Depression may be unrecognized

Doctors at Johns Hopkins Health Centers say fully one third of clinically depressed patients claim they don't feel sad or blue. Instead, they complain about not feeling well for a long time, or feeling as if something is unusual or vaguely wrong. Some are reluctant to report even these clues.

Men, the doctors say, are more likely to deny depression because they are embarrassed by their symptoms. Depression is five times more common in men with low but still normal testosterone levels. This is an easily treated condition diagnosed with a simple blood test.

A large percentage of all cases go unrecognized. But people with clinical depression cannot will it away. They need treatment just as people with arthritis, hypertension, and diabetes require medical evaluation and treatment.

Sometimes it can begin with a personal loss such as the death of a loved one or the loss of a job. Sometimes a genetic factor is at work. Sometimes the feelings of sadness, fatigue, worthlessness, and loss of self-confidence have no specific cause. When such symptoms last more than two weeks, see a doctor.

Depression can nearly always be relieved with medication and counseling. Combining the two is most effective for serious cases. Selective serotonin reuptake inhibitors (SSRIs) are the drugs of choice. It typically takes 10 days to three weeks for patients taking SSRIs to start feeling better and up to six weeks to experience dramatic improvement.