Psychiatric Care for Depression

Depression is more than sadness. It can show up as low mood, irritability, loss of interest, changes in sleep or appetite, low energy, trouble concentrating, or feeling hopeless. In young people it often looks like irritability, withdrawal or slipping grades. Mood disorders can come and go, and they are common and treatable.

How our physicians help

Our physicians begin with a thorough evaluation that looks at your history, health, stressors and what has or has not helped before. Care can combine psychotherapy and medication management from the same physician, adjusted carefully over time. When depression is severe or does not respond, we coordinate with other specialists.

Signs of depression in adults

Some adults keep working and showing up, so no one can tell anything is wrong. Keeping up on the outside does not rule out depression. Common signs include:

• Waking up tired, or sleeping for hours and still feeling drained
• Losing pleasure in friends, hobbies or sex
• Feeling slowed down, or too restless to settle
• Harsh thoughts about yourself, or guilt that does not fit the facts
• Taking far longer to finish simple tasks or make small decisions

Signs of depression in children and teens

Young children rarely have words for this feeling. Watch for a change from your child's usual self that lasts two weeks or more:

• Stomachaches or headaches, especially on school mornings
• Younger children clinging to parents or fearing time apart
• Dropping a sport, club or group of friends
• Teens taking new risks or using alcohol or drugs
• Saying that nothing matters or that others would be better off without them. Do not wait two weeks on this one. Ask directly about suicide, and if you fear for their safety, call or text 988 (the Suicide & Crisis Lifeline) or call 911. We are not an emergency service.

How depression is diagnosed

There is no lab result for depression. Your physician makes the diagnosis by asking when this began, how it affects your days, and about past episodes and family history. With a child or teen, we talk with both the young person and their parents.

A careful evaluation also checks for problems that can look like depression or make it worse:

• Thyroid disease, anemia and other medical conditions
• Sleep apnea, where breathing stops and starts during sleep
• Side effects of other medications, or alcohol or drug use
• Anxiety, trauma or ADHD alongside the depression
• Past periods of unusually high energy, which can point to bipolar disorder and change the treatment plan

Treatment options for depression

The best plan depends on how severe the depression is and what you prefer. Many people improve, though it takes time and sometimes more than one try.

For children and teens with milder depression, therapy usually comes first. Young people who start an antidepressant, including young adults, should be followed closely in the early weeks, because suicidal thoughts can increase for some at first. The main options are:

• Cognitive behavioral therapy (CBT) targets thought patterns that keep low mood going and builds new responses.
• Interpersonal therapy works on relationships, conflict, loss and life changes that may be feeding the depression.
• Behavioral activation means slowly adding back activities that bring pleasure or purpose, even before motivation returns.
• Antidepressants, such as SSRIs and SNRIs, act on brain chemicals that affect mood. Upset stomach, changes in sleep and lower sex drive are possible, and the first choice is not always the right one.

Knowing when to get help

Please call if low mood has lasted more than two weeks, if work or school is slipping, if you are pulling away from people, or if you are using alcohol or drugs to cope.

Worried about someone you love? Ask directly whether they are thinking about suicide. Asking will not plant the idea.

Depression can make the way you feel seem permanent. That sense is part of the illness, and help is available. If you or someone you know is in crisis or thinking about suicide, call or text 988 (the Suicide & Crisis Lifeline) or call 911. We are not an emergency service.

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