IF SYMPTOMS PERSIST Dr. Jose Pujalte, Jr. “for you were not born to be depressed and unhappy with others, but to be happy with them.” Epictetus (A.D. c.50-c.138), Greek Stoic in Discourses. Chap. xxiv. (A.D. 101) While the DOH churns out its daily census of COVID-19 new infections, deaths and recoveries, there is a hidden, unmeasured effect of this pandemic. It’s mental health.   But here’s the thing: how do you make the difference between “the blues” – all the more heightened at a time when are physically and socially isolated – and the medical condition depression? Depression. The World Health Organization (WHO) defines depression as “a common mental disorder that presents with depressed mood, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, low energy, and poor concentration.”So it’s not as simple as being down in the dumps or a condition that can be overcome with willpower. Are you Depressed? MayoClinic.com lists the following warning signs that something’s amiss:

• Sadness, irritability or anger that goes on for two weeks or longer
• Poor school performance or frequent absences from school
• Talking about running away from home or attempting to do so
• Loss of interest in family and friends
• Conflict with friends of family members
• Extreme sensitivity to rejection or failure
• An ongoing sense that life and the future are grim and bleak
• Neglected appearance — such as mismatched clothes and unkempt hair
• Reckless behavior
• Use of alcohol or drugs

However, a diagnosis of depression relies on, over a two week period, fulfilling five of any of the following criteria as enumerated in the psychiatrist’s bible, the Diagnostic and Statistical Manual of Mental Disorders (DSM): Depressed mood most of the day, nearly every day, such as feeling sad, empty or tearful (depressed mood can appear as constant irritability); diminished interest or feeling no pleasure in all — or almost all — activities most of the day, nearly every day; significant weight loss when not dieting, weight gain, or decrease or increase in appetite nearly every day (failure to gain weight as expected can be a sign of depression); insomnia or increased desire to sleep nearly every day; either restlessness or slowed behavior that can be observed by others; fatigue or loss of energy nearly every day;  feelings of worthlessness, or excessive or inappropriate guilt nearly every day; trouble making decisions, or trouble thinking or concentrating nearly every day; recurrent thoughts of death or suicide, or a suicide attempt. Treatment. See a mental health professional. Treatment options include: medication such as antidepressants, psychotherapy and counseling, even hospitalization.  Please note that taking antidepressants have to be monitored because of the increased risk of suicidal thoughts or behavior with abuse or dosage change. Acupuncture, yoga, meditation and massage therapy are known alternative treatments to ease depressive symptoms. Some people feel that they’re on top of the world but some just as easily fall into the ravine of depression. Dr Pujalte is an orthopedic surgeon. email [email protected]