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To Your Health With Dr. Jim Morrow: Episode 5, Depression

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Dr. Morrow’s Show Notes on Depression

• Today’s topic is one I discuss with at least one patient every single day I work – and that’s DEPRESSION.
• People in general have their own idea of what constitutes depression. And in many cases, it is correct but only in a very narrow definition of the condition. So, I guess, first, I need to define depression, in the clinical sense.
• Depression can be present if you are overly or unnecessarily sad – but most people who I see who are depressed are mad, and not sad. Additionally, the depressed patient might be tired, uninterested in usual hobbies or pleasure seeking activities, whether that is being with friends or others, or having sex, or engaging in any way with their surroundings.
• Most people don’t come to my office with a complaint of depression. They are much more likely to complain of increased irritability, making mountains out of mole hills, trouble focusing, not being engaged or interested in their usual hobbies and things they used to enjoy.
• Some are sent in by their spouse because of irritability. I tell patients, “if you think to yourself many times, ‘Why did I react like that?’, then you are likely depressed.
• So, there are many different forms that this can take – if you feel like this could be part of how you feel, please see a doctor. Have this conversation with him or her.

So, why are people depressed?

• Depression occurs when the levels of certain neurochemicals in your brain get too low. The main chemicals involved are serotonin, norepinephrine and dopamine – but the names of these chemicals are really unimportant. What matters is that you have to get these levels back to normal in order to feel like yourself again.
• But what makes these chemical levels fall in the first place.
• Some people are just born with an innate inability to maintain adequate levels of these chemicals and in most cases these individuals have felt some amount of depression from very early in life.
• When it occurs any time later in life, the cause in most cases is CHANGE. Change in life or work or living situation, whatever it might be, it is usually CHANGE.
• Holmes stress scale.
  • Ranked life events – ranked them according to the effect each could have on your mood. Marriage, divorce, death of a spouse, getting a new job, getting fired. Good things were found to have a slightly greater effect on mood than bad things.
• So, depression is a physical illness that has both physical and psychological symptoms. It is as much a physical illness as any other condition we see.
• When your serotonin level is low you can feel all these symptoms that I have talked about. If you do, you might think to yourself, ‘I really should not have these feelings. I should be able to feel better,’ and then if you can’t do that you could feel even more depressed.
• If, instead of serotonin and other neurochemicals, your insulin level was low, you’d be diabetic. If it was iron you’d be anemic; thyroid, you’d be hypothyroid; estrogen, you’re in menopause.
• If your insulin level was low and you were diabetic, you would never, EVER, think to yourself, ‘You know, I’m just not gonna be diabetic today.’ That would never occur to you. But with depression, patients frequently think that they should be able to pull themselves up by their own bootstraps, and this just does not happen.
• Realizing this goes a long way toward getting better because the longer you delay treatment, the likelihood is that you will just get worse and worse.

So, how is depression treated?

• These chemicals we are talking about are only located in the brain. So the first issue is that you can’t measure these levels like you can insulin and others. There is this blood-brain barrier that does not allow the chemicals to get into the blood stream. Because of this, we can’t measure serotonin and other levels and we can’t give you serotonin by mouth because they also do not cross over to the brain.
• So, how do we make you better?
• In 1987, the treatment of depression changed forever. The introduction of Prozac made as big a difference in the treatment of any condition I can remember.
• Prior to this, we have several medications that were antidepressants, but truthfully, they were not very good at treating the problem and they were absolutely fraught with side effects.
• With Prozac (and then the other serotonin medicines like Zoloft, Paxil, Celexa and Lexapro), we had very effective medicines with very reasonable side effects.
• The way these medicines work is to change how your brain metabolizes these chemicals – in this case serotonin specifically. Your brains, under periods of stress, takes up more serotonin than it should from the soup that is the brain, and these medicines block that reuptake of serotonin, so they are called Serotonin Specific Reuptake Inhibitors (SSRIs).
• When you start these medicines, you could have some side effects, but for many people, the longer you take them the less the side effect bothers you.
• The side effects of these medicines vary, can be fatigue or restlessness, nausea, headache, even delayed orgasm. But in most cases side effects are mild and can be managed by adjusting the dose of the medicine or changing to another.
• Improvement does not happen overnight. It takes time for the medicine to get into your blood in a sufficient level to then get into the brain.
• Meds are not mood altering
  • Not addicting
  • Don’t drug test for them in the workplace
  • Safer than Tylenol
• There just is no reason NOT to take these meds if you have this condition. They can make a tremendous difference in how you feel and how you react and interact with others around you. Basically, they can give you your life back.
• Along with medication, other treatment modalities also can help. Therapy – psychotherapy – can help with depression and can especially help people deal with issues in their lives that are ongoing. One of the frustrating things for patients is to recognize the problem and get treatment, only to fall right back to the same feelings when you get off of medicine because you have not learned how to manage the stress and change in your life.
• So, please, if this sounds like it could be affecting you, go see your healthcare provider. See them sooner rather than later.

About Morrow Family Medicine and Dr. Jim Morrow

Morrow Family Medicine is an award-winning, state-of-the-art family practice with offices in Cumming and Milton, Georgia. The practice combines healthcare information technology with old-fashioned care to provide the type of care that many are in search of today. Two physicians, three physician assistants and two nurse practitioners are supported by a knowledgeable and friendly staff to make your visit to Morrow Family Medicine one that will remind you of the way healthcare should be.  At Morrow Family Medicine, we like to say we are “bringing the care back to healthcare!”  Morrow Family Medicine has been named the “Best of Forsyth” in Family Medicine in all five years of the award, is a three-time consecutive winner of the “Best of North Atlanta” by readers of Appen Media, and the 2019 winner of “Best of Life” in North Fulton County.

Dr. Jim Morrow is the founder and CEO of Morrow Family Medicine. He has been a trailblazer and evangelist in the area of healthcare information technology, was named Physician IT Leader of the Year by HIMSS, a HIMSS Davies Award Winner, the Cumming-Forsyth Chamber of Commerce Steve Bloom Award Winner as Entrepreneur of the Year and he received a Phoenix Award as Community Leader of the Year from the Metro Atlanta Chamber of Commerce.  He is married to Peggie Morrow and together they founded the Forsyth BYOT Benefit, a charity in Forsyth County to support students in need of technology and devices. They have two Goldendoodles, a gaggle of grandchildren and enjoy life on and around Lake Lanier.

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