Depression is more than just a depressed mood but a collection of symptoms. They include oversleeping or insomnia (especially waking up too early in the morning), fatigue. Some experience what is called anhedonia. It can manifest like not having the motivation to socialize and failure to enjoy things that a person used to enjoy. Appetite changes can be present such as overeating, craving certain foods or the opposite (loss of appetite). People can experience excessive guilt such as about little things. They may dwell on old shortcomings and fall into a ruminating train of thought. Thoughts of death and suicide may present such as not minding if one died in an accident. Other thoughts include thinking family and friends would be better off without that person. Patients experiencing depression usually have a depressed mood, but not always. Some can have all the other symptoms but not depressed mood. For example, people can experience apathy, insomnia, loss of appetite, low energy and excessive guilt. This would also qualify as a major depressive episode if someone experienced this for more than a couple weeks.

So how do you know whether to consult a therapist first versus a psychiatrist?

It is mentioned in this video that if symptoms have not lasted very long and are milder, such as mild apathy with loss of appetite for a few days and especially with long stretches of feeling normal, it can be reasonable to consult a therapist. Therapists include psychologists and clinical social worker as well as licensed professional counselors. They are trained and can be very successful and performing cognitive behavioral therapy and other therapy modalities proven to cause therapeutic changes in the brain. It promotes cognitive restructuring that help put us in an objective and healthy frame of mind and also help modify our behaviors to be more effective in our lives. Some behaviors include exercising more and socializing. For more intense symptoms, longer standing symptoms, and especially if one feels they are experiencing day to day impairment in how they function, consulting a psychiatrist may be more appropriate per this video.

Can I be cured from depression?

Many cases of depression are chronic illnesses. Chronic illnesses are by definition chronic. For example, if you have hypertension or arthritis, patients are generally not cured but there are measures that can be taken to resume a high quality of life. If one finds a medication for depression at works, the regimen can continue to work for many years. It is not a cure as if the medication is stopped, the depression can come back. But if the depression is in remission and a patient can have their life back, that is very significant. Dr. McMullen himself has been on antidepressants for decades with good relief. For some, being on an antidepressant versus not can be the factor of continuing with their careers or being disabled. Fortunately, many people can go back and resume their normal lives with effective treatment. Even with TMS, which can help people be in remission, that is not a cure. However, it is a great tool for those who had limited relief with medication and therapy. For example, a patient who had a 50% improvement in all their treatments may now be functioning at 100% again with the combination of TMS and antidepressants. There is still chance that depression and recur in the future in a matter of years but ongong effective treatment can help people regain their quality of life.

Back in 1950s and prior, there may have been about 100 million people in the United States. 500,000 were in state hospitals. Now we have only a tenth of that and the population is 3 times bigger. This is due to better treatment options which is keeping people out of hospitals. For example, many people with bipolar disorder can live normal lives. They may marry, get a career, have children and from the outside one may never know that they have bipolar disorder. Dr. McMullen has one patient who knows a woman who was around during the era of longer hospitalizations and before lithium was available. She had recalled going inpatient every 2-3 years or so, be there for months to a year, and be in a delusional episode. She felt humiliated. Then she would recover, get out of the hospital and get a job only to have another episode again. But when lithium was released, it was life changing. Suddenly she stopped having to go to the hospital and she was never hospitalized again.