Paul Golden, MD Speaks; Depression & Bipolar Disorders
“Opening the Black Box on Mental Illness” Seminar, part I: Depression & Bipolar Disorders and…
Depression versus the Blues—In a nutshell:
What is the difference between major depression and the blues? Everyone feels blue or sad many times. These feelings are usually short-lived and pass within several days. Major depression interferes with daily life and causes pain for both you and those who care about you.
Major depression episodes can occur with no apparent reason. The despair associated even with getting out of bed in the morning is overwhelming. The feelings of hopelessness, of guilt, of feeling there is no way out, of nothing but bleakness last for weeks. Contrast the intensity of such despair and bleakness with, say, the feeling of disappointment or feeling ‘bummed out’ when you get a C on a term paper when you were expecting an A..
Nurses, doctors, police, fire fighters, military personnel, prison workers, wardens, deputy sheriffs, lawyers, judges, and volunteers at homeless shelters and with the Salvation Army, United Way, or Goodwill often come face to face with both major depression but not realize it. It is this lack of awareness that I want to change. Priests, ministers, rabbis and clerics advise members of their churches, temples and mosques need to be able to tell the difference between the blues and major depression.
Here is a common analogy that primary care docs see or hear nearly every day. A patient comes in or calls with yellow nasal discharge or cough, no fever and maybe pain over the sinuses. Likely this is just a cold, viral bronchitis or sinusitis. The treatment is fluids, rest and cough syrup and maybe a nasal steroid spray. Juxtapose this with a patient with productive cough of green phlegm or nasal discharge, fever of 101 or higher, headache and body aches. They need antibiotics because the infection is bacterial.
Similarly patients with the blues want pills, and doctors oblige. Determining the kind of unhappiness a patient is suffering often falls to primary care physicians today. Family practitioners and internists are pressed by the big pharmaceutical industry’s television commercials to prescribe drugs. Patients see the same commercials and follow the commercial’s instructions to “Ask your doctor for XYZ drug.”
Sometimes, of course, the distinction between situational depression and major depression can be blurry. If you dig deeper you may find that a patient with prolonged “blues” has a family history that includes schizophrenia, institutionalization or a distant family member who has committed suicide. It can be helpful, in these cases, to try drug treatment. However, if the individual does not see a difference in six weeks or so the drugs should be stopped and the patient observed.
The moral imperative is to be sure of the diagnosis.