Kiester, Edwin Jr and Sally Valente Kiester. "Depression: What You Should Know" Readers Digest November 1995, pp 181-188 Dave Roos of Pittsburgh, a self-professed workaholic, always attacked odd jobs around the house with zest. But one day when his wife mentioned mildew in the bathroom shower, he uncharacteristically shrugged ans said he'd get around to it. The mildew stayed in place. Kerry Flynn who works for a social services agency in Arlington, Va., arrived late at her office after a bad night's sleep. A co-worker joked to Flynn about "setting your own hours." Normally Flynn would have joked back and put the comment behind her. This time, however, she spent the day brooding about the co-worker's remark. These momentary lapses by Dave Roos and Kerry Flynn seemed inconsequential to those around them. In fact, their atypcial behavior was an early - and urgent - warning sign of clinical depression. Fortunately their symptoms were at last recognized, and both have undergone sucessful treatment. Others with little-known signs of dpression have been less lucky. Every year, according to the National Institute of Mental Health (NIMH), six to seven percent of adult Americans - over 17 million men and women - suffer from depressive illness, making depresion by far the country's most common severe mental illness. Worse, perhaps as many as 24,000 depressives, including an alarming number of teen-agers, take their own lives--often, it is believed, before their condition is identified. A nationwide MIMH survey has found that only about one-third of depressed people seek treatment. Yet when treated, 80 to 90 percent can be helped with new drugs and therapy, and may never have another episode --if those around them spot their troubles early and treatment begins promptly. A Life of Its OWN: Clinical depression should not be confused with the blues. Everyone has brief "down" periods. And sometimes depression strikes for perfectly understandable reasons: the death of a loved one, the loss of a job or the breakup of a marriage. But most people gradually adjust to their losses. Clinical depression differs from the blues in duration and severity. for some it may be associated with disturbances i the brain's neurochemistry. Says Dr. Frederick K. Goodwin, director of the Center on Neruoscience, Behavior and Society at George Washington University Medial Center, "In depression-prone people, what starts as a normal response takes on a biochemical life of its own. The regulatory systems keep running, and you get a kind of burnout." Untreated, the condition frequent recurs, and with each recurrence the chances of yet another episode increase. Half of those who have an untreated first episode will have a second, and after three episodes, there is a 90-percent chance of a fourth. So early treatment is critical. Depressive disorders occur in two major forms. Unipolar illness is marked by episodes of depression only--periodic despondency and loss of hope ranging from mild to severe. In bipolar (or manic-depressive) illness, the person swings between extremes, with stretches of depression alternating with times of high energy and odd behavir, such as talking uncontrollably or rashly overspending. For unknown reasons about two-thirds of recognized unipolar victimes are women. Bipolar cases are more evenly divided between the sexes. Both disorders aflict all age groups. According to teh NIMH, classic symptoms of severe depression include: -Marked changes in sleep pattern -Appetite and/or weight loss or, conversely, overeating and weight gain. -Persisent sad, anxious or "empty" moods. -Feelings of hopelessness and pessimism -Fatigue or decreased energy -Thoughts or talk of death or suicide; suicide threats or attempts. There are, however, other warning signs of depression that are not so obvious--and do not fit the popular image of the depressed person as sad and withdrawn. Often tey are so subtle and fleeting that they are misinterpreted by the victim's family and friends. "Even doctors may overlook or dismiss these symptoms." says Ellen Frank, director of the Depression PreventionProgram at the University of Pittsburgh. "yet picking up on thse small clues soon enough can literally be the difference between life and death." UNUSUAL BEHAVIOR What are these little-known signs of depression? The key word is CHANGE - something uncharacteristic about the person. A single, simple difference in behavior doesn't automatically indicate depression. Still, if you observe any of the following, either suddenly or graduallly, Dr. Goodwin says, "a little light bulb should go off over your head." Sudden Silence: A 54-year old landscape gardener in upstate New York who was usually talkative during diner, telling his wife and two children about his day's work, became abruptly silent at the table. Evening after evening he didn't say a word. Whenever his wife mentioned his silence, he brushed her aside and announced that he was going to bed. As the unusual silence continued, his wife suggested, "Maybe you should get some help." He refused. Finally, about two months later, after reading a newspaper article about depression screening, he sought help. Soon he was being treated for serious depression. Today, with the depressive episode behind him, he admits suicide "had crossed mymind" but now finds his life "on the up and up". Typically, says the University of Pittsburgh's Frank, the depressed person withdraws from contact with others, wanting to be alone with his or her morbid or self-accusing thoughts. Often, however, he or she may go through the motions, especiallyin a job situation, so the withdrawal may not