Your Checkup
We are THE patient education medical podcast, delivering engaging discussions on health topics straight from the doctor's office to your ears. Think of this as health class, except you aren't in grade school, and your teachers are a family medicine doctor and a pediatric nurse. Our goal? To bridge the gap between medicine and patients while keeping you entertained. Tune in to learn something new about health—for yourself, your loved ones, or your neighbors.
Your Checkup
Understanding Depression: Symptoms, Diagnosis & Help
Send us a message with this link, we would love to hear from you. Standard message rates may apply.
We are offering a trigger warning for this episode as we discuss topics related to depression including suicide. Please know 988 as a phone number and a resource to get immediate help in a mental health crisis.
Do you feel persistently sad, hopeless, or disinterested in the things you once enjoyed? This episode of Your Checkup explores the complexities of clinical depression, a common yet often misunderstood mental health condition. We'll break down the key symptoms, discuss why people might hesitate to seek help, and highlight the importance of diagnosis and treatment. Learn about the different forms of depression, its connection to other medical conditions, and how to access immediate support if you or someone you know is struggling. Remember, depression is treatable, and there is hope for recovery.
Production and Content: Edward Delesky, MD & Nicole Aruffo, RN
Artwork: Olivia Pawlowski
Foreign. Hi, welcome back to your checkup. We are the patient education podcast where we bring conversations from the doctor's office to your ears. On this podcast, we try to bring medicine closer to its patients. I'm Ed Delesky, a family medicine resident in the Philadelphia area.
Nicole Aruffo:And I'm Nicole Aruffo. I'm a nurse.
Ed Delesky:And we are so excited you were able to join us here again today. So we've got a couple little like diddy catch ups for the last week, a little news update and then our full episode for you all today. Nick, what did we do yesterday as we sit here on a Sunday morning?
Nicole Aruffo:Yesterday we had a great day, a great Saturday. It was like 60 degrees in Philly and blustery. Now it's 25, so that's cool.
Ed Delesky:Big turn.
Nicole Aruffo:We took a nice long walk. It was like three miles. We went to Victory, had a couple beers, had a couple snacks.
Ed Delesky:And then, well, a little more detail on the snack, actually. Keep note.
Nicole Aruffo:Well, I was giving a general overview of the agenda of our day.
Ed Delesky:I like the style. Keep going. Sorry. Thank you.
Nicole Aruffo:Then after Victory, we walked over to the Franklin Institute because we were going to see Body Worlds, which was so cool. Everyone should go. And then after Body Worlds, we walked home. We stopped at 1900 ice cream on the way home, got some ice cream. It was pretty cold by then, but it was still great. And that was our day.
Ed Delesky:It was so nice. It was a really great day date. I think we started walking over there around 3pm by the time we got to Victory, very crowded, but we were able to kind of like, you know, walk weasel our way into a spot. You know, there is one of those awkward situations where there was one bar seat. So we got you in that bar seat and then I stood very closely to that group of guys. And one of them smelled for sure, like definite bo. I'm not sure where they came from, but they were like talking about their Charleston trip. And then eventually, either by way of me being so uncomfortable being so close to me or being a gentleman, either one, he decided to give me that seat. So then they went, they spent their time, got a couple beers like you said. But those fried pickles were delicious.
Nicole Aruffo:Yeah, they're so good.
Ed Delesky:Yeah, it was like, it was a hot garlic aioli. I loved that. And I always, I slept on the. And I was joking with you, trying to make you think that you were the one who didn't want to get the potatoes. Their potatoes are great. They're loaded potatoes. You've been saying that we got it one time, and I didn't recognize it at the time, but they're loaded. Potatoes. Excellent.
Nicole Aruffo:Got to make you think it's your idea.
Ed Delesky:It is pretty comical how often that happens. So then the body world, I thought it was so pure. I love the Franklin Institute. Walking in there, just, like, a blast of so many memories. I mean, like, puking at the Titanic exhibit when I was a young child, just touching that ice and then just sending me over the edge.
Nicole Aruffo:You're so dramatic.
Ed Delesky:But the. I definitely noticed that they took. You know, we noticed they took down that, like, rope, like, bike thing. I was a little disappointed by that. Yeah, you did that. Said you were a pro at it. Yeah, I was like, a keen sense of balance and center of gravity, obviously. And then what was your favorite part of the body exhibit?
