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Depression Nothing To Sneeze At

November 20, 2003

Heather Heilman

hheilman@tulane.edu

Maga Jackson-Triche seated at a table Depression is sometimes called the common cold of psychiatry. The comparison is apt in the sense that depression is extremely prevalent according to some estimates, 16 percent of the population will be clinically depressed during their lifetime.

But thinking of depression as something like the common cold might lead you to mistakenly conclude that it's relatively harmless. In fact, depression negatively impacts every aspect of a sufferer's life and places a profound burden on society.

"Depression really is a systemic illness that affects every aspect of a patient's health," said Degan Dansereau, chief resident in psychiatry. Studies have found that after a stroke or a heart attack, patients with depression are more likely to die in a 10-year period than those who are not depressed.

And evidence suggests that it costs employers more than any other chronic illness in terms of lost productivity. "They either can't get to work or they can't perform at work. And it's prevalent enough to be a societal problem," said Maga Jackson-Triche, associate professor of psychiatry and the author of Beating Depression: The Journey to Hope, a comprehensive guide to treating and managing depression that was released last year.

Depression is defined as a sustained depressed mood or a lack of interest or pleasure in most activities, combined with other symptoms like a marked increase or decrease in appetite, insomnia or excessive sleep, fatigue, agitated or retarded motor activity, inability to concentrate, feelings of worthlessness or inappropriate guilt, or thoughts of death or suicide. It interferes with sufferers' ability to take care of themselves, uphold their relationships and meet work obligations.

The good news is that mild to moderate depression usually responds well to treatment with antidepressants, cognitive therapy or both. But many depressed people don't seek care. "One of the problems with depression is that people feel hopeless, like nothing can help them," said Jackson-Triche. "And a lot of depressed people don't realize what's going on. They think they're just feeling bad. They don't know it's a medical condition and that help is available."

Another problem is that care is sometimes hard to find in rural areas or poor and underserved urban neighborhoods. A group of students from Tulane University School of Medicine is working to identify depression in one such neighborhood in New Orleans and help those who need it get treatment. The Public Outreach Depression Screening program was initiated and organized by students and is overseen by second-year student Pooja Sukhwani with the help of Paul Rodenhauser, professor of psychiatry.

With the support of the New Orleans health department and the Louisiana Department of Health and Hospitals, students will visit the health clinic in the St. Bernard public housing development several times a week to offer free depression screenings to patients. The idea is to reach out to a population that bears a heavy risk for depression but who may be particularly unlikely to get care. Those who agree to the screening will answer the questions from the Beck Depression Inventory, which is the standard for diagnosing and monitoring depression.

The results will be shared with the patient's doctor, who will offer treatment if appropriate. Antidepressant medication and cognitive therapy with a social worker are available to patients at the clinic. Dansereau is offering doctors at the clinic continuing medical education training in the treatment of depression by primary care providers, who as a group see and treat more depression than psychiatrists.

There's a research component to the four-year project. Students will track how many patients are diagnosed with depression, how many accept treatment and how successful the treatment is. They think they might find that those who are successfully treated for depression will show tangible signs of improvement in their livesthey'll do a better job of getting their kids to school, or rely less on public assistance, engage in more social activity or involve themselves in their community.

Maintaining good relationships and social activity also can help prevent a relapse, as can healthy lifestyle habits like exercise, eating well and generally taking care of oneself, according to Jackson-Triche. "Those are things we think are protective, although they haven't been studied," she said. "We tell people to do those things and keep tabs on their mood."

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