La Coop P.A.- General and Forensic Psychiatry - Boutique-Private Psychiatric and Forensic Practice in Tampa-Clearwater-Florida


October, 2012 - Depressive Disorders


One of my amazing patients with Major Depressive Disorder emailed me an article that is fantastic and really explains Major Depressive Disorder (MDD) from a patient perspective. The writer describes the waxing and waning course of this disorder. Also, it mentions one of the major complications of this disorder - suicide.

For those who don't want to read the article, I have included the PG-13 poem in the article (there is a rated R one as well):

Here are some obvious things about the weather:
It's real.

You can't change it by wishing it away.

If it's dark and rainy it really is dark and rainy and you can't alter it. It might be dark and rainy for two weeks in a row.

It will be sunny one day.

It isn't under one's control as to when the sun comes out, but come out it will.

One day.

It really is the same with one's moods, I think. The wrong approach is to believe that they are illusions. They are real. Depression, anxiety, listlessness -- these are as real as the weather -- AND EQUALLY NOT UNDER ONE'S CONTROL. Not one's fault.


They will pass: they really will.

The newsletter this month is about depression, the types and what you should do about it in the case if you or someone you love suffers from it.

Next month, I already have another newsletter idea from another fantastic patient with anxiety. We are going to talk about some things you can do to combat anxiety in real time in your daily life.

Until next time!

Dr. L

Depression comes in many forms

When most people see me and need treatment, they don't realize that there is anything other than MDD. They believe that what they see on the commercials they must have, or they think that because they are not "sad" they don't have depression. Depression comes in many forms. For some it can be irritability, for others it can be sadness, for some it can be apathy, for some it can be striking out at others. Some people sleep a lot, others not at all. What people do know is that they are in trouble.

No matter what form it comes, the important thing to remember is that this is treatable. Some cases are worse than others and some cases are a combination of things. The first step is going to get treatment, which for some people - is the most difficult thing to do. However, the worst thing you can do is continue to avoid because this illness has the potential for deadly consequences.

DEPRESSION DUE TO A MEDICAL CONDITION - When I treat patients I order labs. The question comes up, "why are you ordering these? I've gone to many Psychiatrists and I have NEVER had blood work done." The reality is, that to truly make a Psychiatric diagnosis, you have to rule out a medical condition for the symptoms. I have hundreds of cases of patients that have had a medical cause of their depression for years, and it's no wonder, "no medications work on me... I've tried them all!" It's because they are treating the wrong problem.

***Treat the medical conditions and you are on the way to solving the problem if a medical reason is the cause of the depression.

DYSTHYMIC DISORDER - This is a toughie! No one really talks about this disorder, likely because it's very tough to treat. Of all of the depressive disorders this is the toughest one to have. This disorder is characterized by a long period of time (2 years) where there are depressive symptoms and the person feels down more times than not over the course of that period of time. When I speak about it with patients with the disorder I describe it as, "looking at the world through gray colored glasses." They don't typically get as severely depressed as people with MDD, but they are never really happy. A lot of times, people with this disorder may think that others should suffer with them, that somehow, "if they can understand the pain that I am going through - things will be better." This isn't the case and it's a destructive thought.

***The best course of action in these patients is getting them involved in activities. Exercise is always a good mood elevator. Also, getting involved in hobbies or spending time with your significant other is also a good one. With this disorder there is a need for constant maintenance and also a need for the person to be mindful of what is actually going on. Not just what they feel is going on.

MDD - This is a tough illness, but in a true MDD it's much easier to treat than Dysthymic Disorder and the course of their depression is a shorter period of time (2 weeks), but the symptoms are more severe in that period. People with this disorder can sometimes feel so sad that they can become psychotic (see or hear things that are not there, or believe things that are really not true).

***The best course of action in this case is medication management typically, once it's determined the cause is purely Psychiatric. Then there needs to be supports in place. Depending upon the type of depression (Post Partum Depression is in a subcategory of this disorder) and the actual symptoms the person has, supports can range from just follow up with the doctor every week or every other week to hospitalization if they want to die, hurt someone else, or are psychotic.

ADJUSTMENT DISORDER WITH DEPRESSED MOOD - A lot of times, people that come for treatment and feel bad are just suffering from something bad happening to them in their environment at the time. Whether it's a romantic break up, a bad grade, getting arrested and thrown in jail or a loss of job. Many of these feelings will go away after a reasonable amount of time or if their situation changes. The time you need to worry is when the situation has changed for the better and their mood doesn't get better. The best course of action in that case is getting them in to seeing someone to figure out if it's something more than a simple adjustment.

***The best course of action is to feel things out. If this is a reasonable amount of sadness for the situation and there are no dangerous thoughts - just wait it out. But, if after a month or 6 weeks the symptoms only seem to be getting worse - get yourself into see someone. It's always better to be safe than sorry.

MOOD DISORDER DUE TO SUBSTANCE ABUSE - This is when symptoms come as the result of a using a substance
(alcohol, for example is a depressant) or withdrawaling off of a substance (people coming off of stimulants such as cocaine or amphetamines can experience this). These are difficult cases because most of the people caught in these situations know there is a problem, but sometimes they are more scared of coming off of the substances than the problems that being on the substances create - so they continue. They continue until their spouse leaves them, or if there are other serious negative consequences due to the substance abuse (loss of a job or legal matters).

***The best course of action is treatment in all of these cases. Some substances are deadly in withdrawal (alcohol and sedative) so you need treatment to safely get off of those. Other drugs such as opiates and stimulants are painful in withdrawal, but the withdrawal is not life threatening.

So, that was your primer on Depression. Next month is ANXIETY! See you again then!

Dr. L

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