Soul-Deep Blues

March 1, 1997
Do you feel sad or empty? Do you exhibit slowed behavior, or changes in eating and sleeping patterns? Do you sometimes feel down on yourself or hopeless about the future? Do you feel guilty or anxious? Or cry a lot or become irritable over small things? Perhaps you`ve lost interest in friends and other activities that used to give you pleasure. Or maybe you have nagging physical aches and pains - backaches, headaches or stomach problems, xerostomia, nausea, constipation, or diarrhea - for which

Clinical depression may be depriving someone you know of a good life

Frances Wolfe

Do you feel sad or empty? Do you exhibit slowed behavior, or changes in eating and sleeping patterns? Do you sometimes feel down on yourself or hopeless about the future? Do you feel guilty or anxious? Or cry a lot or become irritable over small things? Perhaps you`ve lost interest in friends and other activities that used to give you pleasure. Or maybe you have nagging physical aches and pains - backaches, headaches or stomach problems, xerostomia, nausea, constipation, or diarrhea - for which there is no medical explanation. Maybe you feel anxious with a sense of dread that something unspecified but terrible is going to happen. Chances are you may be experiencing an all too common disorder: clinical depression.

Clinical depression is a serious medical illness, which is as common as it is misunderstood. Many people go through life suffering from clinical depression, never understanding that it is a medical illness or knowing that effective, successful treatments are available. If you think you notice the signs or symptoms of depression in yourself, a co-worker, a family member, or a patient, it`s important to recognize these behaviors and to find a referral source for professional treatment. The good news is there`s hope and help available!

Temporary "blues" or sadness is not depression; nor is the normal grief that results from the loss of a loved one. Patients experiencing the blues or grief may reveal short-term symptoms of depression, but they continue to function almost normally and soon recover without treatment.

Instead, clinical depression is an illness that interferes with and disrupts a person`s family life and livelihood. No amount of "cheering up" can make depression go away. Neither can "keeping a stiff upper lip" or "toughing it out." Neither will exercise, vitamins, or taking a vacation make clinical depression disappear.

Patients with clinical depression require proper diagnosis and treatment, which often includes medication, psychotherapy or a combination of both.

Is clinical depression the same for everyone?

No. In fact, clinical depression differs significantly in both severity and duration. Some patients may suffer only one episode during their lifetime, while others experience recurring episodes.There are two basic types of clinical depression - major depresssion and manic depression.

Major depression (also called "unipolar depression") is identified by a variety of characteristics. Examples include sad or hopeless feelings, slowed behavior, changes in weight (or appetite or sleeping patterns), loss of interest in friends and social activities, and thoughts of death or suicide.

Manic depression (sometimes referred to as "bipolar depression") results in alternate cycles of depression or manic elation. During the manic phase, patients may exhibit symptoms such as: increased energy or decreased need for sleep, inappropriate excitement or irritability, increased talking or moving, promiscuous sexual behavior, disconnected or racing thoughts, and impulsive behavior and poor judgment, such as shopping sprees. During the depressed phase, many of the symptoms of major depression are experienced.

Doctors have recently identified two additional types of clinical depression - dysthymia and seasonal affective disorder (SAD). Similar to a low-grade infection, dysthymia is a less severe form of major depression that keeps patients from feeling good or enjoying life. People who suffer from this form of depression "go through the motions" of daily life, often with little pleasure or enthusiasm, for years at a time.

SAD is depression associated with the time of the year and with the brightness and duration of daylight. Medical researchers have linked inadequate exposure to sunlight with depressed moods. SAD can be treated successfully with artificial light therapy and medication.

What causes clinical depression?

Sometimes it is possible to identify a specific event that may have triggered an episode of depression. Other times depression comes on for no apparent reason, even for people whose lives are going well. Here are some of the possible causes:

- External events. Loneliness resulting from troubled or failed relationships is one example. Other external events include financial worries, legal problems, or retirement.

- Genetics. Medical researchers now realize that inherited factors are significant - having close relatives, for example, who have experienced depression. Patients with a genetic susceptibility may be more vulnerable to depression when something upsetting occurs.

- Physiological or biochemical factors. Depression may result from complex interactions among brain chemicals called neurotransmitters that influence a person`s energy level, feelings, and sleeping and eating habits.

- Medical illnesses. Contributing physiological factors such as strokes, Cushing`s disease, and thyroid irregularities can trigger bouts of depression. Various medications, such as anti-hypertensives, birth control pills, and steroids have been linked to depression. Alcohol and other commonly abused substances may also cause depression.

Occasionally, no identifiable triggers can be linked to an episode of clinical depression. More often, a combination of stressful conditions are involved.

Researchers have discovered that patients who suffer from clinical depression have changes in vital brain chemicals, including serotonin and norepinephrine. Medications help restore the brain chemicals to their proper balance and relieve the symptoms of clinical depression.

Who suffers from clinical depression?

It strikes more than 11 million people annually. Depression affects people of all ages and races in all walks of life. Studies in the United States have shown that, at any given time, about 5 percent of the population can be diagnosed as having major depression. At least 10 percent of Americans will experience a major depression in their lives, although some researchers place this figure as high as 25 percent.

