Top Doctors: Understanding depression

Depression is a recurring theme in television dramas and celebrity tell-alls. Yet many Americans keep their own ill feelings bottled up, suffering in silence instead of seeking treatment.

"People are still undertreated, the diagnosis is still underrecognized, and it's very unfortunate because it's one of the more treatable illnesses that we have if it's recognized and if people will go for treatment," said Dr. Bruce Rosen, chairman of psychiatry at St. Catherine of Siena Medical Center in Smithtown.

Depression is considered a "mood disorder" because it affects a person's emotional state. An estimated 21 million adults and children in the United States experience depression each year, according to Mental Health America, a patient advocacy group.

SYMPTOMS

Depression may trigger any number of symptoms, including:

* Lack of interest and pleasure in daily activities

* Significant weight loss or gain

* Sleeplessness or sleepiness

* Lack of energy

* Difficulty concentrating

* Feelings of worthlessness or guilt

* Thoughts of death or suicide

"They can be walking very cheerfully and talking to people and all that, but inside they are feeling very sad," explained Yogendra Upadhyay, medical director of South Oaks Hospital, a psychiatric and substance abuse treatment facility in Amityville.

Nearly everyone experiences stressful situations that dredge up symptoms of depression, but those feelings often resolve on their own. A person with major depression, however, experiences persistent symptoms that interfere with daily life, experts say. Without treatment, the depression can linger and worsen.

RISK FACTORS

Though it's more common among women than men, depression affects both sexes. For men, though, the consequences tend to be more severe because men are more likely to die by suicide, according to the U.S. National Institute of Mental Health.

According to the U.S. Preventive Services Task Force, other risk factors for depression include:

* Having a family history of depression

* Having a chronic medical condition

* Having a psychiatric disorder

* Being jobless or poor

CURRENT THINKING

Researchers suspect that depression results from a combination of genetic, biochemical, environmental and psychological factors.

Major depression is typically treated with a combination of "talk therapy" and antidepressants. Selective serotonin reuptake inhibitors (SSRIs), a class of medications that includes Prozac, Celexa and Zoloft, are often prescribed, as are serotonin and norepinephrine reuptake inhibitors (SNRIs), such as Effexor and Cymbalta.

Whether children and teens with depression should be given SSRIs, however, remains in question, Upadhyay noted, because some studies have linked use of these drugs to an increased risk for suicidal thoughts or attempts in children, adolescents and young adults. Other studies have found that the benefits of taking antidepressants outweigh potential risks.

When conventional therapy fails, clinicians sometimes try other treatments. A recent study in the Archives of General Psychiatry found that magnetic stimulation of nerve cells in the brain may be effective in alleviating depression. And for people with severe depression who have failed multiple treatments, the U.S. National Institute of Mental Health reports that electroconvulsive therapy, once known as "shock therapy," is sometimes effective.

THE LONG ISLAND SCENE

South Oaks and its partners, Eastern Long Island Hospital in Greenport, the town of Southold and the Mental Health Association in Suffolk County, are working with primary care physicians on the North Fork to improve efforts to identify older adults with depression.

By integrating depression screening into doctor visits, the collaborators hope to catch more people who could benefit from a referral to a mental health practitioner, explained Kristie Golden, vice president of ambulatory and community services at South Oaks.

The project runs through June 2012.

Who's who

This is the sixth installment of a 26-week series in which Newsday presents Castle Connolly's list of top L.I. doctors. Today: psychiatrists.

PSYCHIATRY

Dr. Thomas Aronson

2 Brooksite Dr., Smithtown, 631-265-0909

Dr. Samuel Bailine

5 Ridgeway Rd., Port Washington, 516-883-3304

Dr. Raymond Behr

81-A Arleigh Rd., Great Neck, 516-482-1980

Dr. John Benjamin

1983 Marcus Ave., Lake Success, 516-216-1780

Dr. Sheldon Berman

8 Payne Circle, Hewlett Harbor, 516-374-4417

Dr. Ashok Bhatt

871 E. Park Ave., Long Beach, 516-889-8853

Dr. Cathy Budman

North Shore-LIJ Health System, Dept. Psychiatry & Neurology, 400 Community Dr., Manhasset, 516-562-3223

Dr. Patrick Carone

2000 N. Village Ave., Rockville Centre, 516-766-2871

Dr. Jovita Crasta

2277 Grand Ave., Baldwin, 516-377-5400

Dr. Marvin Frogel

78 Oxford Blvd., Great Neck, 516-482-5377

Dr. Michael Gurevich

997 Glen Cove Ave., Glen Head, 516-674-9489

Dr. Eli Katus

1035 Rte. 106, East Norwich, 516-922-5607

Dr. Jack Katz

1010 Northern Blvd., Great Neck, 516-336-2565

Dr. Amy Koreen

28 Elm St., Huntington, 631-423-8368

Dr. Kwang Soo Lee

221 Broadway, Amityville, 631-789-7448

Dr. Vera Liang

221 Broadway, Amityville, 631-598-7396

Dr. Jack Nass

580 Sunrise Hwy., West Babylon, 631-321-7697

Dr. Arthur Rifkin

585 Plandome Rd., Manhasset, 516-456-6557

Dr. Bruce Rosen

222 E. Middle Country Rd., Smithtown, 631-265-6868

Dr. Sherif Sami

7 Bond St., Great Neck, 516-487-9191

Dr. Michael Schwartz

33 Walt Whitman Rd., Huntington Station, 631-385-3313

Dr. Yogendra Upadhyay

400 Sunrise Hwy., Amityville, 631-608-5212

CHILD & ADOLESCENT PSYCHIATRY

Dr. Gabrielle Carlson

Putnam Hall, South Campus, Stony Brook University, 631-632-8840

Dr. Carmel Foley

Steven and Alexandra Cohen Children's Medical Center, 269-01 76th Ave.

New Hyde Park, 718-470-3550

Dr. Lajpat Gandhi

110 E. Main St., Huntington, 631-427-6411

Dr. Judith Greenberg

775 Park Ave., Huntington, 631-629-4790

Dr. John Pomeroy

The Cody Center for Autism, 5 Medical Dr., Port Jefferson Station, 631-632-3070

Dr. Deborah Weisbrot

Stony Brook University, Div. Child & Adolescent Psych., Putnam Hall, South Campus, 631-632-8840

Dr. Daniel Williams

3003 New Hyde Park Rd., New Hyde Park, 516-488-3636

How they were picked

Castle Connolly Medical Ltd. is a health care research and information company founded in 1991 by a former medical college board chairman and president to help guide consumers to America's top doctors and hospitals. Castle Connolly's established survey and research process, under the direction of a doctor, involves tens of thousands of doctors and the medical leadership of leading hospitals.

Castle Connolly's team of researchers follows a rigorous screening process to select doctors on national and regional levels. Using mail and telephone surveys, and electronic ballots, they ask physicians and the leadership of top hospitals to identify exceptional doctors. Careful screening of doctors' educational and professional experience is essential to the committee. Newsday is not part of the selection process.

Doctors do not and cannot pay to be selected and profiled as Castle Connolly Top Doctors.

To see the whole list . . .

Who else is on the list of Top Doctors? More than 6,000 listings are in the New York Metro Area edition of "Top Doctors," published by Castle Connolly Medical Ltd. The soft-cover list price is $34.95. For more information, go to castleconnolly.com, or call 800-399-DOCS.