An Essential First Step in Treating Depression: A Medical Evaluation

Visit Your Doctor

Depression can actually be caused by several illnesses. The flu, various other viruses, anemia, low vitamin D, substance abuse, diabetes, and thyroid disease are some conditions that produce depression as a 'side effect,' or mimic its symptoms. Some prescription and over-the-counter medications can produce depression.Your first step in managing your depression would be to visit your doctor to check for these things. Get a complete physical, including a blood glucose test, vitamin D test, thyroid test (T3/T4 test and TSH test--ask for the results) and a blood count. These four tests will help your doctor rule out four major medical causes of depression.

Anti-Depressant Medication?

You've probably been exposed to lots of advertisements about anti-depressant medication. Indeed, the #2 largest US lobbying group is the pharmaceutical industry. You will want your depression diagnosed by a professional mental health practitioner before making any decision about medications. Unfortunately, 80% of antidepressant prescriptions in the U.S. are written by family physicians, who may have little or no training at all in psychopharmacology or in psychological diagnosis, who feel pressured by patients who've seen pervasive drug company advertisements for antidepressants, and are heavily courted by pharmaceutical reps. Because depression and anxiety are often symptoms of an underlying psychological condition, it's important not to medicate the symptom without the diagnosis and, if psychoactive drugs are taken, to make sure side effects are monitored by a psychiatrist or psychologist. This is why most physicians require a patient receiving medication to be seeing a psychologist at the same time.

• If your depression is severe, or you have been diagnosed with bipolar disorder, your psychologist may ask you to consider medication. After a period of being depressed, your brain's neurotransmitters (responsible for normal brain activity) are less available to conduct electrical impulses, leading to the physical symptoms of depression. Antidepressant medications restore neurotransmitters to their normal levels. They won't help you feel happy, but they might eliminate the physical symptoms (fatigue, slowness, agitation, sleep disturbance, and so on) so that you will have more energy to do the emotional work of therapy. Antidepressants work for about 60-75% of people. Antidepressant medications take 2-4 weeks to produce their full effect. Medication for bipolar disorder is extremely effective, although it can take time to find the right medication.
• Antidepressants should only be prescribed by a psychiatrist, since they make some conditions much worse, can be dangerous in interaction with other drugs (including alcohol), and because they have side effects. Psychiatrists receive extensive training in psychopharmacology, in contrast to general practictioners (physicians), who can prescribe them, but again receive little, if any, training specific to antidepressants. For example, "depression" can be a main diagnosable issue, responsible for a client's condition (Major Depressive Disorder, Dysthymia), or a side effect of another condition (see above), post-partum, a sequelae to grief, part of a substance abuse cycle, a symptom of another condition (Bipolar Disorder, Schizoaffective Disorder, and more--many people who are having difficulties in life become depressed at some point), or part of a client's identity and not really "depression" at all. To treat all of these separate situations as "depression," to be treated with anti-depressants is naive, and sometimes, dangerous.
• Consider an over-the-counter preparation. In the most recent large metanalysis of 27 randomized, controlled studies on 3,126 patients comparing it to a placebo (Cui & Zheng, 2016), St. John's Wort was found (at 600-900 mg/day, taken 3x/day) to work as well in reducing depression as do prescription antidepressants, with no side effects (900 mg/day taken in three doses of 300 mg each was sufficient for mild- to-moderate depression). It "did not differ from SSRIs in clinical response, remission, and mean reduction in depression score,"with a significanlty lower rate of adverse events (side effects) than SSRIs. St. John's Wort also "had superior safety." See the study here. St. John's Wort must not be taken with any other antidepressant, should not be taken by anyone with bipolar disorder, and must be stopped 5 days before taking any other drug with which it might interact. You should always check with your pharmacist for possible interactions before you start taking it (or any other medication). St. John's Wort takes 4 to 6 weeks to produce its full effect. Sam-e (400-1600 mg/day, plus vitamin B supplements) is the most often used antidepressant in Italy (and has been for 20 years). It also should not be taken by anyone with bipolar disorder. It is a naturally occurring product in the body. It has not been tested as extensively as St. John's Wort, and it is much more expensive. It is unwise to begin taking either of these without first being diagnosed by a professional, as some forms of depression may be made worse by taking them.