InHealth: Common Questions About Depression

By Dr. Rebecca Cohen

My life is good, so why do I feel so depressed? And why can’t I snap myself out of it?

The most important thing to know is that depression is a medical condition with effective medical solutions. You wouldn’t blame yourself for not overcoming a thyroid condition on your own, and you also should not blame yourself for not being able to “snap yourself out” of depression. With major depression, the brain becomes entrenched in negative, worried and distorted thinking, which makes it hard to be aware of the positive aspects of your life or even to remember how you felt before you were depressed. That can lead to hopelessness, despair and anxiety. 

How can you know if someone is depressed?

The changes from depression can be subtle at first, and they develop over time so we may not even be aware of them. The symptoms usually go beyond feelings of sadness. Everyone gets down sometimes, but those with major depression struggle with symptoms every day. As depression progresses, cognitive function is affected, including lack of confidence and ability to make decisions, even small ones. One client told me, “I go to the grocery store and can’t put anything into the cart. I don’t know what I want any more.” Sleep is often disrupted, and people can lose interest in things that once gave them joy, including food, which can also lead to weight loss. Severe fatigue may drive people to see their family doctor. Staying in bed, lack of grooming, and becoming withdrawn are commonly described symptoms. 

What are treatment options for depression?

The first step is finding a mental health professional who will discuss your symptoms and create an individualized treatment plan. For patients with mild depression, this may mean adjusting stress levels, improving sleep routines and making behavioral adjustments. For major depression, medications are the first line of treatment. Today’s medications are highly effective, much easier to tolerate, and a psychiatrist can nuance medications for best results. These could include antidepressants along with medications to relieve anxiety or help reestablish normal sleep patterns. Proper dosing strategies can improve outcomes and minimize side effects. It also is important for people to reestablish their usual routine, which should include exercise, good nutrition and social engagement. The support of friends and family is crucial.

Will I need therapy, too?

Individuals with moderate or severe depression demonstrate significantly better outcomes by combining medication and psychotherapy. Many options for therapy are effective including cognitive behavioral therapy and those emphasizing mindfulness.

I’ve been on antidepressants, but they don’t seem to be working. What now? 

Keep in mind that it takes time for medications to work–often a month or more. So if you’re just starting treatment, you can be hopeful that you will be feeling much better soon. Some individuals are identified with treatment resistant depression (TRD) and newer treatments offer them real hope for improvement as well. Transcranial magnetic stimulation (TMS) is a noninvasive, well-tolerated treatment that focuses MRI-level magnetic energy on the brain’s mood center. Patients have little or no discomfort, and many show an exciting amount of improvement. I always want to offer my patients hope, and with the current treatments that are available, people can feel better and find the joy in life again.  

Dr. Cohen is a psychiatrist specializing in psychopharmacology for mood and anxiety disorders as well as TMS therapy.

Rebecca S. Cohen M.D.

1217 S. East Ave., Suite 209 Sarasota, FL 34239

941.404.0545

drrebeccacohen.com