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When Depression Isn't Psychological

Posted by Margaret Donohue on March 22, 2015 at 9:20 AM

You feel sad, listliss, have no energy, no concentration, can't sleep or sleep too much, cry easily over nothing.  Depression right?  Not so fast.


There are more than 50 medical problems that can cause these symptoms.  If you add symptoms of manic-lack of sleep, feeling on top of the world and having boundless energy, the list of medical conditions rises to 77.


So how do you know if depression is depression and needs psychological or psychopharmacological treatment?  First get a general physical examination with a complete blood count and urine analysis.  Make sure any abnormalities are accounted for.  If the laboratory studies are normal then do an evidence based treatment for depression.


Evidence based treatments for depression are the following:  

  • Cognitive behavior therapy-the therapist starts off with an agenda, the treatment focuses on changing thoughts that lead to depressive feelings.  Significant improvement generally occurs in 6-8 weeks.
  • Acceptance and Committment therapy-this therapy teaches to accept reactions and be present, choose a valued direction, and take action.  Significant improvement generally occurs in 6-8 weeks.
  • Mindfulness treatment-the client is taught to separate themselves from their thoughts and moods. Significant improvement occurs in 6-8 weeks.
  • Dialectical Behavior Therapy-the client is taught to regulate their reactions to events.  Significant improvement occurs in 8-12 weeks.
  • Interpersonal Therapy-this is a 12 week program to address interpersonal relationships.  It may be extended to 16 weeks.
  • Behavior therapy-behaviors that focus on changing what people do when they are depressed.  Significant improvement occurs in 8-10 weeks.

So you've done 8 weeks or more of an evidence based treatment.  You are still depressed.  Now what?

Here are the options:
  • Did you actually do the treatment?  Does your therapist say you are following the treatment to the letter and they don't know why it's not working.  Have the discussion.  The treatment doesn't count unless you are actually doing it and doing it correctly.
  • Review the medical history and symptoms again.  Ensure endocrine functions, symptoms of infection, and all areas of physical pain are resolved.
  • Review the diet.  Malnutrition is a significant contributor to depression.
  • Consider medication.  
Medication options:
  • Selective Serotonin Reuptake Inhibitors (SSRI)-these work in 6-8 weeks.  If they work in a week or less they are not treating depression.  They are treating pain either in the gastrointestinal tract or in the spinal column.  Consider a gluten free diet and see if your symptoms resolve. Consider a lactose free diet and see if your symptoms resolve.
  • Selective Norepinephrine Reuptake Inhibitors (SNRI)-these work in 6-8 weeks.  If they work considerably more rapidly they are not treating depression.  See SSRIs.
  • Tricyclic Antidepressants-these work in 4-6 weeks.
  • Other medications-mood stabilizers, antipsychotics, antianxiety agents, anticonvulsant medications.  If you have depression and your doctor is considering these, get a psychological evaluation to ensure you actually have depression. These are atypical medications for depression.

Common Medical Conditions Presenting as Depression:

  • Infection
  • Hypothyroidism
  • Hyperthyroidism
  • Hashimoto's thyroidosis
  • Protein-malnutrition
  • Anemia
  • Vitamin B complex deficiency
  • Magnesium deficiency
  • Chronic Obstructive Pulmonary Disorders
  • Sleep Apnea
  • Malignancy
  • General malnutrition
  • Gluten intolerance
  • Lupus
  • Multiple Sclerosis
  • Addison's disease
  • Toxic chemical exposure
  • Diabetes
  • Seizure disorder
  • Left hemisphere head trauma (assuming right handedness)
  • Traumatic brain injury
  • Migraines
  • Hypertension
  • Obstructive sleep apnea
  • Alcohol use
  • Marijuana use
  • Drug use
  • Side effects of legally prescribed medications or over the counter supplements
  • Unusual diets
  • Malabsorption
  • Kidney problems
  • Liver problems
  • Heart problems
  • Lung problems
  • Allergy
If you've had problems with depression and need an evaluation feel free to contact our office.

Categories: Health Psychology

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