Marks Psychiatry

I can’t tell you how many times I hear this.  I see people at the top of their game.  They have everything they want, work is going well, family in place, finances established, yet they’re depressed.  How can this be?

It’s simple.  You don’t need a “reason” to be depressed.  Depression is a biological process/disorder similar to high blood pressure or diabetes.  I tell my patients, the brain is an organ just like your liver and kidneys.  Just as your liver and kidneys can malfunction, so can your brain.  The brain controls everything - your muscular movement, your intellect, emotions, etc.  If the part of the brain that controls our emotions is malfunctioning, then our emotions are going to malfunction beyond our control.  Therefore, just a person with diabetes can’t just “get their act together” to regulate their glucose levels, depression is not a matter of simply getting one’s act together.  Research continues to validate depression as a condition that results in changes in brain chemistry.

Yes, it is common for depressive episodes to be triggered by distressing events, particularly at the beginning of the illness (first few episodes).  But typically, as one progresses through life, subsequent episodes may or may not be triggered by an event.

Fortunately, media coverage has put depression more in the mainstream conciousness and made it more acceptable for people to openly discuss being depressed and therefore seek help. 

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A recent article in the Psychiatric News periodical discusses a survey that reveals a large number of women in the United States are sleep deprived.  There’s a quote saying “Americal women struggle to do it all…”  The women in the poll said they lacked the time to meet all of their obligations in addition to participating in extra leisurely activities.  Thirty percent said they were too weary to or busy to have sex.

You can see the article at Psychiatry Online Women Sleep Article

There are a number of trends documented with the study such as how many women used sleep aids and how 17% reported getting less than six hours.  The most significant finding to me was 25% of the women had been diagnosed with depression and 16% with an anxiety disorder.   This is not completely surprising as sleep is esential to mental well-being. However, these percentages are higher than the prevelance rates of depression and anxiety in the general population.  Are we depressed because we’re not sleeping or are we not sleeping because we’re depressed.

I would venture to say that the respondents in this survey were likely falling into the common pattern of sacrificing sleep for the sake of meeting family, financial and personal obligations.  The author ends by saying women need to make sleep a priority to set an example for their families.  This suggests becoming sleep deprived is a choice women make.  Unfortunately some are unable to sleep due to factors beyond their control (child interuptions, shift work, medical or psychiatric conditions, etc.).  If only they could choose to sleep.

Nevertheless, sleep is critical and affects our mental and physical functioning on a global scale.  More on sleep in future posts.

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Of course, the short answer to this is it depends on your needs and your individual situation.  But in general, according to epidemiological studies, once a person has one episode of depression, they have a 50-60% chance of having a second episode at some point in their life..  That second episode may be months to years later, or not at all.  After the second episode, the chance of having a third is 70%.  After third episode, the chance of a fourth goes up to 90%. 

Therefore usually doctors recommend individuals in their first or second episode be treated for 9 months to a year and then taper off the medication and see what happens.  After the third episode, since the chance of a recurrence is 90%, doctors usually recommend remaining on andepressant medication indefinitely.

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One of the attractive things about medicine is that you never stop learning.  Our medical licenses require us to log a certain number of hours of continuing medical education, but even if it were not a requirement, I would venture to say most physicians would voluntarily seek to improve their knowledge.  That said, in addition to enjoying learning, I also enjoy disseminating useful information.  I do this to some degree (hopefully) with patients in my practice, and the internets allows an even broader reach to those who are interested. 

I hope you find my comments useful and I welcome comments on my comments.  However keep in mind that since my priority is patient care, I may not be able to respond…

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