Health Break: Navigating depression: Signs, support and treatment

Camille: Welcome to Health Break by UPMC Health Plan, your quick guide to health, wellness, and how to make the most of your health insurance plan. I’m your host, Dr. Camille Clarke-Smith. This is your…Health Break.

Depression is one of the most common mental health conditions, yet it often goes unrecognized or untreated. At UPMC Health Plan, we’re committed to helping members understand the signs of depression and access the care they need.

In today’s episode, Dr. Alin Severance is here to share what depression looks like, how to seek support, and the resources available for managing this condition. Welcome, and thank you, Doctor Severance, for joining us on today’s “Health Break.”

Dr. Severance: Thank you so much for having me, Camille.

Camille: So jumping into the first question, can you share some common signs of depression that people should look out for?

Dr. Severance: Sure. Persistent feelings of sadness and difficulty enjoying activities that usually give someone joy are the core symptoms of depression. But it’s more than just that. Everybody can feel sad, appropriately so, and there are times when we just don’t enjoy things. A person with depression often feels overwhelmed by their problems and beyond or even unworthy of help. When faced with a new stressor, they’re less able to identify a solution or to enlist assistance from supports in their life.

Thought processes can slow. Concentration requires significant effort, and fond memories are increasingly difficult to recall. Sleep quality and energy decline. The digestive system is disrupted. Pain experiences can be heightened and libidos diminished. Problems begin to accumulate and fester, contributing to a sense of despair and diminishing the ability to take pleasure in normally enjoyable activities. Suffering may become all-consuming, and in social isolation, the person is closed off to positive experiences and begins to question their own self-worth. In the extreme, they may conclude that suicide would be a kindness for themselves and other people in their lives.

I will say, not everybody identifies with being depressed, even if they are. Some people might focus more on physical symptoms like headaches or stomach aches, muscle weakness, and fatigue. That being said, it’s especially common in patients living with chronic and more severe disease—most commonly heart disease, kidney failure, chronic pain, certain forms of cancer, autoimmune disorders, and stroke. And it makes some sense. Many chronic illnesses are a burden. They can be depressing in and of themselves, and they’re often associated with limited money, physical limitations, loneliness, and the threat of pain or death.

There’s also a bidirectional relationship between physical and behavioral health. Physical illness can exacerbate depressive symptoms, which can then complicate the recovery from the physical illness. If you’re depressed, you’re less likely to seek treatment. You’re less likely to receive treatment or follow treatment recommendations. Just think about how much harder it is to take good care of your diabetes if you’re also depressed at the same time. So we’ve actually been able to demonstrate that effective treatment of depression is associated with better physical health outcomes as well.

I will also add that it’s actually very important to bring this to the attention of your primary care physician. There are a number of medical conditions that actually present like depression. And people might think that, oh, this is “just depression.” When it’s actually a medical condition that hasn’t been identified. I’ll throw out a few examples that are fairly common. Hypothyroidism or low thyroid hormone levels—people often look depressed and feel depressed. Putting them on an antidepressant is going to be a lot less effective than treating their thyroid disease. There are a number of vitamin deficiencies—vitamin B12 comes to mind, which can be associated with an allergy to gluten from celiac disease. That’s not all that unheard of. And treating the underlying medical condition often completely eliminates the mood symptoms.

Camille: Thanks, Dr. Alin, for sharing that. I know I’ve seen a couple of my own clients as a personal trainer dealing with some of these issues as well. So now I’ll be able to pick up on some of those commonalities. And so, share with me, if someone recognizes that their loved one has some of these symptoms, how can a loved one support someone struggling with depression?

Dr. Severance: This is such an important question. So there’s many practical strategies for responding to depression, such as getting more exercise, getting outside and getting some sunlight, increased socialization. But they’re actually quite difficult to implement when someone is depressed. Even small tasks can feel draining when you’re depressed, and there’s just a lot of inertia to overcome. That they may make plans and then run out of steam before they can actually get started.

Inviting your loved one to join you for a walk outside and even meeting them at their house to pick them up, it takes away some of the burden of planning and following through. Other small things: offering to help them with daily tasks like meal preparation or cleaning, or accompanying them to appointments, that can make a difference. Things are less likely to pile up. They’re more likely to make those important appointments.

Kind of on the same lines, if you, out of a place of love and concern, ask them whether or not they’ve considered making an appointment with a therapist or talking to their PCP about feeling depressed, that makes it safe and OK for them to talk to you about depression. You’re normalizing their experience or removing some of the stigma. It may not be something that they thought of, honestly. You could also offer, “Can I help you get this appointment or can I help you start on that search and make phone calls?” So you can really make a big difference by being there as a support and providing, like, hands-on help.

Camille: Decreasing those barriers, right?

Dr. Severance: Absolutely.

Camille: So what treatment options are available for those experiencing depression?

Dr. Severance: So there are a number of forms of individual and group psychotherapy. I’ll just mention one, in particular. Cognitive behavioral therapy is a more commonly available one that many people have heard of.

Sort of the idea behind cognitive behavioral therapy is that when somebody has depression, that some of that is explained by faulty or unhelpful ways of thinking, and some of that is also because of unhelpful behavior that kind of reinforces the feelings of depression. So on the cognitive side, it tries to help people change thinking patterns away from unhelpful patterns towards helpful, more positive patterns. So instead of just focusing on the negative possibilities, they will challenge them to think about some of the positive things that could happen that they weren’t initially thinking about. On the behavioral side, the therapist works with the patient to help change behavioral patterns away from unhelpful patterns towards helpful ones. And at a basic level, that’s things like getting out of the house, but not avoiding certain problems that might be stressing them out like getting their taxes done or having a difficult conversation with your boss at work or, you know, talking with their spouse about something that’s been bothering them.

Many studies have suggested that the specific form of therapy is less important than the bond between the person and their therapist. So it’s very much OK to try a different therapist if you don’t feel a strong connection upfront.

I’ll also say that the number of medications for depression have increased significantly over the past several decades. At this point, we have many effective and safe options, including for pregnant women. I’ve personally seen many patients have a full recovery, even after a poor response to several medications, so it’s important to work closely with your doctor and to keep trying.

Lastly, there’s, you know, lifestyle changes. I mentioned before about exercise, but mindfulness meditation, social support, they can all make a big difference.

Camille: How can someone take the first step in getting help if they’re struggling?

Dr. Severance: Talking to your primary care doctor is always a great first step. If you already have a therapist, or if you’re thinking about getting a therapist, that’s also a very good first step.

At the Health Plan, we have a number of resources, such as behavioral health coaching. And I should mention that all of our behavioral coaches are actually licensed mental health professionals with a lot of experience. So, they are going to have a good understanding of what you are going through and what might be most helpful.

Camille: That was a lot of information, Dr. Severance, and I appreciate it. Thank you for joining us on today’s “Health Break.”

Dr. Severance: Very glad to be here. Thank you.

Camille: If you or a loved one is experiencing signs of depression, reaching out is the first step toward healing. Members can also speak directly with a licensed behavioral health coach by calling 1-888-777-8754 (TTY users should call 711) Monday through Friday from 8 a.m. to 5 p.m. Remember, help is available—and taking that first step can make all the difference.

Find show notes and more information at upmchealthplan.com/podcast. Join us as we continue exploring health, wellness, and how to make the most of your health insurance plan in the next episode of Health Break.

This podcast is for informational and educational purposes. It is not medical care or advice. Individuals in need of medical care should consult their personal care provider. Views and opinions expressed by the hosts and guests are solely their own and do not necessarily reflect those of UPMC Health Plan and its employees.