The depression is severe enough to require professional attention, even hospital care. For the rest of us, less severe attacks of the “blues” will cause real anguish at times in our lives. What is depression, when to help yourself, and how to tell if you need professional help.
Here are the questions most often asked about depression, and the answers now available from research:
1. What causes depression?
If we didn’t feel blue at times, we would not be human. Each of us inevitably will encounter sadness – when a friend dies, investments go sour, in the wake of family argument, a long and futile spell of work, or a sudden stress like a car accident.
In fact, researchers now feel that the prevalence of depression has been badly underestimated. A recent survey shows that a third of the United States’ population experiences significant symptoms of depression.
A first step in handling depression is to admit that it is a normal and natural ingredient of life.
2. Can depression arise simply from physical causes?
It can, and often does. Periods of melancholy, for example, often accompany viral illnesses, even routine ones like the flu. Irregularities of metabolism or vitamin deficiencies can also seriously affect mood.
Patients recovering from surgery may experience a period of depression, often as a result of anesthesia rather than the stress and anxiety involved. Many women are aware of hormone-caused monthly dips in mood that precede menstruation; so are mothers of new babies who have just undergone the massive endocrine changes involved in pregnancy and childbirth.
3. Are there particular periods in life when a person is likely to experience depression?
Depression can intrude at any age, but there are typical periods of stress in which a person’s self-concept is especially fragile, when we are, therefore, most vulnerable.
There are the major transition periods, in which lifestyles are rapidly changing, such as between adolescence and adulthood. So is middle age, when the male has given up his zest for climbing up the social and economic ladder, and when mothers suffer the “empty nest” pattern, their children gone and no longer dependent.
For many, depression strikes often when all the external reasons for happiness are present – for example, after a job is won, or a marriage is consummated, or a child is born. It is as if the achievement of a long-sought goal cannot, after all, provide the expected gratification.
Among returning prisoners of war, depression is common, appearing at a time when elation should be at its highest.
Like thousands of concentration-camp victims liberated after World War II, many of the US veterans returning from Vietnam found that after years of patient-waiting and anticipation, the real world hardly lived up to the expectations and ideals they nurtured for so long.
4. When is a depression severe enough to require professional attention?
When it begins to interfere with our daily activities and casts a black shadow over everything we do and feel, it ceases to be normal.
A sympathetic family member or friend should be able to pick up the signals of severe depression. The everyday routines of living – eating, dressing, working – are difficult. The truly depressed person is beset by feelings of hopelessness, guilt and self-hate that may go on for months.
He slowly withdraws from the world, considering himself unworthy of his family or friends. He broods about his health, cries, and cannot sleep.
Each of us has had occasion to say, “My God I feel punk today. I really should have stayed in bed.” But that is quite different from saying day after day: “Life has completely lost its meaning, and I no longer care for anything or anyone.”
5. Who are more prone to depression – men or women?
Women appear to be more vulnerable to periods of the blues. This may simply mean that women are more likely than men to admit that they are depressed: many experts feel that excessive use of alcohol is how men handle their depressions.
Still, it is likely that women are more prone to depression because their roles invite greater stress. Their emerging independence may bring considerable conflict and tension.
The menopause is often a trouble-filled period for women for physical reasons, but it occurs also just when the children have grown up and left home and husbands may be deeply involved in work, still at the peak of their careers.
6. Is it possible for depression to impair sexual performance?
It virtually destroys sexual feelings altogether. Sex at its best is everything that depression is not – spontaneous, joyous, energetic, pleasing, exciting, and filled with anticipation.
The depressive is totally unable to summon such feelings, and to make matters worse, often feels chronically tired and incapable of the slightest physical exertion.
7. Can depression cause physical ailments?
A number of scientists have demonstrated that the psychological factors involved in depression may play an important role in many physical illnesses.
In those who become depressed after a heart attack, for example, the period of convalescence not only is prolonged, but the likelihood of a later and fatal attack is increased.
Dr George Engel, professor of psychiatry and medicine at the University of Rochester School of Medicine and Dentistry, has reported that the great majority of patients hospitalized for physical illness experienced a psychological disturbance shortly before they got sick.
It was not anxiety, fear, or anger – the emotions generally considered to be associated with illness – but an attitude of helplessness or hopelessness.
8. What is the best approach to take with a depressed person?
Simply telling him to “cheer up” will usually only increase his anger and frustrations. So will telling him to “pull himself together.”
Such remarks imply to the patient that the illness is willful on his part and can only deepen a sense of guilt, which is already too strong. Being unusually irritable or trying to provoke or force the patient to respond is also likely only to make the situation more unpleasant for everyone concerned.
It also does little good to tell the depressed person that “everything is okay,” or that “you’ve got a nice home, your kids and wife love you, you’ve got a great job.” For a depressive, nothing is okay.
A depressed person seriously doubts whether recovery is possible. But the expectation for improvement is excellent.
Most people do not like being depressed and will start acting and feeling normally as soon as possible. The blues sufferer needs reassurance, and a return of that precious feeling of self-worth. The depressed person already feels filled with self-blame. Anything you can do or say to minimize this self-hate will be helpful.
If gloom persists and the depressed person has lost interest in everything, stops seeing friends, keeps blaming himself and perhaps even talks about suicide, it’s time for outside help; a physician, a family counselor, a mental health center or a psychiatrist.
It is terribly perplexing to live closely with a victim of depression, and while it is neither possible nor advisable to be constantly solicitous and yielding to the depressive’s rigid and irritating behavior, keep in mind that you are dealing with a victim, not a sinner.
9. Are there things the depressed person can do to help weather the storm?
Most people have their own techniques to bolster their spirits. An absorbing movie, a hot bath, a long walk, a ball game, golf, or listening to good music. In addition, consider these steps:
- Talk out your feelings with someone you trust. Realize that your blues may be covering up other emotions and attitudes.
- Admit that you are down, and try to identify the real reason.
- Find a way to experience success. Do something that you do well – your hobby, something involving your special skills or talents. Little triumphs can help you rediscover your lost self-esteem.
- Break up your usual routine. Eat new foods, switch your reading diet, look up old friends. Plan a short trip.
- Most important, focus your attention outside yourself. When we do something worthwhile for another person, we tend to forget out own problems.
10. Can drugs help overcome depression?
Today, drugs (the “antidepressants”) provide the most effective treatment for millions of victims.
The antidepressants, such as the tricyclic drugs and the MAO inhibitor group, are specifically tor depression. They do not solve the patient’s problems but they do lift the depression, so that the person can then learn to live with her problems or can undertake psychotherapy so as to iron out her hang-ups.
Severe depression, especially in the elderly, may require what is called “shock treatment.” Electroconvulsive therapy (ECT) is a well-established form of dealing with depression. ECT involves only a needle in the vein. This contains a general anesthetic and a muscle relaxant. When the electrodes are placed on the head and the shock given, the patient is unaware of any sensation.
Yet we still do not fully understand the mechanism of depression. It may even be caused by some drugs, such as ones used to treat high blood pressure. Depression can also occur due to hormonal factors, such as at the menopause, or when the thyroid gland is under active. In these cases it lifts when the deficient hormones are replaced.
NOTE: It is also worth remembering that it is just as common in men as in women. Depression is a treatable illness but it needs to be recognized both by the doctor and the patient.