Dorolei: How can you differentiate between a mild, temporary depression ("a bad week") and clinical depression? I often get depressed for days at a time but always seem to break out of it by myself. Should I see someone? Or just practice more "positive thinking" or other such self-help techniques?

Everyone feels blue once in a while, has a down day, or even a bad week. But if you regularly suffer from feelings of hopelessness, despair, or even just the inability to feel pleasure in activities that you usually enjoy, and this state of mind lasts for two weeks or more, you should seriously consider obtaining a psychiatric evaluation. The reason that seeing a psychiatrist (rather than a psychologist, social worker, or other mental health counselor) is particularly helpful is because in general psychiatrists are the most expert at accurately diagnosing and treating depression. There are a number of different types of depression and different causes of depression. If you are indeed suffering from it, many different medications are available that may be particularly helpful and effective in relieving your symptoms.

Psychiatrists are trained as M.D.s before they specialize in psychological illnesses. In an initial evaluation of a patient with suspected depression, a psychiatrist will take a very careful history not only of your personal and psychological life but also a medical history. You may be asked to get a physical exam from an internist and the psychiatrist may order some blood tests (such as thyroid or other hormone levels) to rule out possible physical causes of your depression. The doctor may ask about your diet and your use of tobacco and alcohol since these may also contribute to depression. Most importantly, the doctor will attempt to make a careful and accurate diagnosis of the particular kind of depression you are experiencing BEFORE initiating any type of therapy.

Chronic low level depression, perhaps the kind you are experiencing, is called dysthymia and is distinguished from an acute major depressive disorder, or from a cyclical mood shift condition known as bipolar disorder (formerly called manic depression). The psychiatrist may also recognize circumstances in your current life, or anniversaries of past losses, that are contributing to your recurring sad feelings. Finally, your doctor may prescribe an antidepressant medication to get you feeling yourself again and to help you cope with your present life situation. Of course, the medication may take several weeks before you feel the full benefit, but many people begin to feel some relief of symptoms sooner than that. The best treatment for most types of depression is a combination of psychotherapy and antidepressant medication. Your doctor will want to customize his or her treatment to your particular needs and discuss his findings with you in detail. For more information on depression, see http://www.psych.org/public_info/DEPRES~1.HTM.