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depression

Physicians Speak Out on Depression

depression Depression is a painful and often debilitating disease that affects nearly everyone directly or indirectly.

In a recent study by Epocrates, over 500 clinicians shared their opinions on trends in diagnosis, gender differences, risk factors and personal experience with depression.

We encourage you to view the survey results, listen to a Q&A with a UCLA psychiatrist, and share your opinions below.
View the survey results »

Featured Podcast: Q&A Diagnosing Depression (9:52)

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Top Five Prescribed
Brand Antidepressants

  1. Lexapro
  2. Zoloft
  3. Effexor XR
  4. Wellbutrin XL
  5. Cymbalta

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Which of the following do you believe is most effective in treating depression?

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39 Responses

  1. ann

    i think the key to trying to get a handle on ur depression is to be aware of it and acknowledge it,accept it as it is part of who u are,i try to

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  2. b

    ive struggled with this inconvience for most of my life,from 7 till now 24..i have tried medication and all it did was put pressure on my head,is there a cure for this?seems like the more i gain the more i ache?what in the world?pf there is advce please share im 24 and feel 60,please respond life must go on.P.S this is lame,i feel yah!

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  3. Marty Johnson

    Although it’s not the cure for everything in the mental health field - I’ve seen micro-current (CME & MET) work with amazing results. I think that it’s probably rejected by most simply because it’s associated with the old electric shock therapy. I know that the military/VA is also using it based on studies that are 9-10 yrs old. Anything that helps in this field should be explored and tried (if appropriate) to help people return to a more “normalized” lifestyle.

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  4. tony

    reading those comments, really gives you an insight of people suffering with this debilitating illness or disorder. I am a 2nd year mental health student nurse, and I struggle with understanding the terms ‘disorder’ and ‘illness’ used intermittendly in psychiatry. However, there is no right or wrong. In my profession, what is important is showing empathy and understanding the whole person as each is different and will have varied experiences of depression. I am impressed with this website as it may bring people hope to know others have similar experiences.
    M..

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  5. SW

    Untill recently, I thought depression was something a person could control. I spent more then 22 years in my employment, promoting 3 times in the last 6 years, only to have a particular supervisor massively retaliate against me for reporting unlawful activities. Within a short time, I developed severe major depression (single episode). The stigma which goes with this is horrifying and humiliating. I have lost all personal and professional credibility along with self respect and confidence. I had no idea of the massive impact this would have on me emotionally and physically. I have now been “totally disabled” for the past 9 months, with very little improvement. I have learned that this is not something I or anyone else can control as God knows I have tried. The effect will be forever for my family and myself. If you cannot understand this illness without experiencing it. Those who think it is a choice are those who cause the negative, inaccurate public opinion. If you care about ill people, then be come a part of the solution instead the the trier of fact without knowledge, Rick Stotelmeyer. You work in the field…you should know better…knowledge is power.

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  6. Carol

    As a therpaist with twenty-seven years’ experience, inpatient and private practice and thirteen of those finally diagnosed with melancholic clinical depression (the kind where anxiety is a major feature), I’m intrigued by the many reactions I read here. I firmly believe that a screening by an experienced counselor or PCP who addresses the reality of possible biological contributing factors as well as the situational stressors is paramount. The need for medicine isn’t always present or even long-term.-For me, learned the hard way, it is, but do I thank God for it! Didn’t fix the longstanding issues, but a supportively confrontational therapist and God brought tremendous growth and healing.

    And Ruthy, sounds like you know what you need to do - or stop doing. I pray you don’t crash first. I’m a recovered workaholic/perfectionist. Actually living is amazing!

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  7. Sarah M., MD

    Dear Ann, NP,
    I very much appreciate your point advocating attention to personal mental wellness, to avoid one family member’s suffering extending to the whole family. Thanks.

