Depression has touched the lives of the most successful and brilliant men and women of our time. Sylvia Plath, Dick Cavett, Georgia O^Keeffe, Mark Twain, Virginia Woolf, and Abraham Lincoln all wrestled with depression.
"I felt a kind of numbness, an enervation," recalls William Styron in his book Darkness Visible: A Memoir of Madness, an account of his herculean struggle with major depression. "Mysteriously and in ways that are totally remote from normal experience, the gray drizzle of horror induced by depression takes on the quality of physical pain."
Is It the Blues—or Depression?
Of course, we all feel a little sad, dejected, or blue now and then. Fleeting unhappiness may briefly cloud your horizon after you lose a job, break up with your lover, or move to a new town. The profound mourning following the death of a loved one may last for several months—a completely normal response to a deeply felt emotional loss. The key difference between sad feelings and a true major depression is that sad feelings eventually pass, according to Douglas Jacobs, a Harvard Medical School psychiatrist who has devised national screening programs for depression.
"There were lots of times when I felt blue or sad," notes Sarah, 42, a North Carolina secretary. "Even when my divorce came through and my father died three weeks later, I managed to work through my sad feelings. But when I experienced major depression, it was very different.
"Before that, I had no idea what true depression was all about," Sarah explains. "Now there is a big ^D^ and a little ^d^ for me. Whenever people say that depression isn^t a real mental disease, I find myself explaining just how terrible it can be."
As Sarah discovered, major depression is far more persistent than simple sadness. It descends as a sort of psychic cloud, numbing the soul with the conviction that the bleak outlook will never change. It interferes with sleep, appetite, sexual interest, self-image, and attitude. If you suffer from major depression, you can^t just "snap out of it." And these dreadful feelings can last for weeks, months, or even years.
It is a disorder that costs this country dearly. The federal government estimates the cost of all types of depression is $43.7 billion each year—$12.4 billion in medical, psychiatric, and drug costs; $7.5 billion in depression-related suicide; and $23.8 billion in work absenteeism and lost productivity.
While effective therapy for depression has been available for decades, the condition is seriously undertreated in the United States, according to a panel of mental health experts reporting in the February 1997 Journal of the American Medical Association . This may either be due to the fact that doctors don^t have the necessary training to effectively treat depression or because they may not view the condition seriously enough.
"There is still an enormous gap between our knowledge about the correct diagnosis and treatment of depression and the actual treatment that is being received in this country," wrote the panel led by psychiatrist Robert M. A. Hirschfield, M.D., at the University of Texas at Galveston.
Some studies have shown that only 1 in 10 Americans with depression get adequate treatment. When left untreated, depression can interfere with personal relationships and job performance and can increase your risk for other illnesses, according to a panel organized by the National Depressive and Manic Depressive Association. The number one cause of disability worldwide, depression is an increasing risk with age; it^s expected to be the second leading cause of disease by the year 2020. In the United States, an estimated 6 million people are being actively treated for depression.
Major depression can be very hard to recognize, because it^s a chronic, progressive disease. If you have major depression you may go into remission, but chances are that without treatment, it usually strikes again, more quickly and more powerfully than before.
While symptoms differ from one person to the next, major depression is almost always characterized by general feelings of sadness and a total loss of pleasure in things that once brought you joy. You might also have sleep and eating problems or a sense of worthlessness. Perhaps you^re no longer interested in sex, you^re feeling apathetic, or you have suicidal thoughts.
According to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association, a typical episode of a major depressive disorder lasts at least two weeks and includes most of the symptoms listed in the box, "Are You Depressed?"
Other common signs of depression may not be found in medical journals. "I ask patients if there are cobwebs in their house," says psychiatrist Andy Myerson, M.D. "If patients aren^t bathing, if their house isn^t clean, if they can^t get out of bed—that^s a good indication that they^re depressed."
Many people in the midst of depression agree with him. "If I have to fight my way to the bathroom and I haven^t opened my mail," Violet laughs, "I know I^m in trouble."
It is possible, however, to have a major depression and not feel particularly sorrowful, sad, or hurting. You may instead have eating problems or problems sleeping, remembering, concentrating, or making decisions. Only a mental health expert can diagnose a depression that is hiding as some of these symptoms. *
Are You Depressed?
Emotions: Do you feel ineffably sad or cry a great deal?
Appetite/weight: Have you gained or lost weight? Do you binge or overeat?
Sleep: Do you have chronic insomnia or excessive sleepiness? Are you tired all the time, regardless of how much sleep you get?
Anger: Do you experience outbursts of complaints or shouting? Have you been feeling resentful and angry?
Outlook: Have you lost interest in hobbies or activities that you formerly enjoyed?
Libido: Have you lost interest in sex?
Self-esteem: Do you feel worthless, unattractive, inappropriately guilty?
Concentration: Do you have a hard time concentrating? Are your thoughts muddy or foggy?
Anxiety: Do you brood, have phobias, delusions, or fears?
Restlessness: Do you have trouble sitting still?
Muted affect: Do you have slow body movements and speech?
Suicide: Have you thought you'd be better off dead?
For more information, please go to www.webmd.com
*Taken from www.webmd.com