The Call-On-Doc Guide to Depression

When it comes to depression symptoms, there are a number of tests and methods used by medical professionals to achieve an accurate diagnosis. Three documents pivotal to achieving that and gaining greater insight into the patient’s condition are the Beck Depression Inventory (BDI), Patient Health Questionnaires, and the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). (2) In reference to those documents, doctors will typically identify depression by the following symptoms: 

• Appetite changes: Significant weight loss, gain, or changes in eating habits.
• Sleep disturbances: Insomnia or hypersomnia, alterations in sleep patterns.
• Psychomotor changes: Agitation or slowed movements noticeable by others.
• Fatigue: Persistent lack of energy or motivation.
• Feelings of worthlessness or guilt: Negative self-perception and excessive self-blame.
• Difficulty concentrating: Impaired focus, indecisiveness, or memory issues.
• Depressed mood: Persistent feelings of sadness, emptiness, or hopelessness.
• Diminished interest or pleasure: Loss of enjoyment in activities once found pleasurable.

It should be noted that a distinct symptom of depression does include thoughts of suicide. Medical providers stress that if you are having such thoughts, and especially if you are remotely considering them, you should use the Suicide & Crisis Lifeline and dial 988. With personnel who can speak English and Spanish, those working the National Suicide Prevention Hotline are available 24 hours a day, seven days a week, in all 50 states and five territories.  

Depression is not just a condition that affects a person mentally, but evidence shows that it can result in physical reactions that can occur on a daily basis. Patients with the condition often report not just fatigue but also aches, pain, trouble sleeping, gastrointestinal problems, and more. The explanation is rooted in the brain, more specifically, the neuro-chemical pathways used by the body to carry chemicals that affect a person’s mood, like serotonin and norepinephrine. (3) Alongside substance abuse and eating disorders, common depression symptoms that affect and contribute to other health conditions such as:

• Asthma: Those with asthma have higher rates of depression, with the chronic condition being the most common for hospitalizations in pediatrics. While one is not a causative of the other, each has a tendency to exacerbate the other. (6) 
• Chronic Pain: Depression and chronic pain can just as much be direct causes of each other as they can coexist separately. In addition to exacerbating each other, the two share a neurological source and are closely related in the brain. (7)
• Erectile Dysfunction: Men with depression run a far greater risk of developing erectile dysfunction, with many studies putting the number well over half of men examined. (8) Alongside the feelings of inadequacy that often factor into ED, depression symptoms like fatigue and difficulty concentrating can also play a significant role.  
• Insomnia: There is a heavy link between depression and insomnia, with healthcare providers often viewing depression as the source of sleeping problems. While there are various causes for both, each is primarily associated with brain function and the paths chemicals use throughout our bodies. (9)
• Sexual Disorder: Women with depression may often find that they have one of several sexual dysfunctions, with common examples including difficulty getting sexually aroused, reaching an orgasm, or being sufficiently lubricated, among other problems. (10)
• Weight Fluctuations: Losing or gaining weight in a manner you do not want is often an indicator of depression. Alongside a close interplay in the brain, depression can lead to changes in appetite, potentially causing weight gain or loss. Conversely, dissatisfaction with one's weight or body image may contribute to depressive feelings. (11) 

In addition to immediate depression symptoms, the condition itself can have an overall negative effect on the body. Not just by lowering your immune system, but depression can also put you at greater risk for heart disease, cancer, and more conditions of that severity. (4)(5) While not the direct cause of any one major disease or condition, depression can play a major factor in conditions and severity of a condition.

Depression is known to be present alongside a number of mental disorders that affect the brain, how people feel, and how they interact with their environment. The most common include: 

