"Depressed? Here's Help" Readers Digest, NOvember l994, 151-157 Lately it's been a colossal effort to drag yourself out of bed. It's impossible to concentrate on your work. Your headaches and sleeplessness make it worse. Weekends are no better. Golf used to be fun, but it turned boring. Even sex is a chore. An alarming thought flashes by: Maybe this misery would end if I never woke up... Warning signals, pal: you've got more than a case of the blahs. These are signs of a common but serious illness: major depression. Because it may masquerade as different ailments - backache, stomach probems, anxiety - and because it often gets dismissed as the blues, true depression is far more prevalent han most people realize. Goof-offs and bumblers aren't necessarily the ones who get clobbred, either. Abraham Lincoln, J. P. Morgan and Winston Churchill suffered too. Says Dr. Jeffrey Lynn Speller, a Belmont, Mass., psychiatrist who specializes in depression: "Often it hits themost ambitious, creative and conscientious." At any given moment, up to five percent of the population in the United States is depressed. Twice as many women report the illness as men. And the incidence of depression has been rising. People born since the l940's aremore likely to report a depression than those who were born earlier. While depression can be a dreadful disease, it is also easily treated. Left untreated, a major depression typically lasts at least six months. But today most depressives can begin recovering within a few weeks, thanks to new therapies and a better understanding of the disease. A tendency to depression is not a weakness or a self-indulgence. Scientiest theorize that depression is caused by an imbalance of chemicals in the brain. It runs in families; the parents, siblings and children of a depressed person are at higher risk for depression than those who do not have a depressed person in the family; an identical twin is at even greater risk. Still, depression can strike anybody. Consider the man in his 50's who signed on as chief financial officer at a Texas company in the midst of a leveraged buyout. Told to fire teh controller, the CFO fought to keep him because of the older man's knowledge of the company. The two men became friends. Then the controller died of cancer. To the CFO's amazerment, his friend's death helped bring on a major depression. I'd never been sick a day in my life," he says. "Suddenly I couldn't eat or sleep." His weight dropped rapidly, and he became so anxious he found himself screaming in the ar on the way to work. He barricaded himself at home on weekends and rarely emerged from his office at work. "I could barely think. I'd stare at six pairs of identical white underwear in the morning and not be able to decide which to put on." After unsuccessful attempts at treatment, the executive attended a special program at the Menninger Clinic in Topeka, Kan., where he received proper medication and attended group therapy. Eventually, he overcame the depression, and it has not been back. Depression is often triggered by stressful life events, but it can also be touched off bypositive news like a promotion, a baby or a new home. Not surprisingly, feeling depressed is one of the two major symptoms. The other is anhedonia, a markedly dimnished interest in food, sex, hobbies - just about everything pleasurable. If you, or people aroundyou, observe either of these midn-sets for two weeks or more, watch out for seven other signals: a big increase or loss in wight, sleeplessness or oversleeping, fatigue, slowed body movements, feelings of worghlessness or guilt, inability to concentrate or make decisions, and thoughts of death. If you display any four of these symptoms along with anhedonia or depressed mood, you've got a major depression. Burnout or grief often complicates the diagnosis of depression. But Dr. Donald E. Rosen, of the Menninger program, points out one big difference. "Depression doesn't respond to common sense. A depressed person takes a vacation and doesn't feel better. Or a friend tries to cheer him up and he feels worse." The biggest problem facing most new patients is waiting to see the effects of treatment. If the depression is mild to moderate, you will fare wellwith antidepresant medication or short-term psychotherapy. "Take your choice and try it for several weeks," says Dr. Frederick K. Goodwin, director of the National Institute of Mental Health (NIMH). The U.S. Department of Health and Human SErvices says taht a typical trial on medication will last four to six weeks, therapy six to eight weks. There's a differece in price. Six weeks on the average dose of one of the new antidepressants will set you back $105 to $125,while once a week on the couch for that long could cost $600. Insurance plans generally pay for 80% of medications, but only half of therapy. Even so, you should not be taking antidepressants without the supervision of a doctor. If you decide to go to the family docotr for help, tell him or her explicitly that you think you're depressed. Goodwin says nonpsychiatrist doctors spot major depression less frequently than mental-helath professionals do. Some primary-care doctors may prescribe an anti-anxiety drug or a sleeping pill, which may act as a depressant and make matters worse. If the treatment you embark on doesn't begin working within eight weeks, your doctor may start or change medication. If you do not feel therapy is helping, find a more compatible therapist. For moderate to severe depression, there is a growing consensus: get medicine right away. The federal guidelines say there is almost no evidence that psychotherapy alone is useful in eliminating severe depression. Says teh NIMH's Goodwin: "If the symptoms are relentless, if you thghts feel as if they're pushing through molasses,nobody would question using medication." Antidepressants seemto work by boosting the levels of two types of neurotransmitters in the brain thought to affect mood. Older antidepressants -tricyclics and AO inhibitors - boost transmitters but cause unwnted side effects when standing and wight gain. Users of MAO inhibitors have to avoid certain foods, such as some cheeses, wines and pickled items. The newest class of antidepresants, by comparison, seems to affect only one tansmitter, called serotonin. This class of drug is safer and has fewer side effects than older drugs; examples include Prozac from Eli Lilly; Paxil, made bySmithKline Beecham; and Zoloft, by Pfizer. One other depression treatment is widely misunderstood; electroshock, or electroconvulsive therapy (ECT), in which a mild current passing through the scalp induces a seizure. ECTis used only in cases when other treatmetns have been unsuccessful. The process got a terrible reputation 30 years ago, when it caused memory loss and dangerous convulsions. But using muscle relaxants and new ways of positioning the electrodes has greatly reduced these problems. Doctors say ECT is safe for most patients, and those who are treated usually respond. The major classes of antidepressants are all equally effective, though sometimes one kind won't work on one person while another will. Doctors usually try easing patients off medication after six months to a year. If symptoms kick up again, the medicine is resumed. If you are unenthusiastic about taking antideprssants, you have company. In one survey, 70 percent of those questioned said they'd use medicine for a headache, but only 12% would touch an antidepressant. They may have been deterred by an anti-Prozac campaign by te Church of Scientology, which asserted that the drug triggered suicide or violence. The Scientologistas' calims, however were refuted by the Food and Drug Administration in 1991. A few other misconceptions about tese new antidepressants should be dispelled: They are not mood elevators or tranquizers. If you are depressed, they will probably make you well, but if you are not depressed, they won't make you extra happy. They are not known to be addictive and don't require steadkily increasing doses. But don't dismiss psychoterapy. Medicine mayhelp a driven executive, for example, who spent a lifetime pursuing his career, then was laid off and fell victim to depression. But if all that ambition snuffed out relationships with his wife, kids and community, pills won't help enough. Therapy might. What if you suspect that a spouse or loved one is depressed? Don't be bashful. If you think the sufferer will deny the problem, call a doctor yourself. "About half the calls I get are from wives. They're rarely wrong", says Dr. Speller. He asks spouses to contact a friend of the depressed person, preferably one who has been through depression himself. Then Speller, the spouse and friend decide together on a way to coax the sufferer into treatment. And if "the black dog", as Winston Churchill called his depressions, starts biting you, don't ignore it. If serious symptoms have lasted a few weeks, or if tey include thoughts of suicide, see a doctor. You'll get better faster if you treat it now."