Depression Help Here

What We Know About Depression

Clinical depression is a serious, often fatal illness that is so common it's hard to recognize. Researchers estimate that almost 20 percent of the population meets the criteria for some form of depression at any given time. And that doesn't mean people who are temporarily feeling the blues and will be better next week, but people who are having real difficulty functioning in life.

In terms of overall economic burden to our society, depression is the second most costly disease there is. The cost, estimated at $44 billion a year, includes direct treatment, unnecessary medical care, lost productivity, and shortened life span. It's second only to cancer in terms of economic impact, approximately the same as the cost of heart disease and AIDS. In addition, the number of deaths from suicide each year is approximately the same as the number of deaths from AIDS.

Approximately 20 million Americans will experience an episode of major depression in their lifetimes. There is no question that major depression is a serious illness. If you have it, most likely you have real trouble getting through your daily routine, you can't comment to other people, you have distressing physical symptoms, you can't concentrate, you feel guilty, worthless, and hopeless, and you think about suicide. Twenty million means one in ten Americans.

Depression is incredibly under diagnosed. Many people don't realize they have it. Often times, people report they have trouble sleeping and have other physical symptoms, feel anxious and overwhelmed, have lost ambition and hope, feel alone and alienated, are tormented by guilt or obsessive thoughts, may even have thoughts of suicide, but they don't say they're depressed. They just feel that life stinks and there's nothing they can do about it. They go to their doctors for aches and pains, sleeplessness, lack of energy and they get a useless prescription or medical procedure or get dismissed as hypochondriacs. They may medicate themselves with alcohol and drugs. Their families don't know how to help; neither sympathy nor moralizing seems to have any effect. The depressed person is caught up in a vicious circle from which there seems to be no escape.

While there are many things that can't be helped within mental health, depression happens to be one thing that can usually be treated effectively and efficiently. Estimates are that when people are treated promptly, 90 percent of them will recover. New medications are quite helpful, with few side effects. Psychotherapy and medication together have been reliably determined to be more effective than either alone.

Mary was admitted to a psychiatric hospital in a severe state of depression. She was extremely upset and confused, could not organize her thoughts, could not drive to the store or take care of her children. She was obsessed with thoughts and impulses of suicide, though she did not consciously desire to kill herself. She could not sleep, felt hopeless and helpless, and had lost all interest in ordinary activities. She was convinced she was losing her mind.

This all seemed to start when Mary found out her husband had had an affair. Although he seemed ashamed of himself and assured her it would never happen again, her world seemed to fall apart. Within a few weeks, her ability to function had deteriorated dramatically. Her husband brought her to the family doctor, and together they arranged for emergency admission.

After a week in the hospital, with the help of medication and the support of the staff, Mary felt much better. Just before she was ready to be discharged, she went home on a weekend pass. Her visit went smoothly until Mary found a letter her husband's girlfriend had recently written to him. Again he tried to reassure Mary that the affair was over. But her condition took a dramatic turn for the worse, and she spent several more weeks in the hospital.

Depression is actually a fascinating condition. There is a great deal of value in thinking of it as a disease. For one thing, it responds very well to medication. Seventy percent of patients who take medication for depression report feeling better. Further supporting the disease idea is finding that the brain chemistry of depressed people is different from that of other people; and it is possible to find the same biochemical differences in the brains of animals who appear "depressed." On a human level, helping people who are depressed understand that they have a disease can free them from much of the guilt and self-blame that accompanies depression. They can learn different ways of reacting to stress and learn to intervene more quickly with medication so that the danger of future episodes is greatly reduced.

But if it's a disease, how do we get it? If Mary's husband hadn't had his affair, would she ever have come down with depression? There was nothing to suggest it about her before she got sick. Mary now thinks she has had a "breakdown." She also now thinks of herself as a mental patient, but isn't this because her husband is unfaithful? Is the depression in Mary or in her marriage? If it's in her marriage, how can the pills Mary takes help her feel more competent and capable? If it's in Mary, is it the part of herself that sees the truth more clearly than she and her husband can admit to?