• Attention Deficit Hyperactivity Disorder: The interaction between depression and ADHD can be intricate. ADHD challenges, like difficulty focusing and impulsivity, may contribute to feelings of frustration and failure, increasing the risk of developing depression. Conversely, depression's impact on motivation and cognitive function can exacerbate ADHD symptoms, creating a cycle that underscores the importance of tailored interventions addressing both conditions for effective management.
• Eating Disorders: Eating disorders that lead to too much or too little weight in a person are common in those with depression. It can lead to mechanisms in the brain that lead to overconsumption of nutrients as a coping mechanism or the urge to appear skinnier due to depression amplifying feelings about one’s physical appearance. 
• General Anxiety: Individuals experiencing both depression and general anxiety often face a heightened emotional burden. General anxiety can manifest as persistent worry, restlessness, and excessive concerns about various aspects of life, while depression contributes to feelings of hopelessness, fatigue, and low self-worth. The combination intensifies the impact on daily functioning, making it challenging for individuals to manage both the physical and emotional aspects of these conditions.
• Obsessive Compulsive Disorder: Depression may stem from the chronic stress of managing obsessive thoughts and compulsive rituals, leading to feelings of despair and hopelessness. Conversely, the emotional burden of depression can exacerbate OCD symptoms, making it challenging for individuals to break free from the cycle of obsessive thoughts and compulsive behaviors. 
• Panic Disorder: Panic disorder involves recurrent, unexpected panic attacks, characterized by intense fear and physical symptoms such as rapid heartbeat and shortness of breath. Depression can develop as individuals grapple with the chronic stress of managing panic attacks, leading to feelings of hopelessness and despair. Additionally, depressive symptoms can heighten the vulnerability to panic attacks, creating a challenging cycle.
• Post-Traumatic Stress Disorder: In individuals who have experienced trauma, depression can develop and further exacerbate the effects that recur with PTSD symptoms. PTSD is characterized by the persistent re-experiencing of traumatic events, avoidance of triggers, negative changes in mood and thought patterns, and heightened arousal. Depression may develop as a consequence of the emotional toll of dealing with traumatic memories, the impact on daily functioning, and a sense of pervasive hopelessness. Conversely, depressive symptoms can exacerbate the challenges of coping with PTSD, intensifying feelings of isolation and worthlessness. 
• Social Anxiety: When depression coexists with social anxiety, individuals may encounter a unique set of challenges. Social anxiety involves an intense fear of social interactions and judgment, while depression amplifies feelings of isolation and disconnection. The fear of negative evaluation in social situations can contribute to avoidance behaviors, further isolating individuals and deepening depressive symptoms.

Very rarely is depression caused by a single cause; usually, it consists of a combination of multiple factors a person can have from birth, develop within themselves, or have imprinted on them from their environment. These depression causes can include: 

• Genetics: A family history of depression suggests a genetic predisposition. Specific genes related to neurotransmitter function and stress response may play a role.
• Brain Chemistry: Imbalances in neurotransmitters like serotonin, norepinephrine, and dopamine can affect mood regulation. Changes in neural circuitry and brain structure may contribute to depressive symptoms.
• Trauma: Physical, emotional, or sexual trauma, especially during childhood, can increase the vulnerability to depression. Trauma can alter stress response systems and affect the way the brain processes emotions.
• Chronic Illness: Certain medical conditions, such as chronic pain, diabetes, or cardiovascular diseases, can contribute to depression. The impact of illness on lifestyle and functioning can be emotionally distressing.
• Stressful Life Events: Loss of a loved one, financial difficulties, divorce, or other major life changes can trigger depressive episodes. Prolonged exposure to chronic stressors can contribute to the development of depression.
• Personality Factors: Individuals with certain personality traits, such as low self-esteem, pessimism, or perfectionism, may be more susceptible. Negative thought patterns and coping mechanisms can influence the onset and persistence of depression.
• Social Isolation: Lack of social support and meaningful connections can contribute to feelings of loneliness and exacerbate depressive symptoms. Social interactions and relationships play a crucial role in emotional well-being. 
• Substance Abuse: Substance abuse, including alcohol, tobacco products, or drug misuse, can increase the risk of depression. Substance use may be an attempt to cope with emotional pain, but it often worsens mental health.

Many factors are known to determine the development of depression, in Americans however a high number of young women ages 14 to 25 are diagnosed with depression. (12) While the susceptibility reduces as women get older, it should be mentioned that rates of depression in that specific age group are exceptionally high when the brain is still developing until 25, when it is complete. Other factors that contribute to the development of depression are: 

• Gender: Women often experience hormonal changes (e.g., during menstruation, pregnancy, or menopause) that can influence susceptibility. Societal factors, such as gender roles and expectations, may contribute to higher rates among women.
• Age: Adolescents and young adults may face increased stressors related to identity, school, and social relationships. Older adults may be susceptible due to factors like health concerns, loss of loved ones, or isolation.
• Family History: Genetic predisposition plays a significant role, with a family history of depression indicating a higher likelihood of developing the condition. Shared environmental factors within families can also contribute.
• Genetics: Specific genetic variations may increase vulnerability to depression by affecting neurotransmitter function or stress response. The interplay of multiple genes and environmental factors is likely involved.
• Personal History: Traumatic experiences, abuse, or significant life stressors can impact mental health and increase susceptibility to depression. Resilience factors, such as coping mechanisms and support, can influence outcomes.
• Chronic Illness: Dealing with chronic health conditions can lead to emotional distress, lifestyle changes, and increased vulnerability to depression. The bidirectional relationship between physical and mental health is crucial to understanding susceptibility.
• Personality Traits: Individuals with low self-esteem, a pessimistic outlook, or high neuroticism may be more prone to developing depression. Cognitive styles that focus on negative interpretations can contribute.
• Social Factors: Lack of social support or strained relationships can contribute to feelings of isolation and increase susceptibility. Socioeconomic factors, such as poverty or discrimination, may also play a role.
• Other Mental Health Conditions: Co-occurring mental health disorders, especially anxiety or substance use disorders, can elevate the risk of depression. Shared underlying factors may contribute to the comorbidity of these conditions.
• Environmental Factors: Adverse environmental conditions, such as exposure to violence or unstable living situations, can contribute to susceptibility. Limited access to mental health resources or stigma surrounding seeking help may hinder prevention and early intervention.

