Depression is an illness that can be caused by a biochemical imbalance in the brain, situational stressors, or both of these.  Dr. Firestein helps by assisting you in determining the causes of the depression, the type of depression you may have, working toward reduction and elimination of the symptoms of your depression through counseling, and making referrals to physicians or other practitioners that can help with depression treatment when indicated. Below is an example of how Dr. Beth responds to clients questions about depression.

Dr. Firestein wrote a monthly Q & A column for the Healthline magazine called Uncommon Sense for seven years.  Below are excerpts from previous columns.

Question: What is the difference between feeling sad and having depression? My husband often acts aloof, withdrawn and uninterested in joining in with our family. He has also been avoiding his friends. If he is depressed can he get help without having to get on antidepressants?

Answer: Depression is something almost everyone wonders about at one time or another in their lives. People used to think that “the blues” were always just sadness and never even considered the possibility that it might be depression.  People were told to “get over it” or just change their attitude and outlook to being positive. There was no broad public understanding or what depression was and people who went to psychiatrists or psychologists were viewed as “crazy.”  These days there are more ads on TV for depression than almost anything else related to health and these ads try to educate the public about the signs and symptoms of depression. So how can we tell the difference?

Sadness is a natural human emotion that happens when people suffer a loss or disappointment. Losing a job, the breakup of a relationship, the death of a friend or failing a class are all situations that can evoke sadness.  Usually sadness is a temporary emotion that passes fairly quickly and most of the time people who are sad can usually keep up with their daily responsibilities and still find some things they can enjoy in spite of the loss.

Grief is a more intense reaction to loss that usually happens in response to death of a loved one, the diagnosis of a serious illness in you or a family member, a disabling accident or similar tragedies.  Grief includes sadness but lasts longer and is more intense. Grief is more likely to disrupt your relationships and life activities for a period of time. Sometimes there are physical and medical problems that occur along with grief and grief can also be emotionally and physically exhausting. Sometimes a person can get “stuck” in grief and it can turn into depression.

Depression may look similar to sadness and grief but there is a lot more to it. Depression is an illness that can be triggered by situational stressors or biological changes in brain functioning. The main symptoms can include chronic feelings of sadness, a decrease or absence of interest and pleasure in activities a person usually enjoys, isolation, loss of motivation, problems with concentration and memory, and sleep difficulties. Other symptoms include overeating or under eating, unexplained feelings of fatigue and exhaustion and sometimes physical symptoms like anxiety, heart palpitations or general achiness.  Symptoms vary from person to person and not everyone has all of the symptoms of depression.

Depression often has a genetic component but this is not always the case. Depression treatments include counseling and/or medication. Some depression is triggered by hormone imbalances, thyroid imbalances or other medical conditions. If you suspect medical issues, these conditions should be evaluated by a medical physician to rule out medical problems as a reason for the depression. Substance abuse can also trigger depression. Substance abuse related depression will not get better by counseling or medicine unless the addiction is also treated.  The good news is that there are many effective treatments for depression. If you are unsure whether what your husband is experiencing is sadness, grief or depression, consult a mental health professional and/or your physician to get more information and an accurate diagnosis.

Question: I know I am depressed and have been for a long time, but I’m actually too depressed to get out of bed or even make a phone call to make myself get in touch with a doctor or counselor. I can barely even get myself to write this email. I hardly eat at all or shower or do any of the normal things I used to do.  I live alone and the only thing that keeps me going at all is that I love my pets and have to take care of them. What do I do?

Answer: You are suffering from a depression that has clearly become disabling in its severity.  I have dealt with many people who have experienced   depression as severe as yours.  This is a dangerous level of depression and you cannot afford to procrastinate any longer on getting help.  Some people even experience suicidal thoughts and feelings when they are this depressed, though not everyone does.  Whether you are feeling suicidal or not, getting help is imperative.

If your depression is this severe and incapacitating you have a couple of different options.  First, you have to disclose your true condition and situation to someone outside yourself.  This can be a friend, family member, pastor, a psychologist or psychotherapist (you can find one online or in the phone book or through a friend’s recommendation) or even call a crisis hotline that can connect you with appropriate resources. You can even have a friend or family member or neighbor take you to the Intake Department of a psychiatric hospital or the ER of a local hospital or to do an immediate assessment. In most cases, admission to a hospital is voluntary, not required, unless you are actively feeling suicidal.

You may or may not need to be admitted to a hospital to stabilize your immediate depression and start you on some medication or therapy.  Don’t fool around or procrastinate on this issue.  It is a serious condition and you are in a serious situation.

If you do need to go to a hospital, you will need to contact (or have the intake worker help you contact) a friend or family member that can check in on your pets.  Hopefully, you have someone, even if it is a neighbor you don’t know well, to help out in a pinch.  Most people are kind enough to do something for a neighbor or friend in need. Most hospitalizations are quite short these days—usually a matter of a few days—and most programs will help you find and connect with a therapist. Hopefully, you have someone, even if it is a neighbor you don’t know well, to help out with your pets in a pinch.  Most people are kind enough to do something for a neighbor or friend in need.

Please know, however, that you probably will not need to go to a hospital to get help.  There are both private therapists and county agencies that provide services to those in severe psychological distress.  You can usually  find a therapist or an agency that can get you in right away or at least quite soon, although you may have to wait for a bit for an appointment if your situation is not an emergency.  If you find it too difficult to call, have a family member, friend or neighbor call a therapist or hospital for you and transport you there.

Whatever you do, please know that there is hope for improving your condition.  Whatever the reason for the severity of your depression, it can be evaluated and treated, either with medicine, counseling or both.  Don’t deprive yourself of the opportunity to feel better and get well. You will be so glad that you made the effort.