Most people who have had a true experience with depression have no trouble at all believing that something biochemical in nature has happened to them. The change in mood, in how the self and the world are perceived, seems so profound and overwhelming that it makes intuitive sense to feel that the self has been invaded by something alien. We do not feel like ourselves. Something very powerful, something from outside us, has invaded and changed us.

But most people with depression also recognize that this feeling that seems so foreign is also very familiar. They remember many times from their childhood and adolescence when they felt the same way. They felt alone, helpless, and friendless. They may remember their parents as kind and loving, but they wonder why they felt so unloved. They may have believed that they had to be perfect, and they may have tried very hard, but failed, and felt again the futility of their efforts. As adults, they may have thought they'd grown out of it, but here it is again.

Depression is a disease both of the mind and of the body, the present and the past. In psychiatry, there are two sides of thought--those who want to treat the brain and those who want to treat the mind. Both sides have powerful motives for pushing their own theories, but unfortunately the patient is caught in the middle. The family doctor, supported by the pharmaceutical industry, is likely to say, "Take this pill"-but when it doesn't work; the patient just has another in a long line of failures to add to his baggage. The mental health professional is likely to say, "Let's talk about it"-and the patient is likely to feel patronized, misunderstood, because, how can simply talking cure such terrible pain?

It's not an either-or question. Both ways of thinking are true. Both points of view have much to contribute to helping the depressed person and their family. Both also have a lot to teach people who simply want to raise emotionally resilient children in a difficult world.

There is a biochemical process in depression, but the individual has been made susceptible to depression through life experiences. The current episode may be precipitated by an external event, but the event has set in motion a change in the way the brain functions.

According to the U.S. Department of Health, up to one in eight people may require treatment for depression during their lifetime. This rate seems to have increased dramatically in the United States at the end of the twentieth century. A lifetime study of 9,500 adults found that people born earlier in the century were significantly less likely to develop depression than those born later. Another study of people with depressed relatives found the same thing-the later in the century you were born, the more likely you were to develop depression. This also means that depression strikes at a younger age. If you were born in the thirties, your own depressive episode was likely to strike between the ages of 30 and 35. But if you were born in 1956, your first episode was likely to strike between 20 and 25. Of all people with major depression, 15 percent will end their lives by suicide.

In most community mental health clinics, depression accounts for 20 percent of the caseload. Mental health experts say that there is a big difference between those who self-report and diagnosis. Only 12 percent of people who call a clinic first state that depression is their primary problem where 45 percent of patients receive a diagnosis of some form of depressive disorder. People usually call, not because they are aware they are depressed, but because they see that something is going wrong in their lives-the children won't listen, they can't get along with their spouse, they are having trouble at work. Experts see someone who looks sad, tired, and defeated, can't sleep, is irritable, hopeless, and blames himself for the situation. Depression often grows in people so slowly that neither the person nor those close to them notice the change, while an objective observer detects it right away.

Depression most often strikes young adults, but 10 percent of all children suffer an episode before age twelve, and 20 percent of the elderly report depressive symptoms. Both children and the elderly are amazingly under treated. Estimates are that 6 million elderly persons suffer from some form of depression, but that three-quarters of those cases are undiagnosed and untreated, despite regular routine medical care.

Depression in the elderly tends to get dismissed as inevitable, but in fact it is caused more by health and poor sleep than grief, loss, and isolation. Among the elderly who commit suicide, almost three-quarters visit a doctor within a week before their death; but only in 25 percent of those cases does the physician recognize a depression.

Twenty-five percent of all women and 11.5 percent of all men will have a depressive episode at one time in their lives. But this reported lower incidence among men may really be a mistake arising from the way they are diagnosed. Men are socially prohibited from expressing or even experiencing the feeling associated with depression. Instead, they act them out through substance abuse, violence, and self-destructive behavior.

Suicide, the "worst case" outcome of depression, is the eighth most common cause of death in America. There are 55,000 documented suicides annually, but the true incidence is more like 100,000. One out of every 200 people will eventually commit suicide.

On the next page we will discuss The Experience of Depression.