Depression can happen to anyone

Depression is really hard. When a person has a persistent low or sad mood for more than two weeks, is unable to enjoy what would normally be pleasant activities and feels hopeless, that person is depressed.

We used to define depression as extrinsic, a depression caused by bad life circumstances, or intrinsic, a depression without those bad circumstances. It is not uncommon for a patient to say to me, “I feel so depressed, but I have nothing in my life to be depressed about.”

We have dropped the distinction because the approach to treatment is largely the same either way, and parsing out whether there is a “reason” to be depressed does not help anyone get better.

Many cases of depression, especially when diagnosed early, can be helped by things that tend to protect against developing depression in the first place. Social interaction, exposure to light and fresh air, regular exercise, getting enough sleep, and limiting alcohol consumption can all be helpful. So is helping others. If you change your lifestyle to include these recommendations and find it is not enough to improve your depression, or you just cannot make such changes, talking to a counselor, participating in group therapy, or participating in cognitive behavioral therapy can be as helpful as medications. Effective therapy for depression is more about making positive changes than reliving painful experiences.

A friend of mine was resistant to group therapy, but when she finally went, she found it helpful to have a place where she felt she could be open about having had thoughts of suicide. She later realized her initial reluctance to go to group therapy reflected the stigma still attached to mental illness even though an estimated 6.7 percent of adults had a major depressive episode in 2013. Depression can happen to anyone, but more women are diagnosed with depression than men.

For more severe depression, which does not respond to lifestyle changes and counseling, medications can be very helpful. The newer medications that have come out over the past 25 years (I am showing my age to call stuff that has been 25 years on the market newer) are safer, better tolerated, and more effective than many of the medications that we used to use. Fortunately they have now been out long enough that many of them are generic and very affordable.

Sometimes depression leads to suicide. Every year, more than twice as many Americans take their own lives compared to the number of Americans killed by homicide. And even though depression is more common in women, more men commit suicide than women.

Do not be afraid to ask someone that you are concerned about if he or she has had suicidal thoughts. Bringing the subject up is not going to cause them to act. Anyone who is depressed to the point of wanting to commit suicide, of being unable to function at work and/or home or of being unresponsive to or unable to engage in practices that can help, should see a healthcare provider. If you are thinking about how or planning how to commit suicide, go to your doctor, an emergency room or an urgent care facility, or call a suicide prevention hotline immediately (800) 273-8255.

Once you have had a depressive episode, you are more susceptible to having another one than someone who has never suffered from depression. Being aware of this and having a written “safety plan” can help. A safety plan can include activities you have found helpful in staving off depression before, reminders that the feeling will pass and therapists’ or counselors’ phone numbers.

Dr. Bob Riggs is a family medicine physician practicing at Group Health’s Riverfront Medical Center.