What Is Depression?

Depression is a clinical disorder that is much more than just feeling sad. It involves changes in mood regulation, thinking patterns, motivation, energy, and the ability to experience enjoyment. Proposed pathophysiological mechanisms include abnormal changes in neurotransmitters, brain receptors, dendritic spine density, neuroinflammation, and functional brain communication. 

The most common depressive disorder is major depressive disorder (MDD), but there are many specific subsets (e.g., with psychotic features, with peripartum onset, with seasonal pattern (seasonal affective disorder)), as well as other depressive forms including persistent depressive disorder (dysthymia), premenstrual dysphoric disorder (PMDD), substance/medication-induced depressive disorder, and depressive disorder due to another medical condition. 

What Causes Depression?
 

Depression develops from one's polygenetic biological baseline and a combination of general factors including:​​
 

• Psychosocial and environmental stressors

• Social isolation

• Hormonal shifts

Secondary, or more direct, causes include:
 

• Medical conditions (hypothyroidism, stroke, dementia, brain Injury, Cushing's syndrome, B12 deficiency)

• Medications (corticosteroids, isotretinoin [Accutane], chronic opioids, chronic benzodiazepines, anticonvulsants, clonidine, beta blockers, anti-androgens, immunomodulating drugs)

• Substance use and withdrawal

What Are the Symptoms?
 

A diagnosis of major depressive disorder generally requires a period of persistent symptoms lasting at least 2 weeks that represent a change from previous functioning and cause significant distress or impairment.

Symptoms may include:
 

• Depressed mood, sadness, emptiness, or hopelessness

• Loss of interest or pleasure in activities

• Significant changes in appetite or weight

• Insomnia or excessive sleeping

• Fatigue or decreased energy

• Feelings of guilt, worthlessness, or helplessness

• Difficulty concentrating or making decisions

• Restlessness or slowed movements

• Thoughts of death or suicide

There are other disorders listed in the DSM-5 as trauma- or stressor-related disorders that share many similar symptoms. Some of these common disorders include:

post-traumatic stress disorder (PTSD) - Follows exposure to actual or threatened death, serious injury, or sexual violence. Symptoms include intrusive thoughts or flashbacks, avoidance of trauma reminders, negative alterations in mood and cognition, and marked alterations in arousal and reactivity (e.g., hypervigilance, exaggerated startle response) that lasts longer than one month.

acute stress disorder - Clinically similar to PTSD in terms of trauma exposure and symptom types, but is short-term. Lasts from 3 days to 1 month following the traumatic event. It captures immediate post-trauma reactions that may or may not eventually evolve into PTSD.

adjustment disorder - Identifiable stressor (e.g., job loss, divorce, moving, chronic illness) that occurs within 3 months of the onset. The behavioral or emotional symptoms are out of proportion to the severity of the stressor and cause significant impairment in social or occupational functioning. Unlike PTSD, the stressor does not have to be catastrophic or life-threatening. Once the stressor or its consequences terminate, the symptoms typically resolve within 6 months.

prolonged grief disorder - Occurs when a person experiences the death of someone close to them, and the resulting grief response is uncommonly severe, persistent, and functionally disabling. Must persist for at least 12 months after the loss (6 months for children/adolescents). It is marked by intense daily yearning/longing for the deceased, preoccupation with thoughts or memories of them, identity disruption, emotional numbness, and a deep sense that life is meaningless, exceeding normal cultural and religious mourning norms.

Common Treatments

​

• Lifestyle modifications, including improving sleep, physical activity, and stress management

• Addressing secondary causes

• Psychotherapy

• Medication management 

• Brain stimulation therapy (ECT, TMS)

                                                                                           Common Medications

Selective Serotonin Reuptake Inhibitors (SSRIs) - Sertraline (Zoloft), Escitalopram (Lexapro), Fluoxetine (Prozac), Citalopram (Celexa), Paroxetine (Paxil). First-line medication. 

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) - Venlafaxine (Effexor), Duloxetine (Cymbalta), Desvenlafaxine (Pristiq)

Dopamine-Norepinephrine Reuptake Inhibitors (DNRIs) - Bupropion (Wellbutrin)

Tetracyclic Antidepressants - Mirtazapine (Remeron)
 

Serotonin Modulators - Vilazodone (Viibryd), Vortioxetine (Trintellix)

Tricyclic Antidepressants (TCAs) - Amitriptyline, Nortriptyline, Imipramine, Clomipramine

Serotonin Antagonist and Reuptake Inhibitors (SARIs) - trazadone (Desyrel)

Monoamine Oxidase Inhibitors (MAOIs) - Phenelzine (Nardil), Tranylcypromine (Parnate), Selegiline patch (Emsam)

NMDA Receptor Anatagonists - Esketamine (Spravato), Dextromethorphan-Bupropion (Auvelity)

Atypical Antipsychotics - Aripiprazole (Abilify), Quetiapine XR (Seroquel XR), Brexpiprazole (Rexulti), Cariprazine (Vyralar), Olanzapine (Zyprexa)

GABA-A Receptor Positive Allosteric Modulators - Brexanolone (Zulresso) and Zuranolone (Zurzuvae) for postpartum depression

Resources

Call or text 988, or chat online at 988lifeline.org for the 988 Suicide & Crisis Lifeline.

National Alliance on Mental Illness (NAMI): Free education programs, local support groups, and the NAMI HelpLine at 1-800-950-NAMI (6264) (Monday–Friday, 10 a.m. to 10 p.m. ET).

Call or text 1-833-TLC-MAMA (1-833-852-6262) for 24/7 support for pregnant and new mothers.

How Loria Mobile Medicine Can Help

Accurate & Comprehensive Diagnosis - I perform a thorough evaluation to identify underlying causes and rule out other conditions that frequently mimic or worsen symptoms. Then, I use diagnostic criteria to ensure an appropriate diagnosis, and I accurately manage the condition with the patient. 

Safe & Informative Management - I ensure you fully understand potential side effects and black-box warnings so you can make informed decisions about your health. I also rigorously screen for relative and absolute contraindications for specific medications, including psychosis, bipolar disorder, serotonergic medication use, uncontrolled hypertension or severe cardiovascular disease, heart dysrhythmias, a history of seizures or eating disorders (especially with bupropion), severe renal or hepatic impairment, uncorrected narrow-angle glaucoma, active substance use or withdrawal, pregnancy or breastfeeding, difficulties with urination or defecation, cognitive problems, elderly, and more.