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Friday, March 31, 2017

Questions About Depression

Written by  Dr. Eva Hersh, MD

Dear Dr. Eva,

I am very concerned about my sister. We are both adults in our 20s. She has had depression on and off for many years, but this time it seems worse. She will sit and cry for hours and sometimes refuses to speak. She doesn’t want to leave the house at all, and I haven’t been able to get her to agree to see a mental health professional –  she says she’s tried that before and it didn’t help. I’m not saying very much to her either, because I’m afraid of saying something that could make it worse. Can you suggest what to say and what not to say, and any other ideas how I can help her?

Sibling

Dear Sibling,

Avoiding talking to your sister also communicates a message. Not speaking to her may make her feel more rejected, as if you think it’s no use to try to talk to her.

One good guideline is to speak in “I” phrases rather then “you” phrases. For example, instead of saying “What’s wrong?” or “What’s the matter (with you)?”  you could say something like, “I care about you very much and I want to do anything I can to help you.” Don’t be discouraged if she says something like, “You don’t love me, and there’s nothing you can do to help me.”  Those are typical depressive thoughts, but it it will still help her to hear you say supportive things, as often as possible. You can also tell her what’s going on with you, about your day – in other words, talk to her the same way you would if she were not depressed.

Your instinctive feeling that it is bad for her not to leave the house is correct. Start with her backyard if she has one, and try to get her to come outside with you or other allies for at least 20 minutes at a time. Twice a day would be ideal. Although medication and counseling are both needed as well, both the sunlight and getting outside the house may help to lift her depression.

I absolutely agree with you that she should be seen by a mental health professional as soon as possible. It might help her if you or someone else that’s close to her would, with her agreement, make the appointment and go with her to the visit. In a case of depression this severe, anti-depressant medication is almost always useful.


Dear Dr. Eva,

I have been taking two prescription medications for depression for more than five years. I am stable, feel well, and I haven’t noticed any side effects. I recently got involved with a new friend who is very warm and caring but is also pushing me to get off the medicine because her religion believes antidepressant medicines are poison and that psychiatry is of the devil. I don’t really think so, myself, but I have been taking this medicine for a long time and I wonder if it would be safe to try stopping it. What do you think?

Debating

Dear Debating,

Although I cannot be sure because I don’t know your history, given that you are doing well, are stable, and are not having any side effects it seems to me that you have a chronic illness that is being successfully treated, and there is no real reason to stop taking the medicine. If you do decide you want to stop it, don’t do that without medical supervision. Some antidepressant medications must be tapered slowly and with some, you can get rebound depression if it is stopped too abruptly. Most importantly, this should be your decision, not your friend’s.


Dear Dr. Eva,

I have been taking medicine for depression for about 18 months. It worked well and now I’m feeling fine. I don’t see any reason why I shouldn’t just stop it, but my partner thinks I should go back and see the doctor first. What is your opinion?

Feeling Better

Dear Better,

In this case I agree with your partner, for the reasons listed in my answer to the previous letter. Please keep in mind that more than half of patients who have one episode of major depression will have another. If you are going to go off the medicine, it’s important for you first to be well-informed on two things:

1) The possible effects of withdrawing from the specific medication you are taking and the best way to withdraw from it.

2) The early signs of recurrent depression, so that if you do need re-treatment in the future you can identify the problem early and not wait until you are severely depressed.

Eva Hersh is a Baltimore family physician. Send your comments and questions to her by email at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

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