Nicole Aruffo:Like, my favorite.
Ed Delesky:Or, like, person, what you noticed?
Nicole Aruffo:I liked the one where the girl was, like, all taken apart.
Ed Delesky:Like, you're in the head and you see, like, the deep structures of the head. Yeah, that was cool. Yeah, you don't get to see that stuff every day. After a while, I thought Plastinet was like, oh, this is a plastic model. And then walking in, I knew that it was, like, real people, but I forgot that in the beginning. And then at some point, maybe like a quarter of the way through, it kind of hit me like, oh, this is. These are real people. And that's what they say. Yeah, I guess that's what they say. I guess they don't.
Nicole Aruffo:Well, just think that it was to make it seem cooler.
Ed Delesky:Yeah. And then the Oreo. The Oreo ice cream was delicious. What was more remarkable was the two people who remarked as we were walking back, it was like a. Now a blustery 40 degrees outside. We have our teeny, tiny spoons with our scoop of ice cream, and these two women walking by us, and they're like, oh, my God, they have ice cream.
Nicole Aruffo:And then it's so cold. Like, they're, like, talking together about how cold it was because it was pretty chilly and windy at the end of the night. And then they, like, looked at us, looked at each other, and they were like, oh, my God, they're eating ice cream.
Ed Delesky:You were about ready to fight them, Literally.
Nicole Aruffo:Shut up.
Ed Delesky:You did turn around, and then we.
Nicole Aruffo:Crossed the street, and some guy, like, two seconds later was like, is it cold enough for your ice cream?
Ed Delesky:Yeah.
Nicole Aruffo:Yeah.
Ed Delesky:Well, actually, no.
Nicole Aruffo:Any weather is ice cream weather for ice cream. What do you mean?
Ed Delesky:Yeah.
Nicole Aruffo:Geez, is it cold enough? How about you put a hat on your bald Head. Is it cold enough for that?
Ed Delesky:He was wearing a hat. So in other news of of food, we did enjoy the crab cavatelli last weekend. You like that dish? Oh, yeah, that was good.
Nicole Aruffo:Famous crab cavatelli.
Ed Delesky:And heading into tonight might enjoy some fat rigatoni. We will hear about that next week if it does happen. But thinking about maybe, you know, weaseling my way in to have some fat ricatonia in this house.
Nicole Aruffo:Yeah. You have to come with me to the store to get the items.
Ed Delesky:But of course.
Nicole Aruffo:Oh, you know what else I want to briefly talk about that I'm annoyed about.
Ed Delesky:This is I feel like your medium.
Nicole Aruffo:The people will be annoyed about too. Okay, so we have White Lotus tonight. Why, as Turdi would say, on God's green diddly dally earth, do these streaming platforms that were built so you could, you know, binge watch a show, Watch a show at your leisure, Release a new episode at 9pm releasing a new episode every week. Okay, whatever. Why do you have to do it so late at night? We are up early. We like to go to bed early. If we start a show at 9pm, I'm certainly not staying awake for it.
Ed Delesky:Nope.
Nicole Aruffo:And then we, like, start it. I fall asleep. Or if we start it in bed, we're both falling asleep.
Ed Delesky:Yep.
Nicole Aruffo:And then we have to redo it the next day, figure out where we left off, who remembers what. Like put it out in the morning so we can watch it whenever we want.
Ed Delesky:Love is Blind does that. They do a 3am release, I think.
Nicole Aruffo:Yeah.
Ed Delesky:Yeah. But 9pm I. I think they're still trying to, like, cater to that prime time.
Nicole Aruffo:Okay. We're not on primetime cable. This isn't cable. It's a streaming platform.
Ed Delesky:Yeah.
Nicole Aruffo:I want to stream it when I want to. It's so annoying.
Ed Delesky:It is annoying.
Nicole Aruffo:I just take a lot of umbrage with that and I needed to talk about it.
Ed Delesky:Do you feel like you got it off your chest a little bit and that you feel a little bit better about it?
Nicole Aruffo:I do a little. Do you feel the same way?
