Part One: 
Understanding Depression

One: You Are Not Alone

That's something of an understatement.

One in twenty Americans currently suffers from a depression severe enough to require medical treatment.

One person in five will have a depression at some time in his or her life.

Depression in its various forms (insomnia, fatigue, anxiety, stress, vague aches and pains, etc.) is the most common complaint heard in doctors' offices.

Two percent of all children and five percent of all adolescents suffer from depression.

More than twice as many women are currently being treated for depression than men. (It is not known whether this is because women are more likely to be depressed, or whether men tend to deny their depression.)

People over sixty-five are four times more likely to suffer depression than the rest of the population.

Depression is the #1 public health problem in this country.
Depression is an epidemic an epidemic on the rise.  

Two:
If You Need It, Get Help at Once

If you feel suicidal and are afraid you might act on it, please call 911, your doctor, a crisis prevention hotline, or go immediately to your local hospital emergency room. (Our thoughts on suicide are on page 36.)

You should also seek help at once if you...

--feel you are "coming apart"

--are no longer in control

--are about to take an action you may later regret

--turn to alcohol, drugs, or other addictive substances in time of need

--feel isolated with no one to turn to

This is no time to "be brave" and attempt to "go it alone." In fact, asking for help takes enormous courage.  

Three:
There Is No Need to Suffer

Long-term, expensive treatments are seldom necessary.

Modern treatment for most depression is antidepressant medication and short-term "talk" therapy--usually just ten to twenty sessions.

Treatment for depression is relatively inexpensive but whatever the cost, it is more than made up for in increased productivity, efficiency, physical health, improved relationships, and enjoyment of life.

Yes, life will always have its "slings and arrows of outrageous fortune," and, yes, they will hurt. But there's no need to suffer from depression as well.
 

Four:
"I Can't Handle Anything Else!"

When we discuss treatment for depression, it may sound as if we're asking you to add even more to your already overburdened life. Although it may seem this way, effective treatment for depression will lighten your load.

Yes, we are asking you to visit "healthcare professionals," and, yes, a simple suggestion such as "Find a doctor or psychiatrist who specializes in the treatment of depression" can seem awfully intimidating.

But it will be worth it.

Most people respond to treatment for depression swiftly usually in a matter of weeks. You may not feel "better than good" overnight, but the sense of being overburdened, overworked, and overwhelmed should significantly ease in a short time.

Treatment for depression doesn't take time, it makes time.  

Five:
"Why Bother?"

Questions such as "Who cares?" "What's the point?" and "Why bother?" circulate in the mind of the depressed person.

Unfortunately, this symptom of depression can keep one from seeking treatment. It becomes a vicious cycle: as the untreated depression worsens, the person feels that life is less and less worthwhile. As the person feels that life is less and less worthwhile, he or she is less likely to seek treatment.

Depression is an illness that robs one of the meaning of life. Heal the illness. As the depression heals, enthusiasm, well-being, and a sense of life's purpose will return.  

Six:
It's Not Your Fault

Your failure to do something didn't cause your depression.

Depression is an illness.

You are no more at fault for having depression than if you had asthma, diabetes, heart disease, or any other illness.

In becoming depressed, you have nothing to blame yourself for and nothing to feel guilty about. (Although two of the symptoms of depression are that you probably will blame yourself and you probably will feel guilty.)

A predisposition toward depression can be hereditary. In addition, life is full of bumps and potholes--many of which simply cannot be avoided. It's not surprising, then, if one of them (or a collection of them) triggers a depressive illness.

So, for heaven's sake, don't blame yourself. Don't even blame yourself for blaming yourself.

It's not your fault.  

Seven:
It's Not Anybody's Fault

It's not your spouse or lover's fault.

It's not your children's fault.

It's not your boss's fault.

It's not society's fault.

It's not God's fault.

No one is to blame.

One of the symptoms of depression is feeling victimized--"They're doing it to me." Many people seem more willing to admit that they're oppressed than depressed.

Depression is simply an illness you somehow got--like low thyroid--which, while serious, is easily treated. The chances for complete recovery are excellent.

Where your depression came from isn't important; how to heal it is.  

Eight:
What Is Depression?

First, the word depression itself. When we speak of depression, we are speaking of what is medically known as clinical depression. We're discussing a specific illness that requires clinical intervention--hence clinical depression.