Diagnosing depression is different than other medical conditions, such as strep throat, with a positive or negative diagnosis, but through an assessment by a medical professional. This is a comprehensive analysis where noticeable symptoms are communicated and observed along with medical history.

The practitioner may further conduct interviews, questionnaires, and discussions to gather information about the duration, intensity, and impact of symptoms. They may rule out other medical conditions through physical examinations and laboratory tests to ensure the depressive symptoms are not secondary to another health issue. Often, the entire process does not take long to establish a depression diagnosis, with a greater amount of focus directed toward treatment and making the patient feel better in the long term. 

The best forms of depression treatment typically involve antidepressant prescriptions, lifestyle adjustments, and psychotherapy, which all work to allow a better quality of life. More specifically, treatment can include: 

• Psychotherapy (Counseling): Cognitive-behavioral therapy (CBT), interpersonal therapy (IPT), and other therapeutic approaches help individuals identify and modify negative thought patterns, develop coping strategies, and improve interpersonal relationships.
• Medication: Antidepressant medications, such as selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs), can be prescribed to regulate neurotransmitter levels and alleviate symptoms. The choice of medication depends on the individual's specific symptoms and response to treatment.
• Lifestyle Changes: Regular exercise, a balanced diet, and sufficient sleep contribute to overall well-being and can positively impact mood. Physical activity, in particular, has been shown to have antidepressant effects.
• Support Groups: Participating in support groups or group therapy sessions provides a sense of community and understanding, reducing feelings of isolation.
• Mind-Body Techniques: Practices like mindfulness, meditation, and yoga have shown positive effects in managing depressive symptoms by promoting relaxation and emotional regulation.
• Electroconvulsive Therapy (ECT): In severe cases or when other treatments haven't been effective, ECT may be considered. It involves controlled electrical stimulation to induce a brief seizure, leading to changes in brain chemistry.

While we do not offer controlled substances, Call-On-Doc does offer a number of other medications proven to help treat the condition and make the process of seeking out a specialist far easier. For depression treatment, we offer: 

• Sertraline 
• Fluoxetine 
• Escitalopram 
• Wellbutrin 
• Citalopram 
• Venlafaxine 
• Duloxetine 

The idea that there is a minimum level someone must meet to seek out help for depression has long plagued American society since its founding. While for some, it might be easily manageable with a change of lifestyle and regular habits, a person can easily seek out assistance to get a medical consultation for the condition. Additionally, depression treatment can be private or it can be done in such a way that allows the patient a measure of control, so that it can not only be beneficial but easy. 

Alongside depression treatment, someone with mental illness can ease their condition with lifestyle habits and changes that can be made over time. These can include: 

• Engage in Physical Activity: Exercise releases endorphins, improving mood and reducing symptoms of depression. Start with manageable activities and gradually increase intensity.
• Maintain a Healthy Lifestyle: Eat a balanced diet rich in nutrients to support overall health. Prioritize sufficient and quality sleep, as sleep plays a crucial role in mood regulation.
• Set Realistic Goals: Break tasks into smaller, achievable steps to prevent feeling overwhelmed. Acknowledge and celebrate accomplishments, reinforcing a sense of progress.
• Establish Routine: Consistent routines provide structure and predictability, aiding in mood stability. Include regular self-care activities in your daily schedule.
• Social Connection: Cultivate relationships with supportive friends and family. Attend social events or support groups to reduce feelings of isolation.
• Mindfulness and Relaxation Techniques: Practice mindfulness meditation or deep-breathing exercises to manage stress. Engage in activities like progressive muscle relaxation to promote relaxation.
• Limit Stressors: Identify sources of stress and explore ways to minimize or cope with them. Learn effective stress-management techniques, such as time management and boundary-setting.
• Monitor Thoughts: Challenge negative thoughts by questioning their validity and replacing them with more balanced perspectives. Keep a journal to track patterns and identify triggers for negative thinking.
• Creative Outlets: Pursue activities that bring joy and fulfillment, serving as positive distractions. Creative expression can be therapeutic and contribute to emotional well-being.
• Educate Yourself: Learn about depression, its symptoms, and available treatments. Understanding your condition empowers you to actively participate in your own mental health care.
• Seek Professional Support: Regularly communicate with healthcare providers about your progress and challenges. Don't hesitate to ask for adjustments to your treatment plan or additional support.

If you or a loved one needs help diagnosing depression, wants to evaluate a current prescription, try another medication or get a prescription refill, Call-On-Doc provides an easy way to privately get care online 7 days a week with pharmacy or home delivery options.

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