Ed Delesky:I do feel the same way. Especially the nighttime release. I mean, so especially when it comes to social media too, that certain people will be posting about things. So you mentioned White Lotus. I think of Traders when it comes to this because we're watching that. We watched the first two seasons and like, I guess like halfway through the third season, like, binge watching it. And now we're at the place where we can watch it every week. And every week is fine. I think it adds to the Allure of it. There's some tension. It's like anticipation what's going to happen. I think it's great. But Again, that's a 9pm release that happened on Thursday. We have not caught up and watched it. We may watch it today, but I've had to be really careful to like not get spoilers because there's like big things that happen in the episode. So yeah, to my point, it's really, it's tough to keep up.
Nicole Aruffo:Yeah.
Ed Delesky:We might just be the type of people that like, you know, some people are up at 9 o'clock. I get usual routine texts, like after 9pm and I like address them the next morning.
Nicole Aruffo:Yeah. During business hours. Wait, did you see Gabby from Traders does this whole thing about how like, I forget what it is now, like verbatim what she says, but she has this whole thing of like her like personal business hours. And then she's like, don't be texting me even at 3pm, I've just had lunch. Or she's like, it's after lunch, I'm lethargic.
Ed Delesky:Now we, now we get the same stuff on Instagram or online. Yeah.
Nicole Aruffo:I love it.
Ed Delesky:And you're like, my algorithm thinks that I'm like a, like a woman, a woman who's watching a lot of reality TV with a husband.
Nicole Aruffo:You, you are a person watching a lot of reality tv.
Ed Delesky:I am. Okay. How do you feel?
Nicole Aruffo:I feel good. What are we talking about today, Ed?
Ed Delesky:Well, before we get to our actual big topic, our episode last week broke down the as it is an evolving topic. Broke down everything to do with measles. And we'll just take a quick little moment here to give an update from the CDC and the Texas State Department of Health. At this time, it seems like there are 146 cases that have been identified since late January of measles in and around Texas.
Nicole Aruffo:And it was like 60 something when we recorded last week.
Ed Delesky:I think it was actually like not like in the high 90s, near 100.
Nicole Aruffo:Never mind.
Ed Delesky:And 20 of these patients have been hospitalized. And for the first time in over a decade, there has been one death associated with measles, which is an abject tragedy.
Nicole Aruffo:Sick.
Ed Delesky:Yeah. Something that should not happen at all. And the quick thing here is that you can get vaccinated if you are of the right health, which is most people in the world who are one year old and older. If you haven't been vaccinated already, ask your doctor. I had someone who messaged me and said like, I'm not Sure. If I was vaccinated, is there any way we can check? There is a simple blood test to check your immunity. So what are we going to talk about today, Nick?
Nicole Aruffo:Today we are talking about depression.
Ed Delesky:Well, what I want to highlight is that we are talking about defining depression, explaining how common it is. We will talk about treatments of depression in the very near future, if not next week. But this deserves a two parter. Yeah, this deserves a whole ground ground level laying the foundation for what major depressive disorder is or clinical depression, depending on how you want to talk about it. And so there are a couple of key facts that I just want to jump right off the back and say that depression. This is from the World Health Organization. Depression is a common mental health disorder globally. It's estimated by the WHO that about 5% of adults suffer from depression. Women are more likely to be affected by depression than men. And a little bit of a trigger warning for this episode, in truth, we will be talking about suicide. And so if that's something that you are not okay listening to, then maybe you sit this episode out or skip those parts. But depression can lead to suicide and there are effective treatments for mild, moderate and severe depression. There are a couple more statistics that I would like to propose from the World Health Organization that just add to the whole argument here about why this is so important. At any given time, an estimated 3.8% of the population worldwide experiences depression. That is a ton of people. Some estimates would say that that is about 280 million people in the world at any given time are experiencing depression. We mentioned 5% of adults, 4% among men and 6% among women, which kind of gets us that 50% more common in women and increasingly 5.7%. So even more prevalent in adults older than 60 years old. In other subgroups, higher rates even exist. Like 10% of pregnant women and women who have just given birth experience depression. And disturbingly, more than 700,000 people die by suicide every year. And in people a lot. It's a lot of people. And in people aged 15 to 29 years old, it is the fourth leading cause of death. And so with all of that, that is why we are talking about this today. But we also realize that this is a topic that people don't like to talk about. And so, Nick, why don't you take us through basically broad strokes, why people don't reach out for help.
