Depression: A Physician’s Perspective

Alexander Papp, MD, ABPN, is a diplomate of the American Board of Psychiatry and Neurology, an adjunct faculty member of Alliant International University and an assistant clinical professor at the University of California, San Diego. Dr. Papp has treated a wide range of mental health conditions in mental health clinics and private practice.

BSTQ: How prevalent is depression?

Dr. Papp: Fifteen to 20 million people are diagnosed with and treated for depression annually. Clinical depression is a serious condition that negatively affects how a person thinks, feels and behaves. It is persistent and often significantly interferes with normal functioning in daily life. When left untreated, symptoms can last for weeks, months or years.

BSTQ: Have you seen an increase in depression diagnoses since the pandemic?

Dr. Papp: Statistics show that both depression and anxiety have increased by as much as 25 percent worldwide. My practice saw a larger increase in new or worsening cases of anxiety than in new cases of depression.

BSTQ: How is depression typically diagnosed?

Dr. Papp: Diagnosis is based on patient-reported symptoms and observable patient behaviors. Patient-reported symptoms typically include complaints about mood dysfunction, decreased energy, persistent sadness, frequent crying and hopelessness. Patients often describe feelings of worthlessness and an overall inability to function in normal, day-to-day activities. Observable behaviors typically include visible signs of listlessness, neglected hygiene, profuse crying and changes in appetite and/or sleep habits. Patient intake questionnaires gather information about symptoms that are not easily observed.

BSTQ: Are certain demographics more at risk for depression?

Dr. Papp: Yes. Women are about twice as likely to become depressed than men, especially during the months after giving birth. Young adults are more likely to become depressed than any other age group. Multiracial people are more likely to suffer from depression than people from a singular race. However, white people are more likely to become depressed than people from other singular racial groups.

BSTQ: Is there any promising new research on effectively treating depression?

Dr. Papp: Researchers are exploring two new ways to treat depression. One avenue involves psychedelic drugs, primarily psilocybin (the active ingredient of the “magic mushroom”). Another avenue involves alternative medications to serotonin-based antidepressants.

BSTQ: What is treatment-resistant depression?

Dr. Papp: Treatment-resistant depression refers to cases of major depressive disorder that do not adequately respond to treatment from at least two different antidepressants from different classes. In this situation, “responding” to an antidepressant means more than just an improvement in mood, but also the resolution of most depressive symptoms and a return to normal functioning.

BSTQ: You’ve had success with ketamine. How does it work to reduce depression?

Dr. Papp: Ketamine works by quickly increasing the activity of the neurotransmitter glutamate in the frontal cortex of the brain, while also allowing new synapses to form in the same area. Ketamine bypasses the traditional serotonin route and directly activates glutamate. This is very different from traditional antidepressants, which first increase the activity of serotonin in multiple areas of the brain before affecting glutamate. Traditional antidepressants usually take two to four weeks to take effect, while ketamine yields an almost immediate effect.

BSTQ: Are there any adverse effects of ketamine as a treatment?

Dr. Papp: Ketamine has a few mild adverse effects, including a dream-like feeling, blurred or double vision, dizziness, nausea, vomiting and short-lived episodes of anxiety.

BSTQ: When should patients ask their doctor about trying ketamine as a treatment for depression?

Dr. Papp: Patients should speak to their doctor after they have tried several different antidepressant medications, or combinations of medications, at the highest dosage levels for at least two months without experiencing a return to normal functioning.