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  8. […] psychiatrist Dr. Luo, clinicians’ comments and comprehensive survey results, please visit http://www.epocrates.com/insights/depression. Comprehensive dosing and drug interaction information for anti-depressants can also be found at […]

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  9. ruthy

    I am a RN with a biology degree, and currently working on my MBA. I am scared to admit to anyone I stuggle with depression. My only living parent died and within two weeks I was in the hospital with meningitis, ICU, in acidosis, O2 sats in the 80’s and I remember the doctors telling me I had gone into CHF. Spinal fluid with elevated WBC’s. It hurt to open my eyes, or turn my head, and I think part of me wanted to go to sleep and not wake up. This was my 10th hospitalization with meninigitis all viral, and all after a stressful event. I have never had a PCP ask me about depression, rather I have said to them I am stressed. The point of this is, even with the stress of daily living and a few significant events, a professional and one willing to look at depression in others and accept it, I find I cannot accept it in myself. So I work long hours, study, and don’t allow myself time to rest, for fear of not being able to stop crying if I let myself feel. Why is it that we can accept dx but not depression? My first husband died of an heart attack, my only child/daughter rejects me, because to her, I loved my work more than her, and I resently left my second hushand to move near my daughter and start a MBA education while I work full time as a Hospital Dir. Again, symptoms = stay busy, don’t feel, it will hurt to much.==Point we can talk about it, but even we professionals cannot accept it(depression) all to often.

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  10. hazel

    Depression is the most terrible condition, it affects ones whole life and those of family and friends too.
    There just are just not enough safety nets to help people with depression,and because of the stigma still attached to that condition some people try to struggle on alone until it sometimes gets too unbearable and sudical.
    Whilst I do not suffer from depression I have seen its effect.Sometimes people are perscribed tablets that zombiefy them. and also have to live with society labeling them. Depression comes in all shapes and sizes and can sometime be triggered off by a severe emotional upset. It is not a perfect world that we live in so some people feel the need to hide depressions to avoid labelling.

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  11. LP

    I have a son who had at age 20 had his fist episode of clinical depression in college. He is a talented athelete and played college basketball. He is doing well now throguh medication but of course I worry about him as my mother also suffered from depression throughout her adult life. ]He had a serous concussion in high school playing football and a study I just read indicated that about 25 per cent of NFL football players who had mutilple concussions suffer from depression. Have any of you had a serious concussion?

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  12. ann, np

    In response to Sarah M, I have a strong family hx of depression and married someone who suffers from clinical depression. In some ways, I think that depreassion is a contagious disease, it certainly affects the entire family.I firmly believe that the best way to support my spouse and family ( and patients) is to maintain a high level of mental wellness myself. Depression is a medical problem like many others — one needs to find the most beneficial therapeutic option and employ that to the best of your ability. Specifically, finding an excellent doctor and/or therapist who is knowledgeable about all treatment options is KEY.

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  13. […] Follow this link to Epocrates survey.  90% of clinicians noticed symptoms of depression in 20% … […]

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  14. S

    I am a health care professional who has been employed off and on for the better part of over 30 years. Yet, I have struggled with major depression that comes in a cyclic mode, staying 6-8 months out of the year since early adolescence. During my teen years, I made 5 suicide attempts - 4 by lethal levels of overdoses that nearly salvaged my kidneys, and once by a near drowning. I now own a gun which is carefully packed away less anyone else should find it, but is there for me if I should ever completely tank again. I blew three marriages, had a couple of bankruptcies, and made my spouses miserable and my children happy to leave home. I spent 20 years going in and out of psychiatric hospitals and living in what seemed to be a bottomless abyss of desperation. Finally, one of my doctors got the right pharmaceutical mix and dose, although it’s much higher than anyone, including the manufacturer, would have recommended. I still struggle with depression. One day, my liver may rot from the long term medication use. I will gladly take the risk and if my liver gives up someday, I will still have had more than I had before. In the meantime however, I have a life. I have a marriage that’s no better and no worse than than of my co workers. I am able to go to work daily, look people in the eye, smile and be of service to others. My own patients get better because I am no longer so cognitively impaired by my depressive mental illness. Yet my current PMD is appalled at my medicine regimen and can barely disguise his contempt for such a medication regimen and for the lack of sanity he perceives must go with it. At this point in my life, what he thinks really doesn’t matter any more. He didn’t live in my shoes. He is so clueless he thinks cancer and such ilks are the worse kinds of pain. Wake up my physican comrades and listen to your patients. You might learn something. You might find out that most mental illnesses have physiologic origins and like diabetes, cancer, strep and gallstones, need to be treated with the same respect. Whether the answer for your patients lies in drugs or in some alternative modality, the bottom line is what it takes to get them better. Frankly, I wouldn’t care if my doctor danced around a campfire of smoldering chicken feathers if that what it took to feel better.

