Dr. Wendy Linderholm (Guest): Thank you.

Deborah: Today’s show is about depression, the signs, the symptoms, diagnosis, and treatment. It’s a huge, huge topic, so let’s dig right in. First of all, what are some of the common causes of depression?

Dr. Linderholm: There are two ways to think about depression. It’s a highly debated field, but just to make it simple, we think of it as reactionary or biological. Reactionary, we think of as a response to life events—not just to the big one, but also the cumulative process of little ones over time. Biological causes, we think of as things like changes in your brain chemistry, your genetics, or any other health factors going on.

Deborah: This is really off-topic, but can depression be caused by living with someone who is depressed?

Dr. Linderholm: I would say not caused by, but the stresses in your life can affect your moods and your behaviors. All of those things can roll up into changes in your overall health.

Deborah: I would imagine if you came home to someone who is clinically depressed, after a while that would become really depressing.

Dr. Linderholm: I always talk about emotions being contagious. It may be not be that you have true major depression, but it’s really obvious with anxiety when you’re around someone who’s anxious. Your heart starts to flutter. You feel nervous. Your palms start to sweat. Any mood—anger, depression—they’re all the same. They’re contagious like that. So it’s about learning how to have boundaries so that you separate those people’s emotions from your own emotions.

Deborah: And so then I guess my next question would be what’s the difference between clinical depression and just, “Oh, I’m depressed today”?

Dr. Linderholm: It’s a matter of time. How long has it been going on? With all “diagnoses,” we really look at it as how much does it affect your functioning? Are you able to do the things you want to do in your daily life? If you’re unable to do those things, then we start to look at an actual diagnosis.

Deborah: Got it. You covered some of these, but let’s get into the official signs and symptoms of depression.

Dr. Linderholm: When we think about major depression, the classic symptoms are feeling sad or blue, down or hopeless most of the time, and then having little interest or pleasure in doing the things that you may have used to find enjoyable. Those are two main signs. Other things are more biological—eating or sleeping too much, or even too little, having difficulty concentrating, feeling slowed down. People often describe it as feeling leaden. Or even the opposite, feeling agitated and restless.

Deborah: Interesting. It’s kind of hard to get your arms around it. How is depression diagnosed? Are there specific tests used to help diagnose depression? Is there a baseline for these tests? Are they different depending on the age of the person and the sex of the person?

Dr. Linderholm: Not really. It’s all about the same. I work in a family medicine clinic. Our gold standard for practice is to use a questionnaire. It’s 10 questions long. It’s called the PHQ9. Most doctors’ offices use it. In fact, you’ll probably see it on that intake form when you go to the doctor. It basically just goes through the same symptoms I mentioned earlier and gives you a way to rate them—how severe are they, how much do they impact you. It’s a quick, easy way to put a number on how severe you feel so that we can get an idea where you are and then be able to also give you those questions again later and see if the interventions that we’ve applied are making any difference with that number changing.

Deborah: And of course you have to go along with the fact that most people will tell the truth to you and then some may not. You have to figure that out. That’s why you get the big bucks, I guess, huh?

Dr. Linderholm: Right. I think, when people talk about their emotions, I find that people don’t really have a lot of evasion to hide anything. If anything, they try to hide how severe it is, but they don’t necessarily try to fake it. People, when they feel crummy, it’s pretty bad.

Deborah: I guess by the time they’ve made it into you, they’re ready to talk about it. How is depression treated? Does it always require antidepressant medicines?

Dr. Linderholm: The wonderful thing about major depression is that it’s a huge thing and it’s caused by all these different factors in people’s lives. Because of there are lots of ways to treat it, the most effective treatments that research shows are when a person is actively engaging and learning. Things where people are in individual therapy, going over their past, or learning new ways to have relationships, couples counseling, family counseling, group therapy, or even being involved in the community, volunteering or teaching others or working on expanding your spiritual life. So, yes, medications can help, but really, only when your symptoms are so severe that you can’t engage in any of those activities do we suggest medication. We think of medications as a way to get a toehold on those physical symptoms—the sleepiness, eating disorder, not eating enough or eating too much, being able to concentrate—the medications help with that. Once you get a handle on those, then you can really do the work to learn how to have a healthier lifestyle.

Deborah: I notice curiously you didn’t mention exercise.

Dr. Linderholm: That is a big error on my part, because exercise is huge.

Deborah: That’s what I was thinking. Even if I’m just feeling a little tired, I’m not saying depressed, but it’s like boy, you go for a run and you have a whole new mental outlook.

Dr. Linderholm: I kind of rolled that up into being involved in your own life and being active. Exercise has all the benefits of it. Throws in all kinds of extra endorphins and you feel a little bit better about your body. It’s hard, because we suggest that, but people who are depressed feel really crummy about themselves and don’t have any energy so that getting up and going for a walk is a big barrier. If you can, absolutely. Anything that you can add in would be helpful.

Deborah: Let’s talk about within the family now. If you have a family and there’s someone in it that you kind of think they might be clinically depressed rather than just sad, what should they do?

Dr. Linderholm: If you think that someone in your family might be depressed, I would encourage you to directly talk to them. Guilt and shame are really common, because the pain of depression isn’t very easy to see. We often think that we should just be able to pull it together and get better and pull ourselves up by our bootstraps. It’s a hard pain to see. It’s really easy to see if someone’s hurting when they’re missing their hair because they’re in chemo, or they have a cast on, but depression is much sneakier. So it’s really important to talk openly with folks and ask them what’s going on. How is this different for you than having a bad day? Is it bigger? Is it longer? What’s going on?

Deborah: As a friend of someone who is depressed and I didn’t know it, I’m guilty of saying, “Come on. Just get out of your funk. Let’s go for a bike ride.” I had no idea he was clinically depressed, and I feel terrible now about that, but at least I learned. Are you calling it a disease?

Dr. Linderholm: That is such a big question. I struggle with that even professionally on a day-to-day basis. For some people, it really is because you can see how biological it is for them, that they are fighting against the chemistry. When they take the medication, they get so much better so quickly. For other folks, it’s really about a lifetime of having not really good boundaries with friends and family and feeling taken advantage and having low self-esteem. It’s a symptom of something else. That’s how it can be these completely different beasts for people. So to put one blanket diagnosis on it is actually a disservice to people.

Deborah: Let’s take it even farther. If one has thoughts of death or suicide or of hurting themselves or others, then what do you recommend they do?

Dr. Linderholm: Again, it’s all about talking to people. The most important thing for me when I talk to folks is that suicide is the one thing every person has thought of. It’s the one thing that we have ultimate control over. Everyone has thought about it, so just demystifying that, that you’re not crazy, that you’re not bad for thinking about it, it is our job as family members and as professionals to keep people safe when they’re in that dark time. You’re not going to put a thought into someone’s head if you ask them about hurting themselves. But really, ask them. We think about the three things. We want to know is there an intent to hurt themselves? Do they have a plan? Do they have the means to follow through on that plan. Anywhere we can intervene will make a difference in keeping those folks safe until they pull back after that dark period.

Deborah: Thank you so much, Dr. Linderholm, for finding the time to talk to us today about the heartbreaking condition of depression, and also for giving us some solid information on how families who are affected by it can get a handle on it. Thank you very much.

Dr. Linderholm: It’s my pleasure.

Deborah: It’s been a real pleasure to have you on this show. I’m Deborah Howell. Please join us again next time. We’re going to be exploring another weekly dose of wellness, another topic that’s meaningful to you or someone in your family or your friends. It’s all brought to you by MemorialCare Health System. Have yourself a very, very fine day.