Clinical depression strikes Americans most often between the ages of 24 and 44, during what are considered by society to be the most productive years. Some researchers believe that women are more likely than men to admit their symptoms and seek treatment for clinical depression. Additionally, even if men recognize their symptoms, many view the illness as a "personal weakness." Others ignore symptoms or cope with their suffering by abusing alcohol, drugs, or both.

What forms of treatment are available?

Medication and psychotherapy are the two most common forms of treatment for clinical depression. They can be used singularly or in combination. For more severely depressed patients, medication is generally required. A complete examination by a physician or mental health specialist is necessary in order to ensure a correct diagnosis.

Anti-depressant medications include three principal categories - tricyclics, monoamine oxidase inhibitors (MAOIs), and serotonin reuptake inhibitors. Additionally, lithium and some anticonvulsants treat manic depression. Patients taking anti-depressants must be monitored regularly by their physicians to ensure the medication is working properly, taken as directed, and prescribed in the correct dosage. Sometimes, during the course of treatment, the physician may change the course of treatment or combine medications to make sure their patients receive the most effective treatment.

Medications for depression may cause side effects, such as xerostomia, drowsiness, blurred vision, weight gain, digestive and urinary disorders, insomnia, agitation, hypertension, dizziness, or sexual dysfunction. It is important to continue to take the medication prescribed. All too often, patients stop taking their medication soon after they begin feeling better or before the medication has had sufficient time to take full therapeutic effect - usually two to six weeks. When they discontinue the medication, symptoms of clinical depression may recur.

Psychotherapy or "talk therapy" may be helpful for depression. For patients with only mild depression, psychotherapy may be the only form of treatment required.

Common forms of psychotherapy include supportive, cognitive, behavioral, and interpersonal. Cognitive and behavioral therapists assist patients in changing the negative styles of thinking and behaving often associated with depression. Interpersonal therapists focus on the patient`s disturbed personal relationships that cause or exacerbate depression. A family physician can make a recommendation to a therapist who may be most appropriate.

Helping yourself overcome depression

As stated previously, depression can make you feel exhausted, helpless, worthless, and hopeless. Often, such feelings lead the sufferer to feel like giving up or surrendering.

It is important to recognize that these negative views are a part of the disease of depression, and they typically do not accurately reflect the actual situation. Here are some steps for making negative self-doubts dissipate:

- Set realistic goals for yourself. Avoid taking on more than you can accomplish.

- Break large tasks down into smaller steps. Set realistic priorities.

- Avoid expecting too much from yourself. This only increases feelings of failure.

- Make time to surround yourself with other people. Being alone can contribute to negative feelings associated with depression.

- Participate in activities that help you feel better about yourself. Try walking, sports, or becoming active in church or social activities.

- Postpone important life decisions for now. Such decisions can include marriage, divorce, or a job change. Seek out advice from those you respect.

- Remind yourself that negative thinking is a part of depression. It will disappear as you respond to treatment.

- Seek out a support group. Sharing your feelings and experiences with others will bring you closer together.

The single most important step you can take to help another person overcome depression is to help obtain appropriate diagnosis and treatment. Afterwards, you encourage the person to stay in treatment and continue to take medication. Depending on your relationship, you may offer to accompany the person for follow-up visits.

Emotional support is very important to a depressed patient. This may encompass listening carefully, going for walks, going to a movie, or simply engaging him in conversation. You also encourage him to participate in activities that once gave him pleasure.

But do not push the depressed person to undertake too much too soon. Never accuse the depressed person of faking an illness or of laziness. Do not expect him to "just snap out of it." Keep reassuring him that he will feel better with the appropriate time and professional help.

Frances Wolfe is a pen name for a long-time dental editor.

Self-Screening Test for Clinical Depression

You can use the following checklist to determine if you, a co-worker, a family member, or patient may suffer from clinical depression. If five or more of the following symptoms have lasted for more than two weeks, professional help should be sought. The good news is that clinical depression can be successfully treated with therapy and medication.

- Feelings of sadness and/or irritability

- Loss of interest or pleasure in activities once enjoyed

- Changes in weight or appetite

- Changes in sleeping pattern (either too much or too little)

- Feelings of guilt, hopelessness, or worthlessness

- Inability to concentrate, remember things, or make decisions

- Fatigue or loss of energy

- Restlessness or decreased activity noticed by others

- Thoughts of suicide or death

_____TOTAL. If you checked five or more symptoms and they have lasted more than two weeks, consult a physician.

In addition, look for the following symptoms of the manic phase of manic depression:

- Increased energy and decreased need for sleep

- Inappropriate excitement or irritability

- Increased talking or moving

- Promiscuous sexual behavior

- Disconnected or racing thoughts

- Impulsive behavior and poor judgment

Need More Information?

Contact the following organizations:

D/ART (Depression Awareness, Recognition, Treatment) Public Inquiries

National Institute of Mental Health

Room 10-85

5600 Fishers Lane

Rockville, MD 20857

Call for free brochures: (800) 421-4211

In addition to professional treatment, many people and their families benefit from joining support groups. For a list of groups in your areas, contact:

National Alliance for the Mentally Ill

2101 Wilson Blvd., Suite 302

Arlington, VA 22201

(800) 950-NAMI

National Depressive and Manic Depressive Association

730 N. Franklin, Suite 501

Chicago, IL 60610

(800) 826-DMDA

National Mental Health Association

1021 Prince Street

Alexandria, VA 22314-2971

(800) 969-NMHA