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  15. Courtney Edwards, RN

    I have had many experiences with depression in my own family and with my patients, but two weeks ago I had the most eye-opening experience of my life. My ex-boyfriend and best friend called me at 3am expressing that he wanted to end his life. He was ironically scheduled the following day to see his PCP and discuss anti-depressants.
    Being 6 hours away, I did what I knew was best to help him by calling his parents. He was placed on Celexa and Ativan prn, but refuses psychotherapy because he feels it is not necessary. I am sure this is not the only case of a 20-something male feeling depression/suicidal ideation shows “weakness” and refusing treatment. I am worried the pharmacotherapy will not work alone without some sort of counseling.
    I am grateful that I happened to open this email and have seen some of your comments. I am hoping the idea of acupuncture may work as well. Anyone else have any other suggestions to getting a stubborn, proud young male to see depression and, furthermore, therapy is not a sign of weakness?

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  16. John W

    People who point to lifesyle change to reduce stress and depresssion miss a very important point.People have different abilities to deal with stress. Some patients may have very few coping skills.
    Pharmacotherspy allows people to regain the ability to deal with their depression and participate in everyday life.Once they begin to improve then they can use a combination of counseling and medicine to treat their depression.
    Most depressed people are ill enough that they can not plan, function, or participate in lifesyle changes.
    An analogy would be an overweight person with severe hypertension.If you stress weight loss only without antihypertensive therapy,you may end up with severe end oragan damage.

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  17. C

    I have heard of many people having great success with acupuncture. It is proven to boost the immune system and heighten awareness to the triggers leading to disconnects. It worked for me and there are zero side effects!

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  18. rosalind B MD

    I have been treated for depression for at least 15 years using three drugs. My major symptom has been fatigue though I have had suicidal ideation in the past. The fatigue has been so overwhelming that I have had to take naps at work. Provigal prevented me from falling asleep at the wheel. Ten years ago I had two small strokes and had an ASD closed.

    I finally asked for a second opinion dispite the fact that my psychiatrist was very helpful and supportive. He left for another job and I felt it time to try a second practise.

    My second opinion suggested that I get a sleep study. I have severe sleep apnea and am now on CPAP. My fatigue is virtually gone. I am off CPAP, Ambien, and my estrogen replacement. I continue to take the Lexapro and Wellbutrin My sleep index score is high enough to explain the increase in my pulmonary pressures to cause the paradoxical clots passing.

    Please spread the word that sleep studies should be part of the work-up for depression associated with fatigue especially if it is unresponsive to antidepressents.

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  19. Michelle P

    I have struggled with depression since age 12 and I’m now 40. I was diagnosed with Major Depression for 15 years before I was correctly diagnosed as Bipolar II. My medications have given me firm ground to stand on as I keep trying to get better. I wouldn’t live without my meds. As an RN, I fully understand their benefit. I HAVE made some lifestyle changes such as a lower stress job that fits my personality (this is easier to do for a nurse I realize), regular exercise, eating healthier. Despite all of this, I can’t prevent the depression from returning, but I can say that the episodes aren’t as severe, and for that I am grateful. I feel it’s up to each person to decide what the best course of treatment is for him/her. One thing doesn’t work for everyone, but if you can find what DOES work for you, then by all means, DO it!

