Matters of the Mind: Understanding Depression

Know the signs.
Initial onsets of depression are often mild and can be difficult to detect. Symptoms of major depression are typically a change from a person's usual behavior, including:

being persistently sad or irritable;
having pronounced changes in sleep, appetite and energy;
having difficulty thinking, concentrating and remembering;
lacking interest or pleasure from activities once enjoyed;
experiencing feelings of guilt, worthlessness, hopelessness and emptiness;
having persistent headaches or chronic pain that don't respond to treatment; and/or
thinking about death or suicide.

If you experience any of them for longer than two weeks and they affect your ability to engage in regular activities, you should seek professional help.

Emergencies
In an emergency, when you or a loved one may be imminently suicidal:

Call First Call for Help at (509) 838-4428 (a 24-hour crisis and referral line provided by Spokane Mental Health) or;
Visit a hospital emergency room. Mental health counselors will refer you for outpatient care at a clinic or recommend admission to an inpatient facility such as Sacred Heart Medical Center.

Non-emergency counseling
If you would like to seek counseling for non-emergency mental health concerns, you may want to seek a professional counselor. Check with your insurance provider about possible coverage for counseling services. If you are without insurance and the ability to pay, contact your local community mental health program, such as Spokane Mental Health.

For more information
Sacred Heart Medical Center
www.shmc.org or (509) 474-3131
inpatient treatment for all ages

Spokane Mental Health
www.smhca.org or (509) 838-4428
outpatient services for all ages

National Institutes of Mental Health
www.nimh.nih.gov or 1-866-615-6464

by Kate Vanskike Smith

In our modern society, discussing illness has become accepted, even normal. We talk openly about our clogged arteries and even the unpleasantries of cancer treatments. Today, people know all sorts of facts about risk factors, signs and symptoms for a variety of diseases. Except for mental illnesses, that is.

Not even depression–the most common mental illness–is discussed openly. It's still too taboo to talk about, even though it affects 9.9 million adult Americans in any given year. Very likely, you know someone who has depression. Maybe it's you.

One thing is sure: it's time we talked about it.

The basics of depression
Like any illness, depression can affect every aspect of a person's life: work, finances, relationships. And like any other illness, it needs to be correctly identified and treated professionally.

Depression presents itself differently in different people. Some people reach a point where they can no longer carry out daily responsibilities; others can still function even though they're miserable. While the stereotypical person with depression is sad and disengaged, others become angry and argumentative. Any significant change in behaviors should be evaluated.
“Even if you aren't positive you need help, you should let a professional make that decision,” says Saj Ravasia, MD, psychiatrist at Sacred Heart Medical Center.

The primary reason people end up in the hospital for inpatient psychiatric care is because their depression escalates to the point they are suicidal. And getting to that point can result from a number of issues.

First, people often don't recognize the signs of depression, or they disregard certain symptoms as being unrelated. Second, they don't have the ability to pay for private counseling and aren't aware of community mental health resources.

But the third and larger reason people don't seek help is their own idea of what it means to have a mental illness and how that effects their self-esteem.

“People have an incredibly difficult time coming to terms with depression because of the stigmas and misconceptions about it,” Dr. Ravasia comments. “And yet, if they would just seek help, some people would be surprised to find out how treatable their condition really is.”

Circumstances and events–positive and negative alike–are not solely responsible for the way we feel. On the contrary, the human brain presents real physiological reasons for our overall emotional health. Neurotransmitters (like serotonin and dopamine) tell our brains how to respond to certain stimuli, which may include our own internal thought patterns or circumstances in the environment around us.

Many people who suffer from stress and depression benefit from cognitive behavior therapy, which helps patients change the way they think–and ultimately, how they feel and behave. However, if a person's neurotransmitters are off balance, he may have constant battles with anger, sadness or fear, despite the counseling, indicating a need for medication.

For many people, antidepressant medications are helpful, often in combination with psychotherapy. Antidepressant medications called SSRIs (selective serotonin reuptake inhibitors) help the brain use its natural serotonin more efficiently. There is a wide variety of antidepressants available to augment therapy.

For some people, even great counselors and quality medications don't successfully resolve depression and its symptoms. It's called “treatment-resistant depression” and when it's present, psychiatrists may turn to electroconvulsive therapy for help.

ECT basics
Due to the way movies and media have portrayed electroconvulsive therapy or ECT, the treatment remains critically misunderstood. The truth is, ECT is a lifesaver for some people who suffer from acute depression and for whom medications simply are not effective.

Essentially, electroconvulsive therapy involves restructuring the brain's neurochemistry by inducing a seizure. And while some would describe this as “barbaric,” the way Sacred Heart Medical Center's staff carries it out is as compassionate as one could imagine.

“I've always wanted to rename the procedure,” says Barb Stagg, RN, who has worked in the ECT department for 13 years. “The term 'electroconvulsive' conjures up so many negative images.”

Once referred to for ECT, patients and their loved ones receive thorough education about what to expect. They watch videos, learn about the use of anesthesia and visit with an experienced psychiatry nurse to discuss any concerns. The procedure is handled the way many other hospital procedures are, with specific instructions, a review of medications, intravenous (IV) therapy and anesthesia. Patients are not restrained, there is no pain and the procedure is over in a matter of minutes.

Patients undergoing the treatment receive a medication that relaxes their muscles so the seizure does not affect their bodies, but is limited to brain activity only. The ECT nurse delivers the tiniest amount of electricity to the appropriate area of the brain; after just two to three seconds, the seizure is induced and the electricity is stopped. Then the brain carries out the seizure for about 20-40 seconds. All the while, a computer is mapping the length and intensity of the seizure. After just three to four minutes, the anesthesia wears off and the patient begins to wake up and receives one-on-one care from a nurse. Patients are released to return home with a loved one within an hour and a half of their arrival.

“More than 70 percent of patients who use it experience a drastic improvement in their quality of life,” says Dr. Ravasia. And while it does have side effects such as short-term memory loss, he says, “Patients who need ECT definitely feel the benefits greatly outweigh the risks.”

A compassionate choice
“Most people don't have the slightest idea about ECT and yet they're so quick to criticize it,” says Barb. “They need to understand it before they make judgments.”

She is aware–on a very personal level–just how devastating depression can be to people who have it and to their families. Her own brother, who had two health care professionals in the family, committed suicide.

“When people are so depressed, they simply feel there is no lifeline. It's such a devastating disease,” she reflects. “When you see people who are convinced that the only way out is suicide, how could you not think of ECT as compassionate?”

Over the years, Sacred Heart's ECT team has seen hundreds of people get beyond their depression barrier with the help of ECT. In 2005, they offered more than 1,300 treatments to approximately 150 patients who receive an average of 7-10 treatments each. Out of those 150, only about 15 patients return for “maintenance” treatments to keep them healthy. Patients are typically 55-70 years old, although the department has helped patients as young as 16 and as old as 99. They are people who simply don't see the results they'd like from medications.

Frequently, the Sacred Heart ECT team receives calls or letters from family members, saying, things like, “Thanks for giving us our mother back.”
“It's pretty cool to see people get better,” Barb adds. “And ECT makes that possible.”

ECT connections
If you would like a consultation with a psychiatrist who offers ECT, please call one of these physicians:
Mark Chalem, MD (509) 455-9090
John Moulton, MD (509) 455-9090
Saj Ravasia, MD (509) 474-6920

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