From time to time everyone experiences feelings of sadness, but when these feelings linger or intensify or are combined with other emotions that negatively affect our productivity or ability to enjoy life, we call this depression.  

Other features often but not always associated with depression are:

• Decreased interest or pleasure in activities.
• Change in appetite
• Change in sleep patterns
• Anxiety or worry
• Anger, Frustration, or Agitation,Restlessness
• Fatigue, or Loss of Energy
• Decreased Concentration

How do you know if you have depression?  It takes a careful interview by a mental health professional.  Frequently, when an individual is feeling depressed, it is very difficult to illicit feelings in a quick office visit.  Specific questions must be asked in the correct manner for an accurate evaluation, much like any specialist asks in their field of specialty.  Feelings are not described too easily by any individual; for example, if asked how you are feeling and you answered "depressed," that is not sufficient enough for an accurate account of your feeling.  Try this:  Describe your feeling after viewing a beautiful sunset, or your first experience with loss, and see how long it takes you to descrbe that.  It was more than a few seconds, right?  Well, this is why the mental health interview is specialized.  Emotion takes time to describe, whether it is positive or negative; especially when negative.  The interview process should take approximately one hour.  
 
Let's talk about treatment.
Antidepressants?  What will they do?  Are they all the same?  Which one, if any, is right for you?  How long should you stay on them?  Does your insurance pay tof them?  What about cost?  Therapy?  Does it really work? How does it work?  What does it work for?  Does my insurance pay for this?

Antidepressants do work, but they are not all the same.  These differences can make you feel better or worse.  A careful psychiatric and medical history, as well as psychiatric family history, should be taken if this is your first time.  There are numerous factors to weigh when prescribing antidepressants; therefore, the samples in your doctor's  medicine closet might not always be the best choice.  Remember, the psychiatrist and psychiatric nurse practitioners have a medical background with a psychiatric specialty, much like any specialist; therefore, they are most qualified to evaluate for, and prescribe antidepressants.  Frequently, when an individual is  depressed, they have utilized all of their resources on the 

precipitating event which brought about the depression or on the dpression itself; therefore, they have lost all resiliency.  Sometimes, an indiviual is utilizing all their energy on the depression so they have nothing leftover; therfore, they cannot work, go to school, or interact with others.  This is where an antidepressant can assist.  An antidepressant can supplement the resiliency to begin treatment, and once treatment begins, assist until remission.  Once you have been prescribed an antidepressant, close follow-up is important to measure side effects and treatment goals.  These treatment goals should be continuously reviewed with your prescriber.  Insurance does pay for antidepressants.  Many are offered generic.

The American Psychiatric Association (APA) recommends antidepressants and Psychotherapy combined as the preferred treatment for depression.

Therapy does work for those appropriate for therapy.  How does it work?  Let's talk about Cognitive Behavioral Therapy (CBT).  CBT utilizes the principle that feelings follow thought; therefore, if a person has negative thoughts, they will experience negative emotions, and if that person can learn to create positive thoughts, they will experience positive emotions.  This might sound very simple, but it can be quite challenging for some without a therapist.  People frequently think in habitual ways, learned early in life.  CBT helps break these old dysfunctional habits and offers new positive ways of thinking.  When a person is experienceing depression, they are plagued with negative thoughts which in turn, invoke negatvie emotions.  Therapists assist depressed individuals to reframe some of their negative thoughts.

We now understand that the brain is plastic, not concrete.  When we learn something new, it causes a wrinkling in the cortex and it becomes easier to repeat what was learned.  We can continue to do this as we age.  This can be compared to a learned activity such as tennis or golf.  The same ca  be applied to our thoughts.   If we can reframe our thoughts to a positive way of thinking, its is a new learned behavior, and if we continue to exercis this way of thinking, our emotions will follow.  In fact, according to recent research in Archives of General Psychiatry 2010, it is suggested that CBT prevents relapse of depression.