Nicole Aruffo:Well, definitely the first reason is because of the whole stigma of not even just depression, any sort of like mental health diagnosis. And people just, you know, I Don't need to talk to someone I don't want to take medicine to. I know a lot of times people will refer to any kind of like, like I've heard people say that they don't want to be on any kind of quote, mind altering drugs and like speak of it as if they're on, you know, like hard recreational drugs.
Ed Delesky:Right.
Nicole Aruffo:To treat their clinical depression stigmas. Yeah, definitely the first one.
Ed Delesky:And to dovetail on that, it's like people with that stigma, which exists but is going away. I would like to think especially as generations come on, people see it as a personal weakness and I'm like, it's not real. Right.
Nicole Aruffo:And if you ignore it, it goes away.
Ed Delesky:Right. Which is just not true. This is as serious as a heart attack. Having diabetes, having hypertension, having depression, having obesity. They all fall toe in step with each other. Why else are people not seeking help? I would say that there's sometimes concern about a psychiatric diagnosis being a part of someone's like permanent medical record. Having a medical record is a real thing and having the people who take care of you look at the medical record and the words that are in there is a real thing. But people worry about that, I think. And that's another reason that people don't reach out. But another piece of this is that if left untreated, depression that is untreated can lead to serious health problems like this. This is not benign. It can lead to very clearly a lower quality of life. It leads to higher rates of death and uncontrolled other chronic health conditions. Of course, it leads to higher rates of suicide. And it really, it can also affect loved ones and circling back to the top, reduced overall quality of life. And so in this little bit of conversation, we've identified that it's extremely important because it's so common. It's also something that people don't reach out for help for. So if you're listening to us and this is kind of your first introduction to depression, we're happy you're here, but it's something that should be talked about more.
Nicole Aruffo:Yeah, I mean, I feel like anyone can off the top of their head, think about someone in their life that you know probably clearly depressed and isn't doing anything about it. And then it affects you or, you know, like your friend group or your family or whatever. Because it's so common.
Ed Delesky:Because it's so common. But I think it also can be a little tricky when there's so much, at least like in terms of social media, very broad strokes, vague definition like people, just like people will go out there and say, oh, I'm like battling with depression. But they don't actually get down to brass tacks definitions about what depression is. And so there is this, like, there is this book, it's called the DSM 5 and it's the psychology manual which provides all of the diagnostic criteria for different mental health disorders. Depression is a formal clinical diagnosis called major depressive disorder. And there are a range of symptoms that someone needs to experience. In fact, they need to get this diagnosis. Someone needs to experience five or more of these symptoms and they need to be present nearly every day for at least two weeks. Which I like to put out there is like not that long of a time. This is different than the like everyday, like up and down moodiness. I've had several conversations with patients who are like, yeah, some days I'll be really down for two or three days, but then I kind of bounce back and go to normal. This isn't that it's persistent symptoms for longer than two weeks. So Nick, why don't you tell us more about the diagnostic criteria or the symptoms that someone will experience when they are depressed.
Nicole Aruffo:So we have a handful of symptoms. And now remembering you would have to fit five of these following symptoms. One is like a no dud, a depressed mood. Specifically feelings of like hopelessness, sadness and irritability. Next, which I feel like this is a big one, loss of interest or like things that you once like found pleasure in or like you did for fun and now you no longer do. Just like that general lack of enjoyment in activities. And that change next are changes in appetite or weight, whether that's an increase or decrease. Insomnia or hypersomnia. So you're either sleeping a lot or you're sleeping too little psychomotor agitation or slowing. So we're either restless or really sluggish. Fatigue or loss of energy, which, you know, we all know what fatigue is.
Ed Delesky:Who isn't?
Nicole Aruffo:Yeah, yeah, I know. Like some of these are like, okay, yeah, duh, we're all tired. We wake up early and we go to work and I'm fatigued. That doesn't mean you have depression, but if you have it in conjunction with, you know, all of these last two are poor concentration with, I mean everyday things, difficulty thinking, concentrating or making decisions. And then last one, recurrent thoughts of death or suicide.
