Coping With Depression:
A Patient's Guide To Conquering Depression
Extract from Chapter
Everyone knows what
depression feels like. Everyone feels the blues at times.
Sadness, disappointment, and fatigue are normal parts
of life. There is a connection between the blues and clinical
depression, but the difference is like the difference
between the sniffles and pneumonia.
are "whole person" illnesses; they affect the
body, feelings, thoughts, and behavior. The depression
itself can make us feel as if it's useless to seek help.
The good news is that 80 to 90 percent of people with
depression can be treated effectively, but the bad news
is that only one sufferer in three seeks treatment. More
bad news is that almost half the American public views
depression as a character defect, rather than an illness
or emotional disorder. In addition, only half of all cases
of depression are accurately diagnosed, and only half
of those receive adequate treatment.
We tend to confuse
depression, sadness, and grief. But the opposite of depression
is not happiness, but vitality-the ability to experience
a full range of emotion, including happiness, excitement,
sadness, and grief. Depression is not an emotion itself.
It's not sadness or grief, it's an illness. When we feel
at our worst, sad, self-absorbed, and helpless, we are
experiencing what people with depression experience, but
they don't recover from those moods without help.
The trademark of depression
is a persistent sad or "empty" mood, sometimes
experienced as tension or anxiety. Life lacks pleasure.
People with mild depressions may go through the motions
of eating, sex, work, or play, but the activities seem
hollow; people with more severe depression withdraw from
these activities, feeling too tired, tense, or bitter
to participate. There is often a nagging fatigue, a sense
of being unable to focus, a feeling of being unproductive.
People with depression
usually experience a lowered self-esteem. In a depression,
you may feel that you are a helpless victim of fate, but
also feel that you don't deserve any better. Feelings
of guilt, shame, and hopelessness are common.
There are often a host
of physical symptoms, of which sleep disturbances are
key. People may have difficulty falling asleep or may
awaken early without feeling refreshed. Others may sleep
excessively, again without feeling rested. Appetite may
increase or decrease. There may be difficulty in sexual
functioning. There may be nagging aches and pains that
don't respond to medical treatment. But there are physical
illnesses that cause symptoms like depression-Lyme depression,
diabetes, thyroid conditions, anemia-and depressions can
cause physical symptoms like other diseases.
If you are feeling
depressed, it is important to be sure that an underlying
health problem does not exist, and you should see your
physician for a checkup. At the same time, if you know
you have a health problem and are feeling depressed, don't
assume you will feel better once the health problem is
Suicidal thoughts and
impulses are often present, and suicide may be a real
risk. Some people are repeatedly tormented by these impulses,
which they experience as frightening and painful, while
others have symptoms appear as if out of the blue, detached
from emotions. The impulse to spin the wheel and drive
suddenly into oncoming traffic is horribly common.
Alcohol and other drugs
may be used to give relief from depression. But the relief
is only temporary, at best, and usually the person just
hates himself more for giving in to temptation. Alcohol
itself is a depressant, and long-term alcohol abuse may
lead to chronic depression-it certainly doesn't help you
make the right decisions in life, and that is enough to
be depressed about.
From all these symptoms,
it might seem that a depressed person is easy to recognize.
It is often easy when the person recognized it himself-when
it's a change from a more normal state of mind, the depression
is experienced as something foreign to the self, something
to overcome. But very often, depression has become part
of the self: the person has felt this way for as long
as he or she can remember, and can't imagine anything
else. These people come to the attention of health professionals
through some other crisis, not seeking help with depression,
but the depression emerges as a big emptiness in the background.
There is a sequential
process in the recognition of depression. First is a stage
of confused pain in which the sufferer knows he suffers,
but doesn't know why. People often blame circumstances.
Adolescents blame their home lives, married people blame
their spouses, and employees blame their bosses. But there
is recognition that the pain is not normal.
The second stage is
recognition that something is wrong with me. It may be
that external circumstances have changed but the pain
continues, or it may be a gradual recognition that the
suffering is so extreme that circumstances can't be blamed.
This is a painful recognition that often takes years.
It is an acceptance of a damaged self. But because of
the nature of depression, the self-blame and guilt that
are manifestations of the disease, this acceptance does
not always lead to seeking help.
People then may move
to the third stage, a crisis that usually leads to professional
intervention and diagnosis. It is often a suicide attempt
or psychiatric hospitalization. The diagnosis often provides
hope, that treatment or a cure is possible, and explanation,
a way to understand what has only been confusion before.
The fact is that this is a diagnosis of a mental illness,
with all the shame and stigma that that entails.
The fourth stage involves
acceptance of an illness identity. Depression comes to
be seen as an outside agent invading the self, rather
than as a manifestation of the self.
It is essential that
anyone suffering from depression get good help from a
competent, qualified professional. These are warning signals:
if you or someone you love experiences four or more of
the following symptoms for more than two weeks, you should
seek competent help as soon as possible:
1) Sad, depressed,
or "empty" mood
2) Loss of interest or pleasure in ordinary activities
3) Eating disturbances (appetite and/or weight loss or
4) Sleep disturbances (insomnia, early-morning waking,
5) Activity level slows down or increases
6) Decreased energy, fatigue
7) Feelings of pessimism, guilt, worthlessness, helplessness,
8) Diminished ability to think, concentrate, or make decisions
9) Thoughts of death or suicide, suicide attempts