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About Us . Salience Health serves those individuals struggling with depression and anxiety. When people are well, they may take for granted their ability to function at work or home. They enjoy their families, friends, and hobbies. However, when depression or severe anxiety takes hold, they may no longer feel productive, no longer enjoy the things they once loved, and their quality of life decreases. During these times, Salience Health is here to help. We have assembled professionals from psychiatry, psychotherapy, neurology, and primary care--all under one roof--to work together to give you the best chance at recovery. Our providers are dedicated to working with other specialties, both in and outside of our offices, to provide you with the best collaborative, outcome-driven care. You are not alone. Why do we call ourselves Salience Health? Great question. The word “Salience” means that something is of importance. To the staff and professionals of Salience Health, you and your recovery from depression are most important. We are unrelentingly committed to working with you to deliver the best, personalized, evidence-based treatments that will set you on your path to improved mental health. If you are ready to move from hopelessness to health, Salience Health is here to help you make that change. Visit our website below, or follow us on Social Media to learn more. www.SalienceHealth.comTable of Contents How to Use This Guide 1 What is Depression? 2 Is Depression the same for everyone? 5 What Causes Depression? 6 Getting Help for Depression 11 Treatment Strategies for Depression 14 How to Talk to a Loved One about Depression 26 Where do I start? 28I ntro If you or a loved one is facing depression, this guide offers a road map to recovery. We created this guide to better educate you, your family, and your friends about depression’s possible causes, impacts, and its available treatments. The more you understand the illness, the better you will be prepared to work with your provider to determine the best path to your recovery. So, what’s the best way to use this guide? A good place to start is to set aside some quiet time to read through it at your own pace. If you’re having trouble getting started or having trouble concentrating, understand that these are normal obstacles in depression, and they are not your fault. It may be helpful to sit down with a friend or family member and read through it together. Take your time. Make notes of any ideas that seem important or any questions you might have. Bring your notes with you when you meet with your care team. If you see the Salience Health Flower symbol next to the text, it indicates a good issue to discuss further with your provider at your next appointment. 1What is Depression? Depression is a common medical illness that affects the brain and body. Depression is also a state of despair. When people feel well, they may take for granted that they can function at work, school, and at home. That they can enjoy their families, friends, and hobbies. Once a person develops depression, all this can change. They may struggle to be able to function in important life roles and lose the ability to enjoy the things they once loved. When a person feels overwhelmed or threatened, they typically react in one of three ways: freeze, fight, or flee. When these defenses become overwhelmed, and the person cannot find a way to escape or cope, their brain will start to shut down. For the sake of survival, their instincts will tell them to hunker down, hide out, and wait for the storm to pass. When the stresses are ongoing, the brain sometimes never finds a way to emerge from shutdown mode. The person may feel helpless and/or hopeless. They may withdraw from life. Over time, physical symptoms may develop, including changes in sleep, appetite, and energy. When these types of symptoms persist for at least two weeks, it is characterized as a medical disorder called major depression. 2How do I know I have Clinical Depression? 2 out of 3 people with depression don’t receive adequate treatment The question we are most often asked is, “How do I know I have Clinical Depression?” If you are experiencing any of the following symptoms for more than two weeks, you could be struggling with clinical depression and should seek the help of a licensed professional. Feeling sad or in a depressed mood during most of the day Loss of interest in activities you once enjoyed Changes in appetite – weight loss or gain unrelated to dieting Trouble falling asleep, staying asleep, or sleeping too much Loss of energy or increased fatigue Difficulty focusing on daily tasks, remembering details, and making decisions Feeling restless, or slowed down Feeling irritable and anxious Having thoughts about death or suicide 16.7 Million Americans are affected by depression Women are 2x more likely than men to develop depressionThe Burden of Depression Of all medical illnesses, depression is one of the most severe in terms of how it affects a person’s life. As with other serious illnesses like cancer or heart disease, depression puts a tremendous burden on the person with the illness, and can create worry and concern among the people who care for them. Brief periods of sadness are common in response