Ed Delesky:Yeah, and just to expand on the recurrent thoughts of death and suicide, some people actually take it a step further and develop plans for suicide or prepare to act on those thoughts. And people can otherwise hurt themselves in different ways. And this is a symptom of the illness, this is a symptom of depression and can improve with treatment. Which is why it's so important to have conversations about this open out there and get people to the help that they need. Some people may experience additional symptoms, including ones that kind of cross over with other diagnoses. We will explore these in the future. But like, people may also experience symptoms of worry about certain situations or all over the place in all situations. Or they may experience things like hopelessness, like you mentioned before, or something called ruminative thinking where they just. People spend so much time thinking about a concept and cannot get themselves off of it. One thing I'll add is that this constellation of symptoms, these can be caused by other things like I have seen where this is a psychological diagnosis. And so what that means is that other medical causes have been considered. And I think if you talk to any psychiatrist, they would say yes, like these symptoms. If you've considered like things that you can find in labs or like body problems that lead to physical fatigue or lead to like weight loss. Weight loss. Right. So that's something to consider here as well. Also I would say when we were talking about how symptoms can run with other conditions, that was. Those were different things for a major depressive episode. There are a lot of conditions that can cause a major depressive episode in addition to major depressive disorder, like bipolar disorder can cause a major depressive episode where you have five of those symptoms for longer than two weeks, One of them being decreased mood or anhedonia, a decreased interest. And so that's why there's a whole specialty about this. And this can get complicated, but for the purposes of today, we really wanted to outline those specific details. So there are also different subtypes of depression. People can have depression with mixed features and there can be components of mania in there. We won't get into too much of what that looks like here today. People can have anxiety comorbid with their depression. We mentioned earlier that there can be situation specific forms of depression like peripartum onset, like during, after pregnancy. You can also have premenstrual dysphoric disorder, which is depression or mood changes that relate to one's menstrual cycle, or seasonal affective disorder, which is depression that is triggered by the seasons. So a lot of times that comes on more frequently in the wintertime. But when people are in the sunshine and the spring, summer, fall, they're doing way better. So then comes the conversation of comorbidity Comorbidity is when two or more conditions occur together, and there can be psychiatric comorbidities. So depression can occur with things like anxiety. Depression can occur with post traumatic stress disorder or ptsd, and also with substance use disorders, people who have trouble using alcohol or drugs, and personality disorders. And the list goes on and on. So it's not just an isolated thing. It can happen with other people. Depression can also worsen medical comorbidities, and it can also occur more frequently in people who have chronic disease like diabetes, heart disease, cancer. This is a known thing, and so it ends up being a very complicated thing. But the point is to have more awareness.
Nicole Aruffo:Cool. So we talked about what it is, what all of those symptoms can be. Someone comes to you or a psychiatrist. How are we diagnosing depression? Is there a test you can do for it?
Ed Delesky:It's not a specific test. What usually does happen is a very thorough conversation, perhaps some blood work to rule out some other common causes of symptoms that people may be experiencing. I do recall one patient where he had a lot of symptoms of depression and his hypothyroidism was out of control. And we treated that, and he got way better. So that is less common than depression, for sure. But the diagnosis ends up being hammered down by a really thoughtful conversation about symptoms. The conversation involves observing signs, determining the timeline, how things are progressing, and understanding this might be most important, the impact that the symptoms have on daily life and function. Some other conversations may include factors that make symptoms better or worse. A family history can be important. And when it comes to picking a treatment plan, understanding other psychiatric comorbidities or medical comorbidities, and a history of manic symptoms, if they exist. Also, another really important piece of that, once you've gotten into the conversation a little bit more, is determining how safe someone is. And by that I mean talking about suicide risk. And so if someone has thoughts about suicide, whether passively thoughts about death or not being around anymore, as opposed to someone having specific plans and which is a very different situation. So with depression being so common, there are certain risk factors for depression that may increase someone's risk. Like if you have a personal history or a family history of depression, I would say compared to the average person, you have a higher risk of developing depression.
Nicole Aruffo:Our interns awake. Look at him in the sun. He's so cute. Do you see him? Oh, he kind of moved. It was shining in his face. He looks so regal.
