Keeping it Real with Dr. Bruce J. Levin

Q: Welcome to Keeping it Real, Dr. Levin. Tell us about your background.

A: I’m a psychiatrist and a psychoanalyst and I’m on staff at Chestnut Hill and Pennsylvania hospitals. I’m also in private practice in Plymouth Meeting. I did my psychiatry residency at the Institute of Pennsylvania Hospital and my psychoanalytic training at the Philadelphia Association for Psychoanalysis. I run a psychoanalytic fellowship, which teaches psychiatry residents, psychology students, social work students and academicians about psychoanalytic thinking and principles. The program has been nationally recognized.

Q: What kinds of patients do you see?

A: I primarily see professionals who are stressed out anxious or depressed.

Q: This week, we're talking about depression. What are the symptoms of depression? And are they the same for men and women?

A: Symptoms of depression would be depressed mood, excessive guilt, low self-esteem, decreased energy, difficulty in getting pleasure out of things in life, lower sex drive, interrupted sleep, sometimes diarrhea, constipation, feelings of hopelessness, feelings of inadequacy, often irritable mood and fits of anger. I would also add feelings of suicide and self-destructive feelings. I would say generally women are more in touch with how they feel. So, they would be more apt to appreciate and recognize that they’re depressed. Men tend to not pay as much attention to their emotions, and often, through a man, depression will come out through angry outburst, drinking more and emotionally cutting himself off.

Q: What triggers these feelings?

A: I think that these feelings can be triggered by both biological and/or psychological influences. Some people have a family history and a propensity to become depressed, and certainly people’s temperament and family background can make a contribution to getting depressed. Also psychological factors and often long-standing problems can express themselves through acute depressive episodes.

Q: Is depression a natural feeling for people to have at some point in their lives? Or does it suggest that something is wrong?

A: Feeling depressed certainly can be a natural feeling. But, it also can suggest that something’s wrong. In order to distinguish whether it’s part of an expectable and normal feeling or if it’s more concerning, several things need to be looked into. First, what’s the depth and degree of the depressed feeling? Second, under what circumstances are they occurring? Third, how much does the depressed feeling or mood affect day-to-day function in terms of work, relationships and other activities? These are some of the important areas that a clinician would be looking at in order to assess whether depression is normal.

Q: Are there varying degrees of depression?

A: Yes. All of us, at various times in life, have experienced depression and it can vary in degree.

Q: How can you tell if someone you care about is really in trouble?

A: A very important thing to look at is how they’re functioning in different parts of their lives. Are they still able to work? Are they able to be involved in important relationships? Have their friendships been maintained? Are they still involved in their hobbies? I think it’s in terms of the level of functioning and the depth and degree of sadness, guilt, low self-esteem and, of course, [feelings of] suicide or self- destructive feelings.

Q: What do you do, or where do you go for help?

A: First, if somebody is acutely suicidal, they need immediate attention and should go to the nearest emergency room. For people who continue to function, but are suffering with depression, they can call the Psychoanalytic Center of Philadelphia in Bala Cynwyd at 610-667-8708 to receive a thorough consultation and evaluation. In certain instances, they can receive reduced fee treatment when it is needed. Patients will be seen in doctors’ private offices in a comfortable, confidential setting.

Q: What, if any, physical changes can people make to overcome feelings of depression?

A: While people can make changes such as exercise, and changes in routine and diet, I think the most important thing that’s necessary when a person gets depressed is to get a complete and thorough psychiatric/psychological evaluation by a well trained clinician. Thoroughly trained clinicians are available at the Psychoanalytic Center of Philadelphia.

Q: Are there other resources, books, Web sites or hotlines that people can consult for information or help? If so, what are some of them?

A: There are the Web sites of the American Psychoanalytic Association and the American Psychiatric Association.

Q: How do you stay fit?

A: I bicycle. I hike. I Nordic Track. And, I garden.