An Essential First Step in Treating Depression: A Medical Evaluation

Visit Your Doctor

Depression can actually be caused by several illnesses. The flu, various other viruses, anemia, substance abuse, diabetes, and thyroid disease are just some things that produce depression as a 'side effect,' or mimic its symptoms. Some prescription and over-the-counter medications can produce depression.Your first step in managing your depression would be to visit your doctor to check for these things. Get a complete physical, including a blood glucose test, thyroid test (T3/T4 test AND increased TSH test--ask for the results) and a blood count. These three tests will help your doctor rule out three major medical causes of depression.

Anti-Depressant Medication?

You've probably been exposed to lots of advertisements about anti-depressant medication. You will want your depression diagnosed by a professional mental health practitioner before making any decision about medications. Unfortunately, 80% of antidepressant prescriptions in the U.S. are written by family physicians, who may have little or no training at all in psychopharmacology or in psychological diagnosis, who feel pressured by patients who've seen pervasive drug company advertisements for antidepressants, and are heavily courted by pharmaceutical reps. Because depression and anxiety are often symptoms of an underlying psychological condition, it's important not to medicate the symptom without the diagnosis and, if necessary, monitoring of side effects by a psychiatrist or psychologist. This is why most physicians require a patient receiving medication to be seeing a psychologist at the same time.

• If your depression is severe, your psychologist may ask you to consider antidepressant medication. After a period of being depressed, your brain's neurotransmitters (responsible for normal brain activity) are depleted. Antidepressant medications restore them to their normal levels. They won't help you feel happy, but they might eliminate the physical symptoms (fatigue, slowness, agitation, sleep disturbance, and so on) so that you will have more energy to do the emotional work of therapy. Antidepressants work for about 60% of people. Antidepressant medications take 2-4 weeks to produce their full effect.
• Antidepressants should only be prescribed by a psychiatrist, since they make some conditions much worse, can be dangerous in interaction with other drugs (including alcohol), and because they have side effects. Psychiatrists receive extensive training in psychopharmacology, in contrast to general practictioners (physicians), who can prescribe them, but receive little, if any, training specific to antidepressants.
• Consider an over-the-counter preparation. In the most recent metanalysis of 22 randomized, controlled studies comparing it to a placebo (Whiskey, et al., 2001), St. John's Wort was found (at 1800 mg/day, 600 mg. three times per day) to work as well in reducing depression as do prescription antidepressants, with no side effects (900 mg/day taken in three doses of 300 mg each was sufficient for mild depression). St. John's Wort must not be taken with any other antidepressant, and must be stopped 5 days before taking any other drug with which it might interact. You should always check with your pharmacist for possible interactions before you start taking it (or any other medication). St. John's Wort takes 4 to 6 weeks to produce its full effect. Sam-e (400-1600 mg/day, plus vitamin B supplements) is the most often used antidepressant in Italy (and has been for 20 years). It is a naturally occurring product in the body. It has not been tested as extensively as St. John's Wort, and it is much more expensive. It is unwise to begin taking either of these without first being diagnosed by a professional, as some forms of depression may be made worse by taking them.