Ed Delesky:One that I think about a lot is a history of substance misuse or trauma. In childhood or adulthood can increase someone's risk for depression, stressful life events, parental loss during childhood, and can also increase someone's risk.
Nicole Aruffo:Well, a little bit ago you mentioned either like physical symptoms or physical changes or something like that, which I think this is pretty interesting. Do you want to tell people the biologic changes in a brain?
Ed Delesky:Yeah, well, they do studies where they look at functional MRIs and several other modalities of evaluating this type of thing in research. And I mean, there's a lot of evidence that shows that people with depression have changes to their brain cells, neurotransmitters, which are the little hormones that communicate between brain structures and changes to brain structures themselves. And some of this relationship is unclear. The. I'm not arguing the fact that that doesn't happen, but some of the question is, are these differences causes or results of depression? And that's a question that's still being evaluated because this is a tricky piece where depression isn't just about someone's like, physical body. Like if you. It's different from blood pressure where you can. Or diabetes where you can identify the thing, you can make some lifestyle changes. Like, depression is someone's physical chemistry and their physical makeup as much as it is their mental makeup and their entire interaction with the world. And these days, the interaction with the world isn't just the person sitting in front of you. Like I have a great view right now, but it's the interaction with your phone and all of the people that are out there and all of the interaction with not even just people with robots and every aspect of social media. And so it ends up being so much more complicated when you consider the 6 inches between your ears and the interaction with everything else in the outside world.
Nicole Aruffo:And well, it's like a little bit of a. What came first, the chicken or the egg?
Ed Delesky:Yeah.
Nicole Aruffo:You know, like, are you depressed and then you, you know, you create new pathways in your brain and has these changes or is this something that was there first that predisposes you to depression and then you have a whole list of other risk factors.
Ed Delesky:Exactly. And taking advantage of some of these systems that exist in the brain is how some of the medication treatments actually work. Which is something that we will talk about next week. But since we talked about one of the. While we're not going to talk about outright, like day to day treatment in this episode, we do want to talk about how to get help. If this episode resonated with you and you feel like you need to. We encourage all of our listeners to go very sincerely go speak with your doctor if you're worried about this, it can be a great jumping off point for you to at least get some advice. If not that person is if that person isn't able to treat you right then in there and so ask them, bring it up to them if you have a concern. If you think someone else is having concerns of self harm or suicide, you can emphasize immediate help and there are a couple different options that you can reach out to. There is very simple contact information for the suicide and Crisis Lifeline called 988. So just like you would dial 911 which is also a reasonable option for these people or for yourself dialing 988-even-in moments of just deep worry and sadness, it does not have to be a point where things are scary and towards the end you can use this resource. 988 is the suicide and crisis lifeline and if not even you're just worried about yourself. If you're worried about a loved one or a neighbor, you can encourage them to get help, encourage them to have conversations about I don't know why we even have to say this. What a very real diagnosis and real pathology to deal with. Now you have access to these tools, so hopefully today you were able to learn something. Become a little bit more informed about depression for yourself, a loved one or a neighbor. We hope that you come back next week when we dive into conversations about the treatment of depression, which will be a very engaging conversation and we hope that you're able to go back and listen to some of our old episodes or share an episode with a loved one or a neighbor. Please visit our website, send us some fan mail, maybe find us on Instagram, Send us an email if you want your checkuppodmail.com and we look forward to having you come back next time. But until then, I'm Ed Dalewski.
Nicole Aruffo:I'm Nicole Aruffo.
Ed Delesky:Thank you and goodbye.
Nicole Aruffo:Bye.
Ed Delesky:This information may provide a brief overview of diagnosis, treatment and medications. It's not exhaustive and is a tool to help you understand potential options about your health. It doesn't cover all details about conditions, treatments, or medications for a specific person. This is not medical advice or an attempt to substitute medical advice. You should contact a healthcare provider for personalized guidance based on your unique circumstances. We explicitly disclaim any liability relating to the information given or its use. This content doesn't endorse any treatments or medications for a specific patient. Always talk to your healthcare provider for a complete information tailored to you. In short, I'm not your doctor I.
Nicole Aruffo:Am not your nurse.
Ed Delesky:And make sure you go get your own checkup with your own personal doctor.
