MMN 046: – The Etiology & Treatment of Depression – with Susan Noonan, M.D.

On this episode of the Make a Mental Note podcast, Susan Noonan, a physician, certified peer specialist and medical consultant discusses the nature and etiology of depression and how people can deal with this mental disorder. Give it a listen and find out why this episode is worthy of a mental note!

Susan Noonan interview (click on Susan’s name to listen to interview)

Mental Notes:

* The longer depression goes untreated and the more episodes a person has the more difficult it is to treat.

* Although there is a stigma associated with mental illness such as depression society is starting to move beyond this as teenagers feel comfortable talking about mental illness and approaching school counselors to get help. However, older people still grapple with the stigma of mental illness. In some cases, they fear losing their jobs if others find out that they saw a psychologist or psychiatrist for a mental health condition – especially if they are in supervisory positions or serve in other important capacities in their companies or organizations.

* Depression is a biologically-based illness that affects the mind, body and lives of people. It affects the things they do, as well as sleep and appetite, their interest in doing things that were previously enjoyed and relationships with people. People may have a sense of despair, hopelessness and worthlessness. There may be suicidal thoughts that go along with depression.

* Researchers have begun to show that there are genes that are associated with depression which, when combined with a stressful life event can lead to an episode of depression. In some cases, depression is inherited from family members. It is just as much as an illness as is diabetes and high blood pressure.

* Diathesis-stress model – stress can precipitate depression in people who are genetically predisposed to exhibit this disorder.

* Positive and negative stressors can precipitate a depressive episode (e.g., a change/loss in a job; moving to a new home; new relationship/loss of relationship; birth of a baby; significant changes in routine). In particular, events that bring about change set the stage for depressive episodes for some people.

* Why do some people experience depressive episodes when they’re under significant stress/experience big changes in their lives and others don’t? The combination of genes and the environment come into play here. Many people have a genetic predisposition to develop depression that makes them vulnerable when they experience a significant life event. Those people who are not predisposed to depression may be more resilient to stress & change.

* Obtaining a family history is important to find out if anyone in a client’s family has experienced a depressive episode as this will place things in context and provides support for the genetic component of depression. It is also important to know something about the family environment as stressful life events that are occurring within the family may be contributing to intense emotions that can precipitate a depressive episode.

* Some people do not recognize that they are experiencing symptoms of depression or are not willing to talk about their symptoms to their physicians.

* In terms of helping people who are depressed, it is a good idea to get them to clearly identify what issues/problems they are bothered by and motivated to work on the most. Focusing on specific problems and helping people take a series of small and realistic steps toward goals are useful. In order to stay motivated, it is helpful for people to look at the benefits of solving problems and compare that to the costs of retaining the problem. Helping them identify resources and people to help them succeed (i.e., social support) is also a key part of the equation.

* Lifestyle habits/changes are important in the treatment of depression. For example, proper sleep, exercise and diet can help people who are depressed. These are the basics of mental health. Also, keeping a daily routine and structure and avoiding isolation/keeping up with social contacts are also basic to good mental health.

* There are many different types of antidepressant medication to treat many different types of depression. In some cases, people do not respond to a particular antidepressant medication and need to switch to a different one or be on two medications – one that serves to augment the effects of the other one.

* In some cases, depression is not accurately diagnosed, which can easily occur with elderly people. They may appear depressed, but it could be because they’re on multiple medications for physical problems.

* There are alternative treatments for treatment resistant depression including ketamine treatment and transcranial magnetic stimulation therapy as well as other types of medications.

* It is important to obtain information about the medications that people are taking to find out if they may be contributing to their mood disturbance.

* Challenges – some people are not open to suggestions of things that might help them. In addition, people who are impatient with the process/the timeframe required to improve can also pose a challenge.

* If someone has one episode of depression they have a 60% chance of experiencing another episode. If they experience two episodes of depression then they have a 70% chance of experiencing another episode. If they experience three episodes of depression then they have a 90% chance of experiencing four or more episodes at some point in their lives.

* Action precedes motivation in the case of depressed people. When people are feeling depressed and don’t feel like doing anything, it is important that they make their best effort to get started and do something anyway. When they do this the desire to continue doing their current and other activities will follow.

Mental Notes Takeaway:

* Depression is an illness that is oftentimes based on a genetic predisposition to exhibit the disorder, which is usually precipitated by stressful life events.

Check It Out:

* Susan Noonan’s website:

* Susan’s book: When Someone You Know Has Depression (

* Managing Your Depression: What You Can Do to Feel Better (

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