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  20. BKLeland MCMS PA-S

    Depression secondary to medical conditions(very commonly severe back pain or chronic conditions) have been among the most difficult for me to treat. I always ask about and recommend certain life style changes to help reduce stress. However many people dont have physical activity as an options in addition many of these patients are very hesitant to start pharmacotherapy.

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  21. Karen Lighthall

    I am not a physician, but an RN who was placed on Effexor XL to determine if it would help chronic pain resulting from a back injury/surgery three years ago. Withim a few days I was falling asleep without any warning–like a Narcoplexia pattern. I totaled my car. It affected me cognitively in a neg way and was often unable to complete sentences or remember what I had been saying. My friends said I was a different person altogether. Naturally, I stopped this med rather quickly and the symptoms did not return, but it made a mess of my life and I am unable to afford a car due to income restrictions secondary to my disability. I understand, as with all medications, people react in various ways, but for me it was like taking poison and it was slowly killing me.

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  22. J. Koch

    Pharmacotherapy (passive therapy) and life style change (active therapy) provided comfort for both patient and doctor.

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  23. John Luo

    I am quite honored to see so much commentary here. I think one of the powerful things here on the Internet is that so much can be shared so quickly. On the other hand, there is an issue of how a quickly written comment can be interpreted as being insensitive.

    I appreciate that patients want to do whatever is necessary in order to not have depression, and that it can have a tremendous impact on their lives as well as the lives of their loved ones. Pharmacotherapy is often used first because in our pressured lives to produce quick results, perhaps not by choice or due to laziness, but due to necessity. Lifestyle change may be overlooked as an option to improve the situation, but certainly is not the only or preferred treatment modality. The best treatment needs to be individualized to the needs of the patient, and there is certainly no one size fits all treatment.

    Depression can be a serious illness, and although the stigma is decreasing in the public eye, it is still present. I am pleased to see so many postings here on this topic.

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  24. Beth

    I have been suffering from depression for 30 years and went undiagnosed until I found an amazing PCP when I was in my late 30’s. She gave me one of those written test to screen for depression, tried an antidepressant (which worked for me) and refered me to a very good psychiatrist. I concur with Dr. Wayne Lamb on this one. I also see a psycotherapist on occasion, but finding one I felt comfortable with took years of trial and error. Blessings to each of you as you work to bring hope and healing to those you serve.

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  25. Judy

    I think I suffer from some kind of anxiety attacks that come on without any warning. I get an extremely “weird” feeling that is very hard to describe. My body goes kind of numb, but it is a horrible kind of feeling, from head to toe and my tongue goes numb. I get a horrible overall feeling before it happens, so I know it’s coming. They last anywhere from a few seconds to several minutes. I am on Cymbalta 60mg. for Fibromyalgia and Klonipin 1mg. PRN for these alleged attacks. It used to work, but, now doesn’t. Has anyone had a similar experience? Any advice?
    Thanx

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  26. Cassandra

    As a person who has suffered from depression since the age of 12, I would to weigh in on this topic. I come froma long family history of depression, alcoholism, drug addiction & bipolar illness. In fact, 5 out of 8 of my immediate family are on anti-depressant medication.
    I tell my patients (I am an NP) that depression is no different that HTN, DM 2, or any other treated disease process. There’s no shame w/ those diseases and should be none w/ depression or related psych dx. One would not (usually) try to “wean” oneself off of insulin or anti-hypertensives, so we should present it as such to our patients. Depression is a chronic if waxing and waning disease - but usually treatment is long-term, maybe even life long.
    I believe the many bouts of depression I have suffered have made me a better provider, and more understanding of my clients’ pain. Much has to be done to increase awareness and decrease the stigma of the biochemical disease of depression. It’s not a weakness. Again, I tell my patients that the strength is in realizing that they need and can get help.

