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Melanie Cole (Host): An estimated 19 million Americans are living with major depression. Depression is a mood disorder that causes a persistent feeling of sadness and a loss of interest. Here to share his insights on depression and how we can help those who are suffering from depression is Dr. Kenneth Robbins. He is the medical director of Stoughton Hospitals Geriatric Psychiatry department. Welcome to the show, Dr. Robbins. Tell us a little bit about depression. What is it and what are some of the symptoms that we might spot in a loved one or in ourselves that would send us to see you?

Dr. Kenneth Robbins (Guest): Well, depression is a confusing term because we all think we know what it means to be depressed, but when psychiatrists, when mental health professionals use the word depression, it is a part of a syndrome. The syndrome includes being either sad or losing the capacity for joy for at least two weeks and generally for months. For an extended period of time, someone is unhappy, can’t experience joy, and then there are a number of other associated symptoms that can be part of this. Someone might sleep too much or too little. They might eat too much or too little. They might be really revved up. They might be somewhat slowed down. They have trouble with their concentration and memory. They often feel hopeless and, unfortunately, for people who have the most severe depressions, they may experience suicide thoughts and even suicide plans, and in the worst cases, make an attempt to commit suicide. It’s a very serious problem. The interesting thing about depression is that for some people, the primary symptom is sadness or very little energy. They withdraw. They just want to cover themselves with a blanket. For other people, anxiety is really the primary symptoms and they’re more agitated and those are the people with less sleep and who tend to eat nervously. It can appear a bit differently for different people.

Melanie: What do you do if you spot this in a loved one? How do you get them the help that they need? Or even if you’re feeling these thoughts yourself, what is the first thing that you should do?

Dr. Robbins: Well, I think the first thing is to acknowledge that there’s a problem, that this isn’t the usual unhappiness, that it is lasting too long, that it may have been triggered by something that was a stressor, but it hasn’t gone away over time and it’s starting to interfere with someone’s ability to function. Step one is to acknowledge that there’s a problem. It’s important to recognize that depression is a biological problem. It is not simply feeling unhappy and it’s likely that if you go out and take a walk or you think of some happy thoughts that somehow it’s going to magically go away. It’s very different from that. It’s related to changes and brain chemistry. We now know that when somebody has a serious depression, there are changes in the way the body’s immune system works, there’s changes and inflammation. There’s a whole cascade of physiologic changes, and so one needs to acknowledge that it’s there and it’s a problem and get help because there is very effective treatment for depression.

Melanie: Tell us about some of those treatments, Dr. Robbins.

Dr. Robbins: The treatment that is most effective is a combination of antidepressant medication and talk therapy, and neither alone is nearly so effective as the two together. There is a large menu of different antidepressants available. They are about equally effective, but different medicines can have different effects. For example, some are more stimulating and that can be helpful for somebody who has no energy. Some help people sleep and that can be helpful for somebody who is struggling with insomnia. Different antidepressants have different ways in which they work neurochemically, and in turn, they may have different side effects. It is almost always possible to find an antidepressant that’s going to be helpful to the person with depression, and when it’s combined with talk therapy where somebody who has the skills to know how to help somebody with depression that think differently, it can make a gigantic difference.

Melanie: Sometimes along with depression come thoughts of suicide. Is there a way to help these people and to actually prevent the act itself?

Dr. Robbins: Well, there are things that can lower the risks. Step one, if you think a person who you are close to may be experiencing suicide thoughts, that they look hopeless, they look very depressed, or they’ve even told you that they have suicide thoughts, step one is to drill down and to talk to them about this issue. People are often afraid that if they talk about suicide, it’s going to put ideas into someone’s head, but I think we know very well now from a number of studies that that’s not the case. In fact, if you can get someone to talk about it, it dramatically lowers their risk of actually making such an attempt. Ask them such things as: Are you feeling hopeless? Have you thought that you’d rather be dead? Have you actually thought about causing your own death? Do you have a plan? What is the plan? Is it something you’re planning to do right away? Is there something stopping you? What’s stopping you? Try to drill down and get details and understand actually what the person is thinking and talking about it. For most people who are thinking about suicide, it’s a relief to have somebody who is interested and who is listening, and that process itself can decrease the risk of them making a suicide attempt. The other thing that one wants to do is do what people call “expand the field,” which is to say, people who are closest to this person who is thinking about suicide should get involved. If they have a significant other or adult kids or parents or close friends and they have been too embarrassed to tell them about it, this is the time to encourage them to tell them about it, because we know the more people who someone who is feeling suicidal shares their thoughts with, the less likely they are going to make a suicide attempt. Of course, if they are thinking about something where you can remove the means, then by all means, do it. If somebody is thinking about shooting themselves and there is a gun in the house, get it out of the house until the person has been properly treated and the suicide risk is dramatically less.

Melanie: That’s great advice, Dr. Robbins. When you do talk therapy or help somebody who is having suicidal thoughts, does the family get involved in that therapy?

Dr. Robbins: Well, it depends. If the family is a supportive family, if they understand what depression is and they want to be helpful, it can often be very helpful to get the family involved. Yes, I think it’s often a good idea, but primarily, the treatment is directed towards the person with the depression and helping them to start changing the way they are thinking so that the hopelessness, the pessimism and negativity, that someone who is a professional who knows how to do this can help them to start changing the way they think.

Melanie: What about at home? Lifestyle sort of modifications for people with depression, exercise, avoiding alcohol and other drugs – are any of these helpful?

Dr. Robbins: Yes, they’re critical. That’s a great question. We know from a number of studies that the one simple thing to do that is almost uniformly helpful for people with depression is to exercise, and exercising 20 to 30 minutes a day where you get your heart rate going, you get a little bit sweaty, something where you’re pushing yourself, can have a very dramatic impact on depression. One wants to be very careful to avoid depressants. You’re already depressed, smoking marijuana, drinking alcohol, certain medications like benzodiazepines, can exacerbate the depression and most worrisome, they can disinhibit people. We all have our inhibitions that might keep us from making a suicide attempt. If you get really intoxicated, we all know that people when they’re drinking, they tend to have less inhibitions. They get up on tables when they would never get up on tables. They do goofy things that they wouldn’t normally do. Well, we also know that if somebody is depressed and they drink, they’re much more likely to make a suicide attempt. They don’t have as much control of their impulses. It’s really important for somebody who is seriously depressed and thinking about suicide that they avoid depressant drugs, particularly alcohol.

Melanie: In just the last minute or so, Dr. Robbins, tell the listeners why they should come to Stoughton Hospital for their mental health care.

Dr. Robbins: Well, Stoughton Hospital has a geropsychiatry unit. It’s a unit that’s specifically for older people. The advantage of that is that other psychiatric units have a mix of ages and it’s often very challenging for an older person to be in a hospital where there are younger people who might be more dangerous. Often, older people are more vulnerable. If someone needs inpatient care to treat their mental health problem, the multidisciplinary team at Stoughton Hospital has the skills to work with people who have not only psychiatric difficulties but medical difficulties, and often for older people, there’s an interaction between medications. They take, medical problems they have, and psychiatric difficulties they are experiencing, and they can do it in an environment where they are around other older people, and often that’s somewhat comforting.

Melanie: Thank you so much, Dr. Kenneth Robbins. For more information, you can go to stoughtonhospital.com. That’s stoughtonhospital.com. This is Stoughton Hospital Health Talk. This is Melanie Cole. Thank you so much for listening.