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January 25, 2013

Are those Post Holiday Blues Something More?

According to the Center for Disease Control, (CDC), depression affects 1 in every 10 adults in the US (2008). Depression is described by the Mayo Clinic as "a medical illness that causes a persistent feeling of sadness and loss of interest" (2012). Depression is more than just a bout of the blues, but instead an illness, not a weakness, that cannot just be shaken off.  It affects one's ability to perform day-to-day activities. In children and teens, depression often occurs alone or with behavior problems and other mental health conditions, such as anxiety or Attention Deficit Hyperactivity Disorder (ADHD). It may appear more subtly in older adults. They may want to stay home, rather than go out to socialize. While the exact cause of depression is not known, many researchers believe that it is caused by chemical changes in the brain. It may be genetically linked as well. There are certain risk factors that are associated with an increased incidence of depression: alcohol or drug abuse, certain medical conditions, such as hypothyroidism, cancer, or long term pain, certain medications such as steroids, sleeping problems, and stressful life events. Examples of these include: breaking up with a boyfriend or girlfriend, failing a class, death or illness of someone close to you, divorce, childhood abuse or neglect, job loss, and social isolation.

Depression can adversely affect the course and outcome of common chronic conditions such as arthritis, asthma, cardiovascular disease, cancer, diabetes, and obesity. The US Preventive Task Force recommends that healthcare providers screen adults for depression in order that accurate diagnosis and effective treatment be provided, along with careful monitoring and follow up. Screening tools ask questions that address the symptoms of depression, such as feelings of sadness, irritability, frustration, loss of interest or pleasure in normal activities, reduced sex drive, insomnia, changes in appetite, restlessness, slowed thinking or speaking, indecisiveness, fatigue, tiredness, crying spells, as well as unexplained physical problems (mayoclinic.com, 2012). Health professions must be skilled at determining if individuals are at risk for causing harm to themselves, by directly asking them if they considered taking their lives and if so, if they have a plan. These signs can never be ignored, as it can literally be a lifesaving tool to conduct the screening appropriately and to make the necessary referrals for treatment once it is identified that an individual is at risk for self harm. Patients that admit to suicidal thinking, and who have a realistic plan, should be referred for emergency psychiatric evaluation. The presence of chronic medical illness may reduce the likelihood that physicians or other health care providers recognize or treat depression. Primary physicians must be alert to the possibility of depression in their patients with chronic disease. Depression should be treated separately because if it is not, patients are often unable to or unwilling to comply with treatment recommendations for their chronic physical conditions. Treatment for depression may begin with the initiation of an antidepressant, especially if the depression has persisted for two weeks or longer and interferes with routine functions of family, work, or school life.

The two classes of drugs most commonly used are selective serotonin-reuptake inhibitors (SSRI) and tricyclic antidepressants (TCAs). SSRIs are often considered first-line treatment for depression based on their relatively safe side effect profile. Non-pharmacological therapies include psychotherapy and counseling, as well as exercise and behavior change. Individuals tend to isolate themselves, so they may benefit from joining a social or religious group, taking a class, or becoming a volunteer. While primary care providers should be astute and recognize when their patients are depressed, they lack the time and expertise for initiating cognitive and interpersonal therapies. Referrals to mental health professions facilitate a more comprehensive approach to managing depression.

We consulted John A. Tallarido, LCSW (Licensed Clinical Social Worker), who graduated from Rutgers in 1993 with a Masters Degree in Social Work. He has been working full time in the counseling field since that time. Mr. Tallarido, a Licensed Clinical Social Worker and a Medicare provider, has his own private practice. He provides counseling in the convenience of one's own home. He has been working with MIHOM Healthcare Inc. for a year. In 1998, he obtained his Law Degree and is also a Florida licensed attorney with a law office in the West Palm Beach area. Mr. Tallarido states, “The reasons why people with depression might avoid seeking help are because they may harbor a belief that they should be able to overcome these negative emotions and that seeking outside help might be a sign of weakness. People may also be embarrassed to seek outside treatment because of the stigma attached, especially for men, in having to open up one's emotions and feelings to a complete stranger, in order to feel better.” Mr. Tallarido believes that embarrassment is also connected to a fear that others may think less of them if they found out that they are in therapy. The older generations tend to believe that they can figure out their difficulties on their own without seeking outside help, as they experienced some very difficult times due to wars and depressions while growing up. He explains, the younger generations have become more accepting in seeking counseling, as the stigma slowly erodes. Additionally, as information becomes more readily available as to the benefits of counseling, people are less inhibited in seeking a therapist.

If one comes from a family that tends to not be supportive, or there is a family understanding that difficulties and problems are solved within the confines of one's home, a family member may be less inclined, or perhaps even embarrassed, to admit that they can't solve their difficulties and problems alone anymore. Mr. Tallarido states, “A family member can help another family member cope with their depression by being supportive, loving and remaining positive“. Mr. Tallarido cautions that comments such as 'just snap out of it' reveals that the family member probably does not understand the depth of emotional turmoil involved. He adds, “If family members tend to not communicate well with one another or if a family member was berated or made to feel weak when they attempted to express their difficulties, they may resist sharing their thoughts and feelings.

Resources that are available for counseling will depend on the type of insurance coverage that one has. Mr. Tallarido offers, “It is best to ask a customer service representative from your insurance company what counseling services are available within the immediate area. Your doctor or psychiatrist may have someone that he or she works with for counseling services. Mr. Tallarido provides counseling in his clients’ homes.  However, most counselors or therapists will require you to go to their office when seeking treatment”. He points out that people suffering from depression, who seek outside  help, are displaying strength, not weakness and that staying involved with treatment will most likely provide the best hope in overcoming their depression. In addition, medications may be needed along with therapy to provide the most beneficial possibilities in their struggles with depression. It is also important to let their other health care providers know that they are in therapy for depression, so they may be informed of the overall care that their patient is receiving.

For a self evaluation for depression visit  http://www.mayoclinic.com/health/depression/MH00103_D.

If you have any further questions for Mr. John Tallarido, he may be reached at: (561) 422-0900, or you may leave a message at Mihom Healthcare and we will be happy to pass it along to him.  Our number is (772) 873-3838. 



CDC: Current Depression Among Adults (2008)

Retrieved from: www.cdc.gov/features/datastatistics.html


Depression (2013)

Retrieved from: www.nimh.nih.gov/health


Depression Facts (2012)

Retrieved from: www.mayoclinic/health/depression/DS00175


Simon, A.G. (2001) Major Depression

Retrieved from: www.ncbi.nih.gov





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