At any given time, it's estimated that five to seven percent of Americans suffer from depression. Yet, many of these people are too embarrassed to seek help. It is not uncommon for individuals suffering from depression to wonder just when it is necessary to seek help.
Many times, I hear comments like the following from depressed patients: "I really thought this was something I could handle." "I feel so weak, like I have failed." "I should be able to control things so I don't get depressed."
Many of these people also tell me that others have made especially cruel remarks to them concerning their depression, including: "You don't have anything to be depressed about." "You just need to make yourself get out (or get up -- or get over it)." "I was depressed and I got over it -- so should you."
I don't think the people who made these remarks would say similar things to someone with a more traditional "medical" illness, such as cancer, diabetes or heart disease. Unfortunately, we still operate out of prejudice and ignorance when it comes to diseases of the brain, or as the more archaic name refers to it... mental illness.
It is important to realize that depression is a disease, a medical illness. It is the result of abnormalities in the brain that appear to be caused by extended periods of stress and duress, from which the brain is unable to re-establish its normal mood. It is actually a "multi-system" disease, meaning that since the brain controls multiple functions or systems when impacted by depression many of these other functions are affected.
The result is a disease with a variety of symptoms that can interfere with a wide range of daily activities and functions. Depression can also be genetically based. Like diabetes, heart disease and other chronic illnesses, it can run in families. Along with evidence of a relationship between alcoholism and depression, there are socioeconomic factors, including economic class and marital status, which seem to create an increased risk as well. The presence of concurrent physical illnesses serves as a stress factor that can precipitate a depressive episode. Given a combination of these risk factors and the presence of unremitting stress, it is not surprising that the development of a depressive episode becomes "an illness waiting to happen."
What then is this disease called depression, and when should someone seek treatment? There are well-established guidelines and criteria for making the diagnosis. This diagnosis is generally based on the presence of any combination of the following symptoms for at least 2 to 4 weeks:
Depressed mood most of the day, nearly every day
Decreased interest or pleasure in one's daily activities
Major changes in weight and/or appetite
Insomnia or hypersomnia
Agitated or slowed thinking
Fatigue, loss of energy -- all activities seem to require excessive effort to complete
Feelings of worthlessness, inappropriate or excessive guilt
Decreased ability to think or concentrate; indecisive thinking
Recurring thoughts of death or suicide; this does not always include a wish or plan to die but an acceptance of the belief that "others would be better off without me."
This list highlights the more prominent features of depression, but it is not all-inclusive. Many women complain of being easily frustrated, irritable or angered, worried about their "lack of patience with my children or my spouse." Others report not wanting to talk with friends, citing a lack of energy or interest in doing so. Their answering machine becomes a sentinel, screening their calls and limiting their interactions. Even their ability to function in the workplace is seriously compromised. There are complaints of problems with memory, concentration, attention and recall. Depressed workers may also experience reduced productivity. In severe cases, individuals who were outstanding employees begin to risk losing their jobs.
It takes incredible strength, courage and faith to seek treatment and commit oneself to it. Which brings us to the question of treatment -- what works and why? Treatment must be individualized. Medications for depression are safe, effective and must generally be continued for at least a year once the depression is controlled.
The patient and physician should then determine together whether it is time to discontinue medications and/or change the approach to treatment. The steps for achieving wellness begin with a personal inventory of one's life: eating habits, exercise patterns, the spiritual self, relationships (at work, home, with friends and family), and other aspects of one's lifestyle, which give pleasure, joy and satisfaction.
Addressing those factors that have gradually stressed the brain enough to make the person depressed will create an understanding of where one's efforts for change should be directed. However, such a necessary "journey" of understanding cannot be fully successful if one is struggling against severe depression. Therefore, I advise my patients to recognize that the healing process may take some time. There is no quick fix to the situation. However, once the medications have become effective, patients experience renewed strength as well as a return of the ability to establish a normal life. Patience and faith are critical factors in this healing process.