News that Senator John Fetterman, a Democrat from Pennsylvania, has reported to Walter Reed National Military Medical Center on February 15, 2023 to be treated for clinical depression sparked a national debate around the need openness about mental health problems. This comes after Fetterman suffered a near-fatal stroke in May 2022. raise questions about possible links between stroke recovery and mental health.
The conversation asked John B. Williamson, an associate professor of psychiatry and neuroscience at the University of Florida, to explain when depression becomes a crisis and what inpatient treatment entails.
What is Clinical Depression?
Clinical depression, or major depressive disorder, occurs in 20% of the population throughout life. It can surface in different ways and vary from person to person.
Symptoms of clinical depression include feelings of sadness and loss of interest and motivation to participate in once pleasurable activities such as hobbies. Other symptoms include changes in appetite – either increased or decreased – changes in sleep patterns, whether too much or too little, loss of energy, restlessness, and difficulty thinking and concentrating. To speak of clinical depression, these symptoms must last for at least two weeks.
A form of the condition can also occur in the context of stressful situations, such as the death of a loved one, divorce, or job loss. Depressive symptoms can also occur in addition to and due to other disorders and medical conditions such as stroke and thyroid disease, and these conditions can make recovery more difficult.
Severe depression can mimic other conditions, including dementia, where a disability in thinking is significant enough to interfere with a person’s ability to live independently. It can also worsen quality of life in old age. Depression has also been linked to depression higher mortality rates from any causesuch as cardiovascular disease.
Untreated depression can negatively impact overall health and quality of life.
When does depression become an emergency?
An acute mood change that lasts for weeks or is accompanied by thoughts of harming yourself should not be ignored. In some cases there may be an emergency situation.
Depressed mood, whether in a major depressive episode or in the context of another problem, can become an emergency situation when thoughts of suicide arise. Suicidal thoughts can be passive, such as preferring not to live, or active, meaning an explicit desire to hurt oneself. Broadly speaking, this means having ideas about ending one’s life.
It is important to understand the signs and risks of suicide to help prevent suicide, both for yourself and others. Feelings of hopelessness, agitation and lack of reasons to live are suicide vulnerabilities. This vulnerability increases with poor sleep and risky behaviors, including substance abuse. Additional noticeable signs may include withdrawal from friends and family and an increased preoccupation with death.
If a person is expressing suicidal thoughts, or a desire to hurt or kill themselves, immediate attention is needed. Help is available through the 988 Suicide and Crisis Lifeline and any emergency care.
What Is Inpatient Care for Depression?
Inpatient mental health care is helpful when a more controlled environment is needed. This environment is important for patients at increased risk of suicide and may also be a useful tool in the management of substance abuse, hallucinations, and paranoia or mania in the context of bipolar disorder.
An inpatient care unit is intended to be a quiet environment with 24/7 supervised care. Services include evaluation by professionals and may include medication management as needed. Hospital care facilities usually offer individual and group psychotherapy options, as well as art therapy and other expressive therapies such as writing. And they may include education about mental health management.
The primary goal is to stabilize the patient, help them develop coping skills, and connect the patient with services to prevent future inpatient care needs.
The average stay in an inpatient unit is about 10 days. It is possible to be admitted voluntarily to intramural care. Others are admitted by a doctor or other qualified person, in most cases a parent, spouse or adult child. Admission sometimes occurs through an emergency room visit or through communication with a healthcare professional. Sometimes, for example, a therapist or doctor can facilitate the admission of a patient.
Is Depression Treatment Effective?
The good news is that depression responds well to treatment. In cases where suicidal ideation with an immediate risk of harm is not present, depression can be treated with psychotherapy, medication, or a combination of the two. There is a much evidence for the effectiveness of these approaches.
Clinical depression can go into remission with psychotherapy or the use of medication. Unfortunately, about half of people who experience clinical depression experience chronic or recurrent symptoms. Long-term treatment and self-care including psychotherapy and medication may be required.
There are additional treatment considerations when there are active suicidal thoughts. It is important to discuss these feelings with a medical professional. GPs often treat depression with medication; just over 13% of Americans take them. However, it may be helpful to seek treatment from mental health specialists such as psychiatrists, psychologists, psychiatric nurse practitioners, and other licensed mental health professionals.
A conversation with a primary care professional or mental health professional is a good way to get started with assessment and treatment. People who are being treated for suicidal thoughts are much less likely to commit suicide.
The Substance abuse and mental health administration operates a national helpline to assist in facilitating appropriate treatment referrals for patients (1-800-662-HELP).