Montefiore in the News

       No matter what kind of you're facing, it's important to remember that help is always possible.

BY LISA MULCAHYPUBLISHED: OCT 3, 2022

If you've recently experienced periods of sadness that feel like they could be something more, know that you're not alone. The World Health Organization (WHO) reports that depression and anxiety have recently increased worldwide by 25%, due to the ongoing emotional and physical stress of the COVID-19 pandemic. “It’s very important to know that depression is very common,” says Simon A. Rego, Psy.D., chief psychologist in the Montefiore Health System and chief of psychology at Albert Einstein College of Medicine in Bronx, NY. “For over two and a half years, we’ve all suffered physically, emotionally, and financially. It’s natural to feel sad in these circumstances.”

However, if your feelings of sadness begin to impede your ability to enjoy life, it’s important to take a closer look at why this is happening. “A lot of people feel sad for a day,” says Dr. Rego. “However, you reach a tipping point when it’s becoming more difficult to manage activities of daily life, such as your family, work, or educational responsibilities. This happens when your feelings are taking up your thoughts for hours at a time, or your feelings are just too distressing.”

“If how you feel is impacting your life, if you find yourself thinking, ‘I function less than I used to,’ then it’s worth getting help,” says Eliza W. Menninger, MD, assistant professor of psychiatry at Harvard Medical School and medical director of the Behavioral Health Partial Hospital Program at McLean Hospital in Belmont, MA.

Start by reaching out to your PCP. Many primary care practices have screening procedures that can get patients quick referrals to mental health professionals; you can also talk to your ob-gyn. Describe your symptoms in detail. Your doctor will most likely want to give you a full physical and run some blood tests as well, as physical conditions can mimic depression. “Sometimes symptoms of depression actually have to do with a low-functioning thyroid,” says Dr. Rego.

What are the symptoms of depression?

According to the Mayo Clinic, depression can range from mild symptoms of sadness to continuous, severe feelings of emotional pain. Depression symptoms can vary depending on the type of depression you have. General signs of depression to look for include:

• Sorrow, irritability, or a feeling of emotional emptiness
• Loss of interest in things you’ve enjoyed
• Trouble concentrating
• A feeling of hopelessness
• Feeling guilty, or feeling a sudden dip in self-esteem
• Fatigue
• Trouble eating or sleeping

Suicidal thoughts are never a symptom to ignore, and they can happen if you have depressive feelings. If you feel you want to or might harm yourself, tell a friend or family member and have that person take you to the emergency room, or immediately call the 988 National Suicide & Crisis Lifeline by dialing the toll-free 9-8-8.

Different types of depression may present with additional symptoms. Some types of depression are lifelong; some are short-lived or are linked to an event in your life. Determining, with your doctor, which type might be causing you distress is the key to finding relief.

Following are ten types of depression and some specific associated symptoms:

Major Depressive Disorder (MDD)

Major Depressive Disorder is characterized by overwhelming feelings of sadness that don’t go away after two weeks. MDD is also called clinical depression. In addition to the symptoms listed before, MDD can also cause:

• Anxiety
• Slower physical movements
• Slowed thinking
• Unexplained aches and pains all over your body.

Persistent Depressive Disorder (PDD)

This form of depression, also called dysthymia, is a kind of chronic depression that can last for years. You can find it hard to feel joy during happy events, like holidays or parties, and people who know you may tell you that you’re a “downer” or have a negative outlook. This can make you feel even worse, as you then may beat yourself up for not being able to feel positive emotions. People with dysthymia may suffer what’s called “double depression”, meaning you might have MDD episodes on top of long-term depression. Other symptoms may include:

• Feeling guilty about things you did in the past
• Tiredness
• Self-criticism
• Avoiding friends and social occasions

Postpartum Depression (PPD)

Postpartum Depression often starts one to three weeks after you give birth. Hormonal shifts are thought to play a big part in why it affects women. You also may have difficulty feeling love toward your baby, or bonding with your child. Additional symptoms may occur, including–

• A sense of panic
• Feeling shame or feeling like a failure
• Extreme mood swings

A major concern is that some women with PDD think about harming themselves or their child, so if you have these feelings, you need to tell someone right away.

Bipolar Disorder

Bipolar Disorder causes extreme shifts in mood, ranging from extreme highs (mania) to prolonged lows. There are three types of bipolar disorder and type I can present with severe depressive periods that last longer than two weeks at a time and can make it difficult to perform even small tasks. For some patients, a period of depression may be so overwhelming it requires hospitalization. Some symptoms of bipolar disorder can be very serious, including:

• Mania
• Racing thoughts
• Doing risky things, such as spending all your money or having unsafe sex

Or, you may feel lethargic, or think about suicide. It’s very important to reach out for medical attention immediately if you experience symptoms that could indicate bipolar disorder.

Seasonal Affective Disorder

Seasonal Affective Depression (SAD) occurs at certain times of the year, usually in the fall or winter. It’s believed that when there’s less daylight in some people’s environment, their brain chemistry changes. SAD, is in fact, often treated by exposing patients to more light. Some signs you may have SAD include:

• Daytime drowsiness
• Increased sensitivity to rejection
• Trouble feeling hopeful
• Brain fog
• Decreased sex drive

Major Depression with Psychotic Features

Major Depression with Psychotic Features is a very serious form of depression in which a patient experiences hallucinations, or delusions, and requires immediate medical care. Some of its specific signs include:

• Hearing critical voices
• Seeing things that are not there
• Believing situations to be true that are not

Premenstrual Dysphoric Disorder (PMDD)

Premenstrual Dysphoric Disorder occurs a week or two before your period starts, and is much worse than PMS. PMDD is marked by severe symptoms, including:

• Extreme depression
• Irritability
• Anxiety
• Mood swings that make you feel like you’re losing control.

Your symptoms will ease a few days into your flow, as hormonal changes are thought to cause the condition.

Situational Depression

Situational Depression happens when you have suffered a loss, such as a death in your family, or if you get divorced or lose a job. You can link the cause of situational depression to a specific event–this is what many people who have suffered a loss due to the pandemic have experienced. Symptoms usually start within three months of the circumstance you have gone through, and include:

• Worry that you can’t stop
• Sadness that lasts longer than two weeks
• Crying spells
• Trouble making decisions
• Feeling worthless

Atypical Depression

Atypical Depression means you have ongoing symptoms of depression that temporarily resolve when good things happen in your life. This type of depression has a few unique symptoms, in addition to general depression symptoms, such as:

• Feeling a heaviness in your limbs
• Feeling rejected in your relationships

Treatment-Resistant Depression

Treatment-Resistant Depression occurs when two courses of medication for any form of depression don’t alleviate your symptoms. It’s thought that a third of people with depression may have this form of the condition. Medication changes can solve the problem, as well as adding other forms of counseling and tracking shifts in how you feel.

What to expect when working with a doctor for depression:

The road to feeling better is different for everyone. If you are diagnosed with depression, there is a wide range of treatment options available, from medication to cognitive behavioral therapy (CBT), a very effective form of talking out your feelings. “Some patients feel better in a relatively short amount of time,” says Dr. Rego. “Some medications, for some patients, begin to reduce symptoms in a few weeks.”

“It’s important not to compare yourself to other people,” says Dr, Menninger. “Everyone is on a different path, and each person has individual needs.” No matter what kind of depression you may be diagnosed with, know that there is help, and it starts by taking that first step forward. “Put one foot in front of the other,” sums up Dr. Menninger. “Tell yourself, ‘I can get better.’ Don’t expect it to happen in any specific amount of time. Just advocate for yourself, and you’ll find the therapy that works for you.”