Depression
Patient Education

Doctors Who Treat Depression - Patient Education

Visits with healthcare providers would most likely be conducted with the physicians individuals have an ongoing relationship with:

General Practitioner - Deals with prevention, discovery and treatment of illnesses in all age categories.

Internist - Focuses on diagnosis, treatment and prevention of adult illness.

Gynecologist - Deals with female health.

Pediatrician - Specializes in infant, childhood and adolescent care.

Gerontologist - Deals with senior or elder health.

Nurse Practitioner - Focuses on prevention, wellness and education of patients about health and health choices.

Once a diagnosis of depression has been determined, a collaborative team approach is often most beneficial for the patient.

Psychologist - Provides therapy for depressed individuals through counseling and psychotherapy.

Psychiatrist - Medical doctor who focuses on health and disorders of the mind and mood. This doctor may prescribe medications in addition to the psychotherapy and perform medical procedures (e.g. shock therapy or electroconvulsive therapy-ECT.)

Holistic Practitioner - Views the body overall, considering physical, mental, and spiritual components. Herbs and nutritional supplements are considered in addition to meditation, cleansing, diet and exercise protocols.

Nutritionist - Formulates diet plans to impact positively on health.

Occupational Therapist - Devises and encourages participation in daily activities, especially for those with compromised cognitive or emotional function. They evaluate the environment, whether it be home, school or work, and recommend training and guidance with the focus on helping the individual to adapt.

How to Prepare for your Depression Doctor Visit

When depression is suspected, a doctor will review several aspects of the patient's medical history. It is important for the patient to note the following listed in this patient education guuide:

• Medications and dosage being taken.
• History of all previous illnesses and surgery with dates.
• List of all new symptoms, noting, if possible, when they began.

If you are scheduled to have a CAT Scan, you can prepare by doing the following:

• Do not eat or drink 4-6 hours prior to the test.
• Do not wear jewelry to the test site.
• If you are over 300 lbs, check to see whether the machine can accommodate you.

Questions to Ask Your Doctor About Depression

From your initial diagnosis throughout your treatment and care, you will have questions about your depression. This patient education guide lists helpful questions for you to discuss with your doctor so you can make informed decisions about your condition.

Questions About My Diagnosis

• What caused my depression?
• Are there diagnostic tests that I should have?
• Can I be cured or is this a life-long problem?
• Will psychotherapy cure me of depression?

Questions About My Treatment

• What medication will I need to treat depression? Why was this medication chosen? Are there side effects?
• How long will I need to take this medication before I see relief of symptoms?
• Will I always have to take the medication?
• Is there a treatment that I can have without drugs? Are there supplements, vitamins or herbs that can cure my depression?
• What will happen if I don't take any treatment?
• Will I get progressively worse?

Questions About My Lifestyle and Family

• Does this type of depression run in families?
• Will my children develop this depression?
What signs should I look for?
• Is there a special diet that will help me?
Are there foods that I should avoid? Can I drink alcoholic beverages?
• Will exercise relieve my depression?
• Will antidepressants interfere with my sexual performance or sex drive?
• Can I drive with antidepressants?

Common Tests or Labs to Diagnose Depression

The first step in evaluating a patients depression level is a thorough history and discussion including any new symptoms, distress, new life changes, lifestyle changes, etc. and a complete physical examination. The following patient education guide included in depth information about depression.

