friends or family, or be brave enough to conduct a survey of passing strangers on a street corner, I guarantee you would get a variety of different responses. That is because depression has become an umbrella term used by many individuals to describe a number of different moods ranging from "the blues" or feeling "blah" to a severe, debilitating state where nothing but suicide could end their pain. There is quite a gap between these two ends of the spectrum. So, let's begin by defining depression more clearly.

First of all, I am very grateful to have a person who is feeling "depressed" actually sitting in my office. Most of my patients who are depressed may be referred by their primary care provider (and may not follow through). Some are brought by a family member or friend, not necessarily willing to provide details to a complete stranger. Very few individuals come on their on volition. So, when I am given this opportunity, I better be able to diagnose my client correctly. 

As a psychiatrist, I rely on specific criteria to diagnosis an individual with a major depressive episode. The interview is critical in gathering the objective data. I rely on an acronym to obtain the necessary information - SIGECAPSS. This represents the following symptoms: (S) Sadness or depression; (I) lack of interest or anhedonia; (G) guilt, poor self-esteem, worthlessness; (E) loss of energy; (C) poor concentration; (A) changes in appetite, either increased or decreased; (P) psychomotor retardation or agitation - most likely observed by others ("All you do is sit around" or "You seem more edgy than usual"); (S) changes in sleep pattern, either increased or decreased; and, most importantly, (S) suicidal thoughts, plans, or intent. The DSM-IV manual (the psychiatrist's bible for establishing diagnoses) requires that at least five (or more) of the above symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) (S) depressed mood or (2) (I) loss of interest or pleasure. If the symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning such as family relationships then it becomes a major depressive disorder. I have also been required to rule out any medical condition that could contribute to depression (e.g. hypothyroidism), any concurrent use of alcohol or drugs that can influence or mimic some of the above symptoms, or bereavement symptoms that have not become more debilitating after a two month interval. I am not at all dismissing the depression that can be attributed to other general medical conditions, substance abuse, or pathological bereavement. These individuals are just diagnosed under a different terminologies. In addition, individuals with other mental illness, including bipolar disorder, schizoaffective disorder, or adjustment disorder with depressed mood can also experience the same symptoms. It is beyond the intention of this posting to address these other conditions but will be discussed at another time.

When I wrote above that I am "grateful" to be able to assess a person face to face, I truly meant this. Depression is treatable. Statistics claim that women are twice as likely to develop depression than are men. Based on the gender of my clients, I suspect that this statistic is true. However, men are also less likely to admit that they might be suffering from depression. Considering the other statistic that woman are more likely to attempt suicide but that men are more successful, I am concerned that this younger segment of my generation (the 46 to 54 year olds) are experiencing more stressors.

PLEASE!!!!! Even if you are feeling "a little blah", or if a friend, a colleague, a family member gives you some feedback about a change in your behavior, promise me that you will at least talk to your primary care physician. If you do not have one, turn your insurance card over and call the number for behavior health services for a referral. If you do not have insurance, there are community mental health services in your county that can offer you services. MOST IMPORTANT - if you have thoughts of suicide, please go to the nearest Emergency Room for an evaluation. Please promise me that. I may not know you or the extent of your grief or your stressors. But I do know that everyone on this earth is precious. Life is precious. Please have faith and know that you are loved.