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Depression screening and treatment at GreenField

October 3, 2014

If you’ve had a recent visit at GreenField, you may have been asked to answer two questions:

  • During the past month have you felt down, depressed or hopeless?
  • During the past month have you felt little interest or pleasure in doing things?

As you probably have guessed, these questions screen for depression symptoms. Depression screening is a recommendation of the US Preventative Services Task Force. Screening is recommended because depression is incredibly common – it is thought to affect about 7% of Americans at any one time, and over the course of our lifetimes 12% of men and 25% of women will be affected.

Depression is a medical illness, and like other illnesses it is thought to result from a combination of genetic predisposition, environmental influences, and life stressors. There are effective treatments for depression, and treating depression can help improve management of chronic illnesses such as diabetes and arthritis. Unfortunately, only half of people with depression receive treatment.

What are the symptoms of depression?
People with depression feel down or sad, daily, to the extent that it significantly impacts their function. In addition, people with depression usually have several of the following symptoms:

  • Increased or decreased sleep
  • Trouble concentrating
  • Less interest in activities they used to enjoy
  • Excessive guilt
  • Increased or decreased appetite
  • Fatigue
  • Feeling either very slowed down, or restless and agitated
  • When depression gets severe, thoughts of suicide (thoughts of suicide should be brought to the attention of a clinician right away – call our office or 1-800-273-TALK (8255) )

What other medical problems can cause depression symptoms? 
Several other conditions can cause depression symptoms. A discussion with your clinician, and often a physical exam and lab test, can help identify these. Conditions that can cause some similar symptoms include thyroid disorders, misuse of alcohol or drugs, and bipolar disorder.

What are available treatments for depression? 

There are several actions people with depression can take to help themselves feel better, and help other depression treatments work. These include:

  • Exercise such as walking.
  • Setting small, achievable goals and meeting them. Breaking big problems into very small steps.
  • Pleasurable activities such as hobbies, listening to music.
  • Spending time with supportive friends or family.
  • Making healthy food choices.
  • Making time to relax.

Counseling is an excellent treatment choice for most people with depression. We are lucky to have many excellent counselors in the Portland area, although some people find it hard to initiate a search given many choices of types of practice, and variable insurance coverage. GreenField clinicians can provide referrals to counselors and answer questions about the process.

Medication can be very helpful for some patients with depression, especially moderate to severe depression. Medications work well in combination with counseling treatment. A few tips about starting a medication:

  • Many antidepressants take several weeks to work.
  • Many people starting antidepressants feel side effects early on; often these improve with time, but sometimes medications need to be changed.
  • Usually the dose of an antidepressant needs to be increased from the starting dose, to get to an effective dose.
  • When a person doesn’t feel better with a full dose of one medication, often switching to a different medication, or adding a second medication, can improve depression.
  • If you also take herbal medications for mood, let your clinician know so that we can help you avoid medication interactions.
  • When taking a medication for the first time, many people taper off the medication after 6-12 months. However for some people with depression, taking medications indefinitely helps prevent further episodes.

When depression is severe, intensive therapy by a treatment team, and hospital treatment, can be very effective and sometimes lifesaving.

Although primary care clinicians, including all of us at GreenField, commonly diagnose and treat depression, we recognize that not everyone with symptoms of depression seeks treatment. If in reading this piece you recognize symptoms you have been experiencing, we encourage you to make an appointment with your clinician.

Where can I get more information? 
National Institute of Mental Health
International Foundation for Research and Education on Depression
Mental Health America
Depression and Bipolar Support Alliance