Ask the Doctor: Dr. Bruce Saltz of Boca Raton Community Hospital
1. Can signs of stress also be signs of depression?
Dr. Bruce Saltz: Yes, they share certain characteristics. For example, stress implies that some force is negatively influencing or overwhelming our usual coping skills. Stress may contribute to disturbances in concentration, memory, appetite, weight, sleep and energy, and may contribute to excess anxiety or sadness.
2. Once you begin taking medications for depression is this a lifetime commitment to the drug?
Dr. Bruce Saltz: No, this depends on many variables, not simply the taking of medication for a single episode of depression. Many forms of depression are time and situation limited, so medical treatment may also be time limited. When integrated with psychological therapy designed to strengthen coping skills and to characterize and treat underlying vulnerabilities and stressors, prevention of future episodes is often made possible.
3. Can depression be cured?
Dr. Bruce Saltz: Yes many subtypes can be cured. However there are many subtypes of depression ranging from the bipolar depression to non bipolar depression, to depression associated with other conditions like chronic pain syndromes, medication side effects from other maladies such as steroid treatment or substance abuse, depression associated with psychosis, and a host of other causes. Proper identification of the underlying causative factors, when they can be identified, and family history or genetic predisposition, is very important for designing a proper multi-factorial approach to treatment.
4. Can hypnosis be used as a treatment option for depression?
Dr. Bruce Saltz: While this is not a modality in which I work, to the extent that hypnosis is a form of hyper concentrated attention that blends conscious and subconscious elements, I suspect that it may work under certain limited circumstances. However, I am a big believer in conventional pharmacological and psychological therapies for the symptom relief, learning and preventative functions.
5. Is depression heredity?
Dr. Bruce Saltz: Certain forms of depression are certainly hereditary, which means predisposed by heredity, but we are still relatively early in genetic characterization studies because the genes involved are most likely multiple and scattered in the genome, so where individual cases are concerned, the diagnosis and treatment strategies are still largely driven by observational information of the patients symptoms and contributing factors, and not by dna data. The field is beginning to go in the direction of being able to identify, for example, fast and slow metabolizers ("digesters") of medications, allowing us to identify those who may require high vs. low doses or else suffer intolerable side effects or lack of benefit to certain medications. This does not predict anything about responsiveness to psychological therapy.
6. I'm a woman that is post-menopausal and my doctor thinks I may be suffering from depression. Not severe, but enough that she would like to start me a low dose of anti-depressant. I don't feel depressed but maybe I'm not recognizing symptoms. Is depression common in post-menopausal women?
Dr. Bruce Saltz: Depression is a fairly highly prevalent condition and certain does appear during biochemical changes associated with women's hormonal status, such as puberty, pregnancy, post partum states and menopause. Since sadness or depression of mood is not always a symptom that is endorsed by people with the condition, it is important to screen for a number of characteristics like appetite, sleep and energy level disturbances, decreased capacity for pleasure, irritability, impatience, and others. The concept of low dose medication is not particularly meaningful to me, because the dose has to be strong enough to do its job, employing a drug product that is appropriate for the person, and what works for one person may be totally irrelevant to the next. The manufacturers and the FDA give us dosing guidelines, but these must be tailored to the individual person's needs and prescribed in the context of the individual person’s life, personality, situational circumstances, biochemistry, and other factors.
7. Is there an alternative to treating depression besides oral medications?
Dr. Bruce Saltz: There is one medication available by patch, and at least one product that is now in a clinical trial that employs intravenous administration. Also there is VNS which stands for vagal nerve stimulation, ECT which stands for electrocunvulsive therapy, and TMS which involves transcranial magnetic stimulation.
8. What are the warning signs for depression? I consider myself to be very happy and well-balanced but then there are times that I feel like I’m losing control. Should I be concerned?
Dr. Bruce Saltz: There are a large number of symptoms that may signal the presence or development of depression. a number of variables are important to consider, for example duration of symptoms, magnitude of symptoms, numbers of symptoms, "identifiability" and "fixability" of contributing variables, and the nature of associated factors like other substances or medications in the mix, stressors, etc.. mild depression and irritability may or may not remit spontaneously or require medication therapy, but persistent pervasive sadness with active suicidal planning, such as after a divorce or death certainly would. anyone who feels sad, or fatigued, hyper , irritable or persistently angry or with reduced capacity for pleasure, body aches and discomforts not better explained by other maladies, appetite, weight, or sleep disturbances, problems with concentration, memory or attention, suicidal ideation, loneliness, social withdrawal, or just plain unhappiness definitely ought to be considered for a diagnosis of depression or other mood disorder.
9. Is sleepiness a symptom of depression?
Dr. Bruce Saltz: Excessive daytime sleepiness or tiredness or fatigue can certainly be symptoms of depression, as can inadequate sleep. No one symptom defines depression however, because excessive sleepiness can occur in a variety of conditions such as endocrine abnormalities, drugs side effects, sleep apnea, and a multitude of other conditions.
10. Define clinical depression?
Dr. Bruce Saltz: a simple answer with less complexity than the more extensive descriptions above may be that it is a condition in which sadness or reduced capacity for pleasure develops, often but not always associated with loss, and often associated with disturbances of, concentration, attention, appetite, weight, sleep, energy, hopefulness, patience, tolerance or a desire to live.