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  27. Tom Mc.

    I can only speak as someone whose father committed suicide recently. His oldest brother died in a mental institution after three suicide attempts. His sister underwent numerous electro-shock treatments for depression. One of my father’s other brothers was a highly functioning alcoholic, and another brother never got out of bed for the last two years of his life, except to go to the bathroom. I think there could be a genetic link to all of this.

    I have been on a SSRI for about 15 years, sporadically. Now I am taking two antidpressants and a mood stabilizer. I have also been in psychotherapy sporadically for the past 30 years.

    What makes the situation difficult sometimes is that I must own firearms, I am a police officer. My therapist is probably more disturbed by this than I am; she has never had a patient who had a legitimate reason for owning multiple firearms, or carrying one concealed when not at work.

    To get to the point, I would not be alive if it were not for psychothropic medications.

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  28. Amy, RN

    This is mainly in response to Rick Stotelmeyer & John Luo. I don’t know if either of you are “medical professionals” in any capacity, but you certainly do NOT know Depression!
    How Dare you state that “patients see pharmacotherapy as a much easier option,” rather than a “lifestyle change”??!!?
    I have struggled with depression since the age of 11, which means, as most true professionals would agree, that it is a genetically~based depression; particularly when taking into account the multiple family members with depression &/or alcoholism (which is usually masked depression).
    Would you suggest to a suicidal 11~year~old that she “make lifestyle changes?” I have worked many & varied jobs, with varying stress levels; my personal life has ranged from quite content to total upheaval & back again. Through it all, the ONE CONSTANT is the Depression.
    Yes, I have been through therapy, quite a few times; I have been in support groups; I have a supportive husband & an extremely supportive group of close friends; I am not overweight (I’m actually considered quite attractive & young~looking for my age); I have never had substance abuse issues; I have had some great accomplishments in my life, such as graduating from Nursing School with 5 children; and yet, the ONE CONSTANT is Depression. I have tried multiple meds, with at best, short~lived relief, and at worst, horrendous side~effects.
    My depression affects my marriage & my children, despite my best efforts, HOWEVER…one thing I can say with Absolute Certainty is this~a “lifestyle change” is NEVER going to cure, or even help, my depression. And if you truly believe that pharmacology is “the easy way out”, you have obviously never experienced, or even known anybody who has experienced some of the god~awful physical/neurological/emotional/mental side~effects of some of these meds!
    I truly hope that neither of you are in any way “caring for” any depressed people, as coming across your negative commentary & condescending attitudes would almost certainly drive them to suicidal ideation!

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  29. Rick Stotelmeyer

    I do believe that a small percentage of people need pharmacotherapy, however, in my experience most would benefit from lifestyle changes. This includes, but is not limited to, substance abuse such as Alcohol, etc. Pretty much anything that causes an individual to exercise poor judgement in day to day living that can ultimately lead to feeling helpless and the corresponding depression.

    Rick Stotelmeyer Senior Psych Tech, Coalinga State Hospital

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  30. Wayne D. Lamb, DVM

    To Mark J. and any other interested PCPs or pDox,
    As a professional myself who had suffered from this debilitating disease, I would say this;
    1) Join http://www.depressionforums.org and find out what those suffering from depression are going through and what they really need from you.
    2) Depression is a dysfunction of neurotransmitter, either temporal (situational) or permanent (genetic) and needs to be approached as thus, the diagnosis is simple enough, if they have had it since an early age, it’s probably genetic.
    3) Explain to your clients that any medication you choose my not be the right ‘guess’ for them and if one doesn’t work for them that there are others that can be tried. That there is no blood test to determine which neurotransmitter is amiss.
    4) PCPs, if you are going to treat it, keep up to date, otherwise refer to a pDoc. The goodwill you generate will far outweigh the client you may lose when they lose confidence in you.
    All of the above can benefit you and your clientele… How does it go? “Do No Harm?”

