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Depression Basics

Updated: Dec 13, 2023


First of all, if you have or think you have clinical depression and it's causing you difficulties in your life, I need you to know it's not your fault, a character flaw, or something you did or deserve. Depression happens to people like any disease. It has a physical cause (neurotransmitter imbalances in the brain, often serotonin related), runs in families tending to be easily inherited, and is further worsened or brought to life with stressful surroundings (I know ZERO people who live stress free enough to avoid being at risk for depression or anxiety).


Depression has many faces and isn't always a clear cut presentation of feeling sad all the time. Some common symptoms are sleep (too much or little), inattentiveness, inappropriate feelings of guilt, depressed mood, abnormally low energy levels despite adequate sleep, difficulty concentrating, greatly heightened appetite or food bingeing, severely reduced appetite, feeling heavy sluggish or like your legs are made of lead, thoughts of self-harm or suicide. It is often accompanied by feelings of hopelessness and feelings of anhedonia (lack of joy). It may be harder to experience happiness in the things you used to enjoy, almost like the world has been dimmed or blunted, like the flavor is gone even though you know it should be there. Maybe you're having trouble even summoning up the will to get out of bed and each breath feels like a heavy burden.


Let's pause there a moment. Suicidal thoughts, if you have them right now loud enough you are considering it or have a plan, call a hotline, go to an ER and get help immediately. Thoughts of self-harm that powerful are to depression what chest pain is to a heart attack. You may not even be trying to think of it, but it can be pervasive and is an affect of the low serotonin or other neurotransmitter imbalances. You owe it to yourself to stay safe and an emergency room or suicide prevention hotline is trained to help you do that. If this is you, go now, call now. You are worth saving. You deserve to be well.


Medications help depression in most every case I ever diagnosed. Sometimes we get lucky and our first pick is a great fit. Other times we have to switch it around until we find one that works and has minimal or no side effects. If we run into a lot of blocks, there is a new genetic test that I can order to help determine which medication types would work best for you (Genesight, possible out of pocket cost $200 if not covered by insurance).The reason medication works as well as it does goes back to the root cause of depression, imbalance in serotonin release in the brain. This can be caused by genetics, where the decreased serotonin is inherited (or other neurotransmitter deficiency), by environmental causes exhausting serotonin pathways making them become less robust over time due to stress/trauma, or both.


Please note there is a published risk of suicide or self-harm that was observed in a small percentage of people starting anti-depressants. It is theorized this occurs because energy levels return first giving a still depressed person with suicidal thoughts a sudden improvement in energy levels to complete an attempt. If you have suicidal thoughts start, get louder, or develop into a plan while starting a medication, stop right away and be seen right away in person by an in person clinic or emergency room.


In most cases, medication will be generally well tolerated with side effects including dry mouth, possible nausea, low libido or lasting longer in sexual encounters for men (can be remedied with adjunctive bupropion if this side effect becomes troublesome). Improvement in mood and overall enjoyment of life and depression symptoms is usually seen in 2-3 weeks after starting medication but can begin as early as the first week on them.


If you feel like this could help, sign up for our free 14 day trial. Once you're signed up you'll complete a simple medical intake form so our doctors can design the best care plan for you covering the same questions that would be asked you if you came into the clinic. The answers will go securely to the doctor through our HIPAA compliant form. Your doctor will then reach out to discuss diagnosis, treatment, and/or medications. You can talk to a doctor anytime to ask questions, discuss medications, get referred to psychologists/counselors, or schedule a video chat if you need a real time visit.




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