Depression Quiz

Suicide is a devastating event, but fortunately it is rare. The overwhelming majority of depressed individuals do not commit suicide. Thinking about suicide is a form of suffering in its own right, so mental health providers pay attention to it, especially in people who have symptoms of depression. Relieving this kind of suffering is one way to reduce the risk of suicide. The best treatment for suicide risk is to treat the underlying problems, for example, by giving medication to relieve intense sadness or anxiety, addressing dependence on substances like alcohol, or bolstering support if a person has suffered a recent loss or stress. The first order of business is to help a suicidal person stay alive to get that treatment. Thoughts about death or suicide are surprisingly common, but you should get help immediately if you are preoccupied with death or thinking about acting on a suicidal thought. It is an emergency when you think that suicide is an option and you should contact a professional immediately.

Depression screening is very effective and can be very simple. Research indicates that a large number of cases of depression can be detected by asking two simple questions:
Have you been feeling down, depressed or hopeless? and Have you had little interest or pleasure in doing things? A questioner may ask you to think about how you’ve been feeling over the past few weeks. You may find it helpful to use a longer period of time as a target, such as months or even years. Have you been able to answer yes to these questions over a significant period of time? Primary care doctors are now being encouraged to ask these two questions as part of routine care of their patients.

Stress increases the risk of depression, but your genetic make-up is at least as important. Genes heavily influence your temperament and personality style. They also govern how prone you are to an unhappy change in mood. There is not one single gene that governs a person’s susceptibility to depression. Scientists have found some of the genes that are associated with depression. It will be many years before they identify all of them, and even longer for them to determine what those genes do and how to correct the problems. But there is great hope that much more information is coming that will lead to better treatments. On average, genes probably account for about half of a person’s risk of becoming depressed. The risk is also increased by such stresses as: troubled family relationships; career disappointments; deaths in the family and other losses; any stressful life change; a history of being neglected or treated badly as a child; a medical illness; another psychiatric illness. Thus, it is very important to take both your biology and your environment into account when planning treatment.

Overall, research still shows that a combination of psychotherapy and medication is the best treatment for depression. However, whether psychotherapy alone, medication alone, or a combo is best for you will depend on the specific nature of your problem. Often, if your depression is mild, you may opt for psychotherapy alone. In some cases, medication gives a great deal of relief, and that’s all you need. A combination of the two does not necessarily mean that your depression is worse. It is ultimately very hard to generalize. The best approach is to see your situation as unique. With the help of your provider, choose a comfortable place to start. But also be open to trying different approaches until you find what works best for you.

Sadly, electroconvulsive therapy (ECT) is misunderstood, even though it is a very safe and effective treatment for severe depression. It is the quickest way to gain improvement in certain cases and the risks compare favorably with other antidepressant treatments. When the risk of suicide is high, this treatment can be life-saving. People who receive the treatment are often very satisfied with the results. The overwhelming majority would be willing to have the treatment again were depression to relapse. The seizure that occurs during the procedure seems to restore the brain’s functioning in the domain of mood, while decreasing symptoms of serious mental illness. It is the seizure (not the electricity) that generates this improvement. In its modern form, the discomfort of ECT is actually about equivalent to a minor surgical procedure. The person receiving the treatment is given a short-acting anesthetic and muscle-relaxing medicine. Thus, the person is asleep throughout and there is no outward sign of a convulsion. Some people feel a bit sedated or fatigued on the day of the procedure. There may also be a transient mild headache or nausea. Some of these symptoms may be related to the anesthesia rather than the ECT itself. The effect that concerns people most is temporary memory loss. Memory problems following ECT are usually very limited—what is lost tends to be only events occurring immediately before and after treatment. Relatively few people have long-lasting problems with memory. To date, no study has proven that ECT causes brain damage. The main disadvantage of ECT is that it requires the involvement of two physicians (a psychiatrist and an anesthesiologist) along with nursing staff and a facility with available equipment. Medication is clearly an easier treatment to give, but when ECT is needed, it is an excellent option.