Type of Test	What is Tested?	Normal Range
Blood Test	Thyroid function and glucose levels	TSH= .5-6 uU/ml T4 = 4.6-12 ug/dl T3 = 80-180 ng/dl RAIU= 10-30% TBG= 12-20 ug/dl Glucose= 70-100
Blood	Complete blood count (CBC)	CBC (complete blood count) Hemoglobin Men: 13-18 gm/dL Women: 12-17 gm/dL Hematocrit Men: 45-52 Women: 37-48 WBC= 4300-10,800 cmm RBC= 4.2-5.9 million cells/cubic millimeter
Cat Scan	Brain	Scan uses many x-ray views Normal would show no masses, no constriction of cerebral blood flow, no obstruction of sinuses or fluid sacs
MRI	Brain	No breakage in neural synapses, no masses, no obstruction, no constriction of blood vessels
EKG	Torso	A normal EKG is a pattern with a P wave followed by a QRS wave, with an interval rest period whereupon the pattern recurs. P wave rate = 60-100 bpm P height < 2.5 mm in lead II P width < .11 in lead II PR interval= .12-.20 s QRS complex < .12 s Normal ST segment= no elevation or depression
EEG	Head	8 Hz most wave frequencies when awake. Some waves are recognized by shape, scalp location and distribution as well as symmetry. There are certain patterns considered normal for both awake and asleep. Epileptics and various nerve disorders demonstrate an abnormal pattern or wave frequency of 7 or less.

There are several well-respected cognitive tests available to screen for depression and some are geared to a specific age group.

Age 7-17 years - Children's Depression Inventory (CDI)

• Seeks input from parents and teachers about the child
• Input reflects family and home situations
• Input reflects academics and school interactions
• Questionnaire of 27 questions with 3 descriptive statements each reflecting feelings within a 2-week interval.
• Developed by Dr. Maria Kovacs at University of Pittsburgh

Age 14-80 - Beck Depression Inventory (BDI-II)

• Questionnaire with 21 multiple-choice questions
• Depression symptoms are measured in each item
• Extent of depression is determined by score tally
• Designed by Dr. Neil Beck at University of Pennsylvania

Adults - Hamilton Depression Rating Scale (HAM-D)

• Oral examination of 21 questions as opposed to the others
• Gold standard for rating efficacy of antidepressants (according to March/April 2003 issue of "Psychotherapy and Psychosomatics")
• Devised by Dr. Max Hamilton at University of Leeds

Adults - Zung Self-Rating Depression Scale (ZDS)

• Questionnaire of 20 questions and 4 choice
• Extent of depression measured by score tally
• Devised by Dr. William W. K. Zung at Duke University

Elderly - Geriatric Depression Scale (GDS)

• 30-item Yes/No questionnaire
• Targets seniors both ailing, healthy, or cognitively impaired
• Designed by Dr. Joseph Yesavage at Stanford University

Common Medications and Treatments for Depression

There are several mood-altering medications on the market to treat depression. Talk to your physician about the benefits, risks and side effects of each which are listed below in this patient education guide.

Treatment Type	Description
SSRIs (Selective Serotonin Reuptake Inhibitors	Blocks reuptake of brain neurotransmitter serotonin
SNRIs (Serotonin And Norepinephrine Reuptake Inhibitors)	Blocks reuptake of brain neurotransmitters (serotonin and norepinephrine)
NDRIs (Norepinephrine And Dopamine Reuptake Inhibitors	Blocks reuptake of norepinephrine and dopamine in the brain
Tricyclic Antidepressants	Block the absorption of neurotransmitters serotonin and norepinephrine (making it more available in the brain)
Atypical Antidepressants	Alters the level of brain neurotransmitters
MAOIs (Monoamine Oxidase Inhibitors)	Blocks the breakdown of Monoamine oxidase to increase the level of neurotransmitters in the brain
Dietary Supplement & Herbal Therapy	St. John's wort and Omega 3 fatty acids have been shown to Help the brain manufacture neurotransmitters.

Alternate Depression Treatments

In addition to the medications listed above, there are other therapies that can help elevate a patient's mood.

Electroconvulsive Therapy (ECT) - Formerly known as shock therapy, ECT encourages a patient to have small seizures. This therapy is usually used on patients with severe depression who have not responded well to other treatments. Results are often immediate and positive.

Vagal Nerve Stimulation - Requires surgical implantation of a stimulation device that delivers electrical impulses that affect mood centers.

Transcranial Magnetic Stimulation - Uses magnetic fields to stimulate nerves and alter brain activity and mood.