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  31. Trish S.

    I empathize with Michael Mayfield. My husband is Bipolar 1, Thankfully, he only cycles very infrequently, but when he does it is totally exhausting for the whole family. No one wants to know! From the first, my collegues refused to acknowledge it was happening, despite my pleading for help. The poor man had to completely decompensate before anyone assisted,By that time he had lost half of his practice. It was totally avoidable, but our Professional “friends” refused to accept my diagnosis.. it was easier to call it “burnout”. Once the diagnosis was made,again our “caring professional friends” chose to ignore the issue. I never felt so alone! God knows how he felt!
    Second time around, I avoided our local medical group and got him help via the Outpatient Department at a city hospital, where no one knew who he was.
    Throughout both episodes I had to cope as best I could with both his and my practices. Few called to see how he was doing, and only one offered help. Mental illness is still stigmatised…I would not have beleived how much so , had it not happened within my family.
    The good news is that he is now in good follow-up care, and doing very well.

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  32. Steph - PharmD student

    Depression often occurs when the brain responds inappropriately to stress - this is a chemical problem that typically requires a chemical solution. However, when a person experiences depression, they do not think “my neurotransmitters are misbehaving, I should seek professional help,” they feel the emotional symptoms of depression. Their response generally involves development of pathological coping mechanisms - this is a psychological problem that requires a psychological response. To effectively treat depression - both chemical and psychological factors must be addressed.

    Thanks to loving friends, family, my primary physician, and a great shrink, I have successfully lived through an episode of major depression. I highly recommend Dr. Peter Kramer’s book “Against Depression” for anyone interested in learning more about this physical and mental illness.

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  33. Michael O Mayfield

    I’ve been suffering from depression for 16 years and it is worse and worse by the day. Nothing is helping meds or anything. I have no insurance so no one will help when I heve no money or insurance. Like I said getting worse by the day.

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  34. P Mack

    I agree that it is shocking that so many of our collegues are so ignorant of the physical disease called Depression. Get out of the Dark Ages, and start to treat your depressed patients with the respect they deserve. The combination of medication and psychotherapy, whichever form you choose, is the best route to take. The recent work that is being done on recognizing the chromosomal and gene differences in how different people respond to stress, brings “mental illness” into the realm of general medicine.”It’s all in the genes!”, just like Diabetes, Thyroid problems etc..

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  35. D

    I believe most cases of depression are mental yet the combination listed above of fewer work hours, a new job, etc. is sometimes in this day and age difficult to accomplish. I also believe that a lot of cases of depression come from stress of ones current job. But I also believe that medication is not always the answer yet it is usually what happens when one is diagnosed with depression. I also think they need to recommend lifestyle changes before medication.

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  36. Sarah M., MD

    When a family member or other loved one suffers, it is in some ways worse than suffering one’s self. And yet, when depression arises within the dynamics of a family or friendship – are those very same friends and family the best ones to support an individual through healing? I am interested to know how other physicians have successfully helped a depressed friend or family member who is undergoing counseling and/or pharmacotherapy for depression.

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  37. Mark Johnson

    I find it shocking that 17% of respondents perceived that physicians do not consider depression a disease and therefore do not diagnose it. There is certainly transient reactive depression to life events, but at the other extreme there are those patients with severe depression who may not respond at all, or relapse no matter what the treatment. What more can be done to educate/penalize the physicians who ignore the pain and disability of depression????

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  38. John Luo

    I believe that patients see pharmacotherapy as a much easier option versus a lifestyle change, such as a new job, fewer work hours, or a diet. Even though these factors should be utilized together with medications and therapy.

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  39. M. Kain

    Interesting that most physicians cite stress as the leading risk factor of depression (80%), but then recommend pharmacotherapy (96%) significantly more often than lifestyle changes (60%).

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