Mental Health Matters about Depression

Mental Health Matters is a blog created by the treatment staff of Aspen Day Treatment, a community mental health center in Halethorpe-Arbutus. This first entry is written by Dr. Jeff Lafferman, a board certified psychiatrist and Medical Director/CEO of Aspen.

Aspen Day Treatment was established 4 years ago. We have treated hundreds of clients, and most are doing well and pleased with their care. Aspen Day Treatment started off licensed as a Partial Hospital Program (PHP). A PHP is called a "partial" hospital because it provides similar services as an inpatient psychiatric hospital but it operates a partial day between 10am and 3 pm.  It is also nicknamed a "day hospital" for obvious reasons. The purpose of The Aspen PHP is to substitute for or prevent a psychiatric hospitalization or to shorten a psychiatric hospitalization. We can shorten a psychiatric hospitalization by accepting patients from psychiatric hospitals like Sheppard Pratt and University of Maryland that would otherwise be hospitalized a longer time. We can also avoid admissions to psychiatric hospitals by providing the necessary treatment that would otherwise be provided in the hospital. Patients are expected to come daily Monday through Friday until they fell better, usually in about 3 weeks. The Aspen PHP accepts Medical Assistance, Medicare, and some commercial insurances.

 This year Aspen Day Treatment also added a second service, called an outpatient mental health clinic. In the Aspen Clinic, we can see our clients weekly or sometimes monthly with a combination of psychiatrist’s visits for meds and individual, group, or family psychotherapy. There is a great deal of flexibility in the Clinic, which allows Aspen to provide the best care for you.  The Aspen Clinic accepts Medical Assistance.

 As a community health center with these programs cited above, we have seen many different kinds of problems, which we will be writing about in this blog. I am interested in your feedback so the staff at Aspen Day Treatment and I can respond in a way that will provide useful information to the community.  My first entry will be about depression as follows below.

 Everybody gets sad at times because there are many hurtful things that happen to people. Sometimes we are sad for a few days, other times we are sad for extended periods of time.  When there is an event that causes an extended bad mood, or as we call it"dysphoria", it is called an Adjustment disorder with depressed mood.  That implies that when we are healthy, people can cope with all kinds of sad events and hurtful things that occur. Repeated hurtful events can break down the ability to cope. Sometimes it occurs because there are not enough outlets in our lives, like friends, family, activities, faith, or charity.  This condition responds very well to psychotherapy, when the usual outlets we have in life are not enough.

 A more serious kind of depression is Major Depression, which usually involves a group of symptoms occurring together, including a dysphoric mood, appetite and sleep changes, low energy, feeling no pleasure from things that we used to enjoy, poor concentration so we cannot pay attention, can't think, or can't make a decision, and sometimes feeling suicidal which can be an emergency. Some famous people have experienced Major Depression like Winston Churchill, who said this about being depressed, "you have no idea what it feels like to wake up every morning afraid you are going to live". Hospitalization may be necessary for suicidal thoughts that are leading to actual suicide attempts.  Most of the time, care can be provided in Doctors offices and community mental health centers. Treatment is a combination of anti-depressants and psychotherapy, which may take several months for the depression to lift. Often, Major Depression is not easily identified so treatment is not offered.  A dysphoric mood is not always a sad mood. People with major depression can also present with an angry irritable mood, an apathetic mood that they don't care, or an anhedonic mood in that they don't feel anything. Basically if the mood changes from normal to one of these moods listed here, then this can be a major depression.  In older patients, mood changes can present with a heightened focus on physical problems, like constipation, arthritic pain, stomach aches and headaches. This may become obvious that after many trips to the doctor, the complaints are considered "psychological". Given that Major Depression has an underlying chemical imbalance in the brain involving neurotransmitters, I don't accept it as "psychological". These complaints of pain and constipation due to Major Depression have a medical basis too!  

 Major Depression doesn't happen often. Usually 3% of people at any given time have it.  Some people have it because they have a genetic predisposition, in that members of their family on one side or both, have had serious depressions. People with a genetic predisposition may not need much happen to stimulate a major depression. Sometimes, it occurs spontaneously when everything is going along just fine.  Other times, a Major Depression will occur as a result of a minor thing going wrong. I've had a lady develop a very serious Major Depression following a normal colonoscopy!  On the other hand, for people without a family history or genetic predisposition for Major Depression, it takes a lot more to tip them over into a Major Depression. For instance, I've had a patient who put his heart and soul into his small business, then lost it in the recession. This was quite a blow to his self-esteem. Similarly, another patient who was a mother to a teenaged daughter saw this daughter was deteriorating due to drugs. The mother's whole life seemed crushed. These are called injuries to self-esteem and when severe lead to major depression. One thing I have noticed about Major Depression, is it is more likely to occur between August through February as the daytime light starts getting shorter.

 There are other causes of depressive conditions including drugs and alcohol. Drugs and alcohol are a big problem with depression, because most people start using drugs and alcohol to feel better from their depressive symptoms, then the drugs and alcohol become a problem in addition to depression. 

 Patients with depressive symptoms should always also see their Medical Doctor because there are medical conditions that cause depression, for instance hypothyroidism and anemia.

 Major Depression has a 65% chance of responding to treatment, anti-depressants and psychotherapy. Sometimes the condition relapses and re-occurs every year or less often, perhaps every decade. It may be useful for people with relapsing or recurrent Major Depression to stay on anti-depressants chronically to prevent these recurrences from happening.

 This was a summary of depressive conditions for our new blog, Mental Health Matters. There will be additional posts by other members of our staff at Aspen Day Treatment in the future. Thank you for reading and I look forward to your responses.

 Jeff Lafferman, MD,

Aspen Day Treatment

1634 Sulphur Spring Road

Halethorpe, MD 21227

410-242-0920

www.aspendaytreatment.com