Q&A with the Doc: How to tackle and treat depression

Depression can take on many different forms and manifest with a variety of symptoms. 

While social media opens up many good opportunities, it also means individuals are constantly able to compare themselves to others, according to Dr. Erin Miller, psychiatrist with UPMC Behavioral Health who specializes in depression disorders. 

“One of the things, unfortunately, that I think has happened in our culture oftentimes is that we have an expectation that we should be happy all the time, and that that’s kind of the normative life experience,” Miller said. “That has been made worse by things like social media where we can compare ourselves to other people.”

The transition to a depressive disorder comes when these feelings begin to impact a person’s life in a meaningful way, Miller said. On the PULSE sat down with Miller recently for a discussion on the complexity of depression, how it manifests and what treatment options look like. 

See the full interview here: 

Q. What is depression?

A. There are several different types (of depression).

The most common subtype of depression that you’ll hear about is what’s called major depressive disorder. 

The criteria for major depressive disorder are having the following symptoms within a two-week period. And that would include feelings of sadness, emptiness or worthlessness, a decreased interest in activities that you used to enjoy. And then there’s a few other things such as appetite disturbance that can be either increased or decreased appetite … We often see sleep disturbance as well so people are either having problems sleeping or they’re spending the majority of the day in bed sleeping. We also have people who experience a lot of feelings of worthlessness or excessive guilt when there’s really no reason to feel that way, other individuals may experience cognitive difficulties, so that would include issues with attention or concentration or memory. 

And then finally, people will often experience suicidal ideation or thoughts about death that are uncharacteristic for them. So when you hear the term depression used that’s often what we’re referring to. 

There are other categories of depressed disorders as well. Another one that we frequently see is what’s called persistent depressive disorder, and that oftentimes is referred to as dysthymia. Persistent depressive disorder actually mimics the symptoms of major depression, but it’s longer lasting so it’s a more chronic condition, and oftentimes people will describe that they’ve felt this way their whole life. The specific criteria is a two-year period that people have experienced those symptoms. 

Then we can also have what’s called double depression. And that’s actually when the persistent depressive disorder, and the major depressive episode overlap, and that can be a particularly risky intersection of symptoms where we often see that people are at heightened risk for suicide with the double depression.

Q. What causes depression?

A. Some of the key causes can be genetics or biology. We know that some people are prone to having disruptions in different neurotransmitters. And one of the common ones you’ll hear about is serotonin. Therefore, some of the treatments that we use such as medications actually focus on serotonin and helping to balance that out. So genetics can be a cause.  

Situational or external factors can also be a cause. When people go through any kind of event that disrupts their lives, ie. a divorce or the loss of a loved one, here’s a period of time where certainly we expect that there’s just an adjustment to that. But if the symptoms persist after that time expires, then that’s when we start to think maybe more along the lines of major depression. 

Q. What are some misconceptions about depression?

A. We could probably make a day’s-long list of misconceptions about depression. But I would say that some of the ones that prevent people from getting the help they need is that depression is a sign of weakness or that people should be able to help themselves out of a depression and that they shouldn’t have to rely on medication or on therapy to help them through that. 

We know that that’s just not the case. It’s really difficult to dig yourself out of that hole on your own. So that’s one misconception that we see. 

Another misconception is that once I have depression I’m going to have it forever or the symptoms are going to be present forever. And we know that especially major depressive disorder tends to wax and wane. So there’s actually a term for that which we call recurrent major depressive disorder where people may go throughout, let’s say, a 10-year period of life, and they will have some exacerbations where their symptoms are present and then for months or years the symptoms disappear, and they’re able to function, completely fine within their environment.

Q. Are the rates of depression increasing?

A. There’s mixed evidence on that topic and one of the things that we actually see happening is that more people are coming forward to receive treatment, which is a good thing, but that can also lead to higher rates being reported. 

And that’s particularly true if you look at gender differences. In many ways it’s easier for women to come forward with symptoms of depression than men but we do know that, fortunately, men are seeking help at higher levels than they used to in the past. So whereas we used to say that women tend to experience depression two-times as much as men, we’re finding that that discrepancy is starting to balance out a little bit more in terms of increasing rates in general. We’ve had a lot of societal changes not only this year, but just within the past decades that that also likely contribute to things like increased depression. I mentioned social media before and that’s probably one of them too that can potentially cause the increases in depression. 

Q. What are treatment options for depression?

A. The treatment actually varies depending upon how severe the symptoms are. For mild depression, many times people can do some therapy, do some supportive talking and do what we call behavioral activation, which just means getting out there and getting some exercise or connecting with people. That can actually oftentimes be enough to push back the symptoms of mild depression. 

When we get into the more moderate to severe types of depression, that’s when we’re most likely going to usually consider a medication. And those can be very effective. They’re more effective if paired with a well researched therapy approach such as cognitive behavioral therapy that I mentioned earlier. In those cases we like to see a combination of the medications and the psychotherapy to help people. 

Q. What is seasonal depression? 

A. We have a very heavy seasonal component here. Our seasons are great and they’re very enjoyable for a lot of people. That winter period, especially when it starts getting into February and March and it’s really not relenting and it can be really challenging. That’s referred to as Seasonal Affective Disorder.

What can be very helpful for that is something called lightbox therapy. You can actually go on Amazon and purchase a lightbox for a relatively reasonable amount of money and you can keep that in your home or your office. It requires very little time during the day about 15 minutes, and it shoots some UV rays your way in a safe way.

When we’re not able to get those UV rays that we’re able to right now with the beautiful weather that we’re having. 

Q. How should friends and family members help?

A. I hear from a lot of patients about well intentioned but unhelpful actions that family and friends take. So one of the things I like to tell people is just to help someone feel heard, and in psychology that’s a term we call validation. So if someone comes to you and talks about their problems and talks about feeling depressed. You want to say, ‘Hey, I hear you, it sounds like you’re having a really rough time right now.’ 

Inadvertently what often happens is people will try to fix the problem or they’ll try to say ‘Well look on the bright side, look at all these great things that you have going on for you.’ And that backfires because it minimizes how the person is feeling, and we know that with depression, it’s not as simple as just focusing on the good things that we have going on or trying to fix the problem because chances are the person has already tried to do that.

One of the other things we talked about in psychology a lot is the difference between empathy and sympathy. 

You want to try to do your best to display empathy to someone who’s hurting, and we use a metaphor to describe this. If you have a friend or family member who’s kind of down in a pit and feeling pretty low. You can either stand at the top of the pit and wave down to them and say, ‘Hey I’m sorry that you’re down there that kind of sucks.’ That’s sympathy. Or you can actually climb down in the pit with them, put your arm around them and sit beside them and say, ‘I’m here with you, as long as you need to be here.’ And that’s more what we describe as empathy. So that’s what we encourage when people are going through those hard times.


  • On the PULSE is an online media outlet in Northcentral, Pennsylvania. We specialize in in-depth journalism, human interest content and video features. Our mission is to build engagement in community through local news.

On the PULSE

On the PULSE is an online media outlet in Northcentral, Pennsylvania. We specialize in in-depth journalism, human interest content and video features. Our mission is to build engagement in community through local news.