be completely evident. Magnifying things: "My boss didn't come over to say hello," one man complained to his wife after an office party. "Maybe he's mad at me." She pointed out that her husband hadn't crossed the roo to greet his boos either. She also noted taht the place was crowded and that the boss had stayed only a short time. But her husband was not mollified. "On some subtle level," says Dr. Goodwin, who treated the husband, "the person who has always seen teh glass as half full maybegin to see it as half empty. Petty things that once would have seemed insignificant are magnified and worried about." Forgetfulness: When Gary Martha Turner, now of Oxnard, Calif., was workign for a company in the photocopying field, she bean to grow increasingly forgetful. she had to look up addresses twice, always had to double-check appointments and sometimes even had to pullover to the side of the road to remember where she was going. "I told my doctor I thought I was developing Alzheimer's disease, even though I was onlyin my 40's, Turner recalls, "He told me to count backward and recite a couple of other ghings, and then he said, "You're just stressed. Go home and rest." The doctor did not probe deeper, and depresion struck Turner not long afterward. She later received treatmetn and recovered. Thin skin: A nursing director in Morgantown, W.Va was talking with a nurse whose husband didn't want her to work nights. Instaead of discussing the problem, the director snaped angrily, "What's the mater with him? Doesn't he know nurses work nights? Why'd he marry a nurse in the first place? Irritability and anger are cloaks that depressed people often use to cover their sadness and isolation. Unfortunately an angry, peevish or thin-skinned response may make things worse. The other person may snap back angrily, escalating a minor quarrel into a major outburst. Result: the deprssed person feels worse about himself or herself, deepening the depression. Hiding in a routine: ONe man whose passions had been theater adn baseball began staying home, keeping to a set routine. When his wife suggested atending a particular performance, he rebuffed her. This behavior was so unlike him that she consulted the family physician, who began treating her husband for depression after confirming other symptoms as well. "An early clue," Dr. Goodwin says, "is when a person who has always seemed so alive, suggesting different activities, doesn't reach out any more and takes refuge in the ordinary." Declining appearance: Bruce Arnow, director of the behavioral Medicine Clinic at STanford Heath SErvices in STanford, Calif., points out tha a sharp decline in how a person looks could provide a clue about illness. "It could be that a person who used to take great pride in is appearance and was very fastidious in his dress suddenly doesn't seem to care anymore adn looks a little bit unkempt," Arnow says. "That could be a sign of depression - a loss of interest or pleasure, or a lack of self-care." Indecision: A woman began to have trouble choosing from restaurant menus. "you pick for me," she told her husband. Similarly, even with the TV remote in her hadn, she couldn't decide which channel to watch. Indecisisvieness often accompanies lack of concentration in a depressed person; sometimes it appears alone. In either case, making choices seems overwhelming. Mysterious pains: Depressed people may complain of stomachaches, bachaches and toher discomforts that do not respond to treatment. The most common complaints, Dr. Goodwin says, are all-over muscle stiffness and achiness. Often a full medical workup is needed. Sudden brightening: Sometimes a person wil remain in the depths of despair for weeks or even months, then one day appear to snap out of it. Family members may finally relax, thinking the worst is over. In fact, this can be the most dangerous period, calling for more, not less vigilance. The 'improvement' may indicate that, after unsuccessfuly seeking a way out of what the depressive consideres a hopeless situation, he or she may have decided on suicide. The presumed 'improvement' may reflect relief at finally deciding on a course of action. Helping Hand: If you recognize one or more of these signs persistently in a friend or lived one, what should you do? First, talk to the person abou tit. Try to discover what he or she is feeling. If you can't persuade the person to duscuss the problem, try an approach like "You remind me of the time when I was depressed." This may cause him or her to open up. Second, suggest professional help. Call a doctor yourself if necessary, and accompany the person if that seems warranted. Then follow up to make sure he or she takes medication and keeps appointments. With antidepressants, womeone who is severely depressed willnormally show improvemment in four to six weeks. Psychotherapy takes longer. Many doctors use a combination. Recovery maynot occur for six months, however, adn medication may be required for a longer period. Third, provide emotional support. Don't offer simplistic solutions like "Things will look better tomorrow." Help the person to focus on activities still enjoyed - playing tennis, working in the garden - while de-emphasizing those that deepen the depression. Listen sympathetically, point out the realities of the situation and always offer hope. Above all, don't ignore threats of suicide or discussions of death. Consider these threats serious, not gestures for sympathy. Depression is a crippling illness. But with a little help from observant friends or family, and with proper medical treatment, most people recover and return to healthy, productive lives.