Realities of Depression, How to Understand, Recognize and Treat Depression

Dr Starovic explores the realities of depression—one of the most common and debilitating mental health conditions. Learn how to distinguish depression from normal sadness, understand the symptoms, and discover why early diagnosis and treatment are crucial. The video covers risk factors, treatment options (including therapy and medication), and emphasizes that recovery is possible. If you or someone you know is struggling, remember: help is available, and taking the first step can change everything.

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There is never too much talk about depression. There is continuous   need to keep on raising the awareness. It is important to keep on educating public about the disorder, talking about depression, ways to understand the disorder and encouraging people to seek help by injecting hope and explaining that there is just som anyways to successfully treat depression. Why is this important? Because it's one of the most common and one of the most debilitating conditions.

At every given moment about 5% of population is suffering from active  episode of major depressive disorder. That is huge. And your risk of developing depression throughout lifetime, even if you never had depression before, is 60%. If you ever had depression before, your risk of developing depression again is rising and if you had more than two depressive episodes, we do recommend indefinite treatment with medications because your probability that yet another depressive episode is going to come is over 90%. 

We are trying to prevent new depression from happening, and we are trying to mitigate the intensity and the extent of disability connected to your depression. Depression is very clearly different from sadness. Sadness falls under the umbrella of normal human emotions, and we all can be profoundly sad and distraught if we are under those types of circumstances.

If you are facing a life challenge, if you are facing loss, if you're facing a disappointment, if you're facing failure... two things are very important when we are trying to make a difference between sadness and depression. One of them is that there is usually no excessive feeling of guilt and worthlessness, so your self-esteem, no matter how distraught and sad you are, is usually not impacted. Then the second thing, you're usually able to meet at least some basic elements of your day-to-day functioning. Is it taking care of yourself, your professional needs, social, interpersonal needs, you name it, you're able to at least do the bare minimum.

A person with depression tends to be unable to do so. Finally, there is a time criterion; a big life blow, big hit, profound sadness, or huge loss can really incapacitate you. But usually, within two weeks, we start functioning again; it starts being processed. We start getting better. When you are suffering from depression, one of the criteria is the time criterion.

You want to make sure that you're not jumping to conclusions, that you're not jumping to a diagnosis, and that at least two weeks of symptoms exist or more before saying, okay, now we really need to diagnose you with major depressive disorder. Also, before we do so, we want to make sure that there is nothing else going on that can present itself like depression.

Thyroid function needs to be checked. We do need some basic labs. We want to make sure there is nothing behind the bushes that could be a medical problem and that could be a cause of your symptoms that we miss. We don't want to miss that, and we want to rule out medical conditions that can present as depression, and then expand the knowledge about the fact that it's not about sad mood, although sad mood is one of the major criteria for depression but you can also just have this profound   disorder of will and motivation and feelings of emptiness, inability to find joy in people, places, and activities that used to be joyful to you before. And we call that anhedonia. This usually comes with some type of sleep disorder. You are exhausted. You are suffering from low energy, but you cannot seem to be able to find that rest that is absolutely necessary.

You have problems falling asleep, and you have problems staying asleep. Sleep is not restorative, or you are typically waking up very early, very depressed, ruminating about dark, dark things on your mind and not being able to continue sleeping. You might suffer changes in appetite that are out of character, and you might gain weight, or you might lose weight and of course, if this is proceeding and impairing functioning more and more, you can sink into this inappropriate ideas of being worthless, not having anything to live for, having passive or active ideas of killing yourself or ending your life, being guilty for things that realistically are not consequences of your own doing.

If this proceeds to a severe depressive episode, it can show up with psychotic symptoms. So if it causes a breach from reality, you can start hearing voices. Usually, these voices are in line with depressive thought content, often a voice telling you that you are worthless, that you're useless, that you should kill yourself, and questioning your capability to function goes down to the point that everything is not just difficult, but literally impossible from high level tasks. Cognitive functioning is impaired. You can't really respond to all those emails. You can't think clearly. You cannot focus and concentrate, but to more mundane tasks. Getting out of bed is hard, putting clothes on is hard, taking a shower is hard, eating, preparing food, cleaning your house is all becoming unrealistic expectation and sooner rather than later...

you have to ask for help !

Help is available. Depression's hard to treat when you treat depression. Most of the treatments that exist out there are approved on the basis of response, meaning that you do get better, but there is a difference between response which means that your depressive symptoms are reduced in the extent and intensity... and recovery, meaning that you're back to normal, that you're not depressed anymore, that your depressive episode has resolved.

That is a clinical challenge. How do we help you reach that recovery, not just help you get a little bit better. The goal of care should be recovery, not a response.  So what's the next step? How do you keep yourself well? Do you need to be on this medication forever? Initially... I would say no, but your goal of care should be to be on a medication for at least six months if you really are somebody who suffered Major Depressive Episode.

The second question is: what do we do if you're not responding to medication? How do we augment treatment to achieve that recovery?This is really not easy because only 40% of people are going to be fortunate enough to achieve recovery with the first intervention sometimes intervention is not effective, sometimes intervention is not well tolerated... We have to switch medications around. We have to combine medications, we have to augment medications, and of course, therapy therapy, therapy. There is no depression without anxiety, there is no depression. Without life hardship or life complexities, and using therapy together with medication treatment is the best possible approach.

The other thing that isvery important is preventing a poor outcome, preventing death because depression does come with suicide and depression is a potentially deadly psychiatric condition, not only due to self harm, but also due to fact that when you're depressed, you don't take good care of yourself, and your risk of getting sick with other medical illness is increasing.

Good news is that there is hope. Good news is that  there is abundance of treatments out there, there are antidepressants. First, second, third, fourth, line of treatment. Combinations of medications, augmentation with anti-psychotics, augmentation with mood stabilizers, augmentation with hormones. There are interventions that are proven to alleviate depression.

Ketamine treatment, transcranial magnetic stimulation,  ECT..... The point is that there is such a long road when it comes to treatment, there is so many options that I would argue with confidence that there is a possibility for absolutely everybody to get cured, to reach remission, and to be depression free.

If you are actively depressed, you are by definition, discouraged and you do not believe that this is a possibility. As a board certified psychiatrist, I'm guaranteeing you.   That this is not the possibility. This is a FACT !, and I am encouraging you to make the first step to seek for help and to embark on this journey of getting yourself better because it is important for you. But the moment you help you, it is important for everything and everybody around you.

When you're less depressed, you help yourself. You help your loved ones, you help your romantic partner, you help your kids, you help your parents. You have help your colleagues, you help your neighbors, you help your employer because a non-depressed you is a whole different person and can function at a way superior level and you deserve that so please! if anything about this conversation rings a bell, do not hesitate to make that first step. SEEK HELP!

I do hope this content shined some light on the question how to understand, recognize and treat depression