to life stresses, but these usually resolve without resulting in prolonged symptoms. When sadness or a loss of the ability to enjoy the things one usually values lasts for two or more weeks, and is associated with other mental and physical symptoms, we call this Major Depressive Disorder. The severity of a person’s symptoms is usually in direct correlation with their ability to carry out important life roles. Even mild depressive episodes can cause difficulty with energy, focus and concentration, and mood. Moderate to severe episodes may result in struggling to function at work, school, or home, and may result in them being unable to carry out parental or spousal responsibilities, and/or to withdraw from family and friends. At this level of severity, depression has a very negative impact on quality of life. One of the most severe consequences of depression can be suicidal thoughts and urges. Some people may have a single episode of depression from which they recover. Unfortunately, for many sufferers of depression, recovery is followed by another episode. In some cases, depression may recur many times over the course of one’s life. When a person suffers from depression and does not achieve full remission (no residual symptoms and a return to their normal level of function), the likelihood of relapse is increased. For some people, depression takes on a more chronic and unrelenting course that can burden them with depressive symptoms for years (Persistent Depressive Disorder or Dysthymia). Once a person has experienced an episode of depression, it is important that they learn to recognize the signs and symptoms that come with a relapse. One effective strategy is to periodically monitor their moods using a clinical tool designed to screen for depression. If their symptoms do return, recognizing this early allows their provider to evaluate and address them in a timely manner. Thus, they can modify their care plan and attempt to prevent the consequences of the illness becoming more serious.Is Depression the same for everyone? The experience of depression is not universal. People respond to the stresses of life in different ways, both emotionally and physically. For each one of us, our individual life experiences, our current situation, our physical health, and our biology and genetics all play important roles in how our depression shows itself. “My friends keep asking what’s wrong with me, but I don’t respond to them. I have a great job and a wonderful family. However, I don’t seem interested in them anymore. I’m tired all the time. I feel lonely, sad, and don’t have the energy to get things done. I feel like I’m a bad mom and a burden my family.” “I am ashamed to talk to anyone about my depression, I’d rather drink and push the depression away. When I wake up the next day, it is always back. I struggle to sleep, and must push myself through the day at work. My irritability and anger are pushing my friends and family away. Why is this happening to me?” “I am constantly bullied. My heart keeps getting broken, and my grades are falling. The anxiety I suffer from day after day, night after night, is unbearable. I feel as if I am drowning and want to stay in bed. How am I supposed to talk to my family about this? Or even my friends? I can’t be alone in this fight.” “My mother is 70, and I’ve started to notice some changes in her. She isn’t interested in any of the activities she used to love to do. She seems to have trouble sleeping more and more and even snaps irritably at the family more. I am worried about her because she seems to get confused more. Where do I need to go for help?” P erson 1 P erson 2 P erson 3 P erson 4 5Biological Factors • Genes may play a role in depression. Depression often runs within families. It appears that one can inherit a vulnerability to developing depression. • Other medical conditions are frequently associated with depression and may be a contributing factor. Depression is very common among individuals with: • Diabetes • Cardiovascular Diseases • Parkinson’s Disease • Autoimmune Diseases • Thyroid Diseases • Medications can contribute to depressive symptoms: steroids, chemotherapy, immunosuppressant agents, antihypertensives are a few examples • Hormonal imbalances are likely involved in perimenopausal and post- partum depressions • Other biological factors that can push the brain into depression mode include diseases with inflammation like lupus or rheumatoid arthritis • We are also learning that the common types of bacteria that live inside out intestines can sometimes make substances that push the brain into depression, when their growth is out of balance. When the brain is in depression mode, it’s normal to experience a loss of self-confidence and to become stuck in a cycle of self- blame. It’s important to remember that these are symptoms, not facts. Depression is not your fault! If you are suffering from depression, then you have a medical illness similar to having other medical disorders like high blood pressure or diabetes. As with any medical illness, the causes are usually a mix of factors: biological, social, and psychological. There can be many pathways to depressive illness. Next, you will find a review of some of the factors that may contribute to the development of depression. 6Next >