We are not discussing the pain that immediately follows loss, or the "down" cycle in life's ordinary ups and downs.

Nor are we discussing the popular use of the word depressed, which usually means disappointed.

("The coffee machine ran out. I'm depressed.")

When we use depression, we're talking about a specific medical illness--one with a highly effective treatment.  

Nine:
The Three Primary Types of Depression

Major Depression. Like the flu, major depression has a beginning, a middle, and an end. Unlike the flu, major depressions often last for months. Left untreated, they tend to reoccur. Each reoccurrence tends to last longer and is more debilitating than the one before.

Chronic Depression. Chronic depression is a low-grade, long-term depression that can go on for years. Some people have had it most of their lives. Long-term, low-grade depression is also known as dysthymia. dys, meaning disorder, and thymia for mood. Dysthymia, then, is a disorder of one's mood.

Manic-Depression. Here the lows of depression can alternate with days or weeks of maniaextreme elation, unreasonably grandiose thoughts, and inappropriate, sometimes destructive actions. This is also known as bipolar depression, because the manic-depressive person fluctuates from one emotional pole (down) to the opposite pole (up) in unpredictable, rapid swings. (By contrast, major depression is unipolar--it focuses on only one pole: down.)

We'll discuss other types of depression later. For now, let's take a look at that burning question, "Am I depressed?"  

Ten:
The Symptoms of Depression

Symptoms of Depression Can Include:

• Persistent sad or "empty" mood
• Loss of interest or pleasure in ordinary activities, including sex
• Decreased energy, fatigue, being "slowed down"
• Sleep disturbances (insomnia, early-morning waking, or oversleeping)
• Eating disturbances (loss of appetite and weight, or weight gain)
• Difficulty concentrating, remembering, making decisions
• Feelings of guilt, worthlessness, helplessness
• Thoughts of death or suicide, suicide attempts
• Irritability
• Excessive crying
• Chronic aches and pains that don't respond to treatment

• Decreased productivity
• Morale problems
• Lack of cooperation
• Safety problems, accidents
• Absenteeism
• Frequent complaints of being tired all the time
• Complaints of unexplained aches and pains
• Alcohol and drug abuse

Symptoms of Mania Can Include:

• Excessively "high" mood
• Irritability
• Decreased need for sleep
• Increased energy and activity
• Increased talking, moving, and sexual activity
• Racing thoughts
• Disturbed ability to make decisions
• Grandiose notions
• Being easily distracted

Eleven:
Are You Depressed?

The symptoms on the facing page are not "just life." If four or more of the symptoms have been a regular part of your life for more than two weeks or regularly tend to interfere with your life, a consultation with a physician experienced in diagnosing and treating depression is in order. You need not suffer any longer. Treatment is readily available.

"With available treatment, eighty percent of the people with serious depression--even those with the most severe forms--can improve significantly," say the National Institutes of Health. "Symptoms can be relieved, usually in a matter of weeks."

Please talk to your doctor. (And read on!)
 

Twelve: 
You Can Be Depressed without "Feeling Depressed"

Yes, many people who have clinical depression feel down, sad, disappointed, and upset. One can, however, feel all of these emotions ("I'm depressed!") without being clinically depressed.

Pain after a loss, for example, is a natural part of the healing process, not a sign of clinical depression. (If the pain becomes extremely severe or continues for an unusual length of time, the loss may have triggered a type of clinical depression that's known as a melancholy depression. When mourning becomes melancholia, or if a loss has dealt a severe blow to your self-worth, see your physician.)

On the other hand, some people do have a clinical depression and do not feel unusual amounts of sorrow, sadness, or emotional hurt.
 

Symptoms of clinical depression include: 
insomnia; eating disturbances; physical aches and pains; difficulty concentrating, remembering, or making decisions. These are not, however, what most people call "down" or "depressing" emotions.

If in doubt, it is best to get an objective, outside expert--your physician--to make an accurate diagnosis.  

Thirteen:
Seeking Treatment for Depression Does Not Imply a Lack of Character, Discipline, Common Sense, or Personal Strength

This is not the case.

Seeking help for an illness (any illness) does not imply a lack of mental, physical, emotional, or moral character.

To the contrary, it takes great courage to admit something may be wrong. It is a sign of deep wisdom to consult professionals, seeking their advice and direction.