A person can seldom experience the feelings associated with depression misery, fear, anger, hurt, or an inability to experience pleasure without looking for a cause.
The symptoms of depression are often blamed on everything but depression.
People look for a cause for these feelings in two places: within themselves or outside themselves.
Those who look inward for the cause of their depressive symptoms feel blame, guilt, and shame. They are mercilessly criticized by the inner voice of depression.
Those who look outside themselves for causes of depression tend to become angry, contemptuous, arrogant, destructive (sometimes physically), and spend a great deal of time complaining--usually to other depressed people.
Members of the Ain't-It-Awful Club gather in bars and cocktail lounges all over the country between five and seven, when drinks are half price, and the only rule is, "You get to tell me your problems, but you have to listen to mine." For some unknown reason, this is known as the Happy Hour.
Inappropriate blame either inner or outer contributes to an ever-deepening depression.
Thus far, we have been exploring the emotional pain caused by depression. Depression can cause physical pain, too.
Physical pain can be both a symptom of and a cause of depression.
Vague physical aches and pains that do not respond to treatment may, in fact, be a manifestation of depression. Some people feel the pain of depression primarily physically rather than emotionally or mentally.
On the other hand, the chronic (long-term) physical pain caused by an accident, arthritis, back problems, burns, cancer, AIDS, or other illness can trigger a depression. Biologically, chronic pain can deplete the supply of neurotransmitters in the brain.
To make matters worse, depression can lower the threshold of pain--pain tends to be felt more often and more intensely.
All pain is real. Nothing we say here is to imply that the physical pain from depression is only "in your head." It is as real as any other pain, and needs to be treated.
If you know you are depressed, do not simply write off physical aches and pains as symptoms of depression. Pain is a signal from the body that something needs attention and care. Report all physical pain to your physician.
Those with chronic pain due to an accident or illness would do well to discuss with their physician whether depression is also present.
Obviously, the symptoms of depression on page 22 would not be a listing of what people refer to when they discuss "the quality of life."
But on top of the pain, misery, and unproductiveness depression brings, it also brings an increase in physical illness.
Many people with depression produce a higher-than-normal level of the hormone cortisol. Cortisol suppresses the immune system.
A suppressed immune system makes one more vulnerable to infectious illness. In addition, a suppressed immune system can make one more susceptible to cancer. People who suffer from "poor health" may run from doctor to doctor putting out one fire after another, when the underlying cause may be depression.
In a vicious cycle, a depression can contribute to chronic illness, and chronic illness can contribute to depression. It's often hard to tell which came first, but it's easy to see how both can feed upon each other, causing more illness, more depression, and shortening life.
Those suffering from a chronic illness would do well to discuss with their doctor whether depression is also present.
Depression can be an all-pervasive emotional-mental-physical source of misery. It's hard to hurt so completely and for so long without seeking some relief from the pain.
Almost any drug or distraction will do. Alcohol is the most commonly self-prescribed painkiller for depression. It is readily available and socially acceptable. Unfortunately, alcohol is chemically a depressant. After its brief euphoric effects, it only worsens the depression. This is especially true when alcohol is taken in the quantities some people consume in order to obtain mental and emotional oblivion.
Drugs of all kinds--legal, illegal, over-the-counter, or prescription--are sometimes inappropriately used by depressed people for numbing specific symptoms. Alas, they do not treat the underlying cause. Uppers, downers, painkillers, tranquilizers, "getting high," and all the rest are ineffective treatment for depression. In fact, they can worsen the depression.
We certainly aren't saying that social drinking, prescription drugs, or appropriately selected medications for either therapeutic or recreational purposes are always bad, always a sign of depression, or always cause depression. We are simply saying that anything--even good things--can be abused in an effort to "self-medicate" the symptoms of depression.
Tobacco is both a stimulant and a depressant. Consequently, it can be used by smokers to regulate mood--up, down, or both. Unfortunately, nicotine is one of the most addictive substances known, and the "side effects" of smoking result in numerous illnesses and 500,000 deaths each year in the United States. Even if smoking were the cure for depression (which it's not) and even if tobacco didn't contribute to depression (which it does), the side effects alone would rule it out as a drug of choice.
These "self-medications" need not be chemical. People have been known to abuse just about anything you can name in an effort to distract themselves from an untreated depression: food, sex, TV, gambling, work--even romance and religion.
Anything can become a compulsion--a joyless, driven, addictive behavior. What may be good and positive in its proper place becomes not only a cover-up for the depression, but, in time, contributes to the depression itself.
Certainly people can have compulsions without being depressed, and not all depressed people have serious compulsions. If you have a "bad habit," however, it may be worth exploring the possibility of depression with your physician.
Depression may contribute to eating disorders, and eating disorders may contribute to depression. It's another of those downward spirals.
Anorexia nervosa is characterized by severe weight loss, distorted body image, and an extreme fear of becoming overweight.
Bulimia is binge-eating, followed by purging either through vomiting or laxatives. Some bulimics also have anorexia nervosa.
Obesity is caused by eating until the body is dangerously overweight.
Depression can be an underlying cause of eating disorders. In one study, as many as three out of four bulimic individuals were depressed. The vast majority of them benefited from treatment for depression.
Eating disorders are illnesses. They are not anyone's fault. They are not a lack of will power, character, or self-discipline.
If depression is contributing to these illnesses, treating the depression is an important complement to treating the eating disorder.
ALICE CALDWELL RICE
Most people with depression have a sleep disorder. The most common is insomnia. People with depression often tell their doctors, "I can't remember the last time I had a good night's sleep."
There are basically three types of insomnia:
Difficulty falling asleep
Difficulty staying asleep, also known as intermittent awakening
Early morning awakening, in which one awakes at three or four in the morning and is unable to get back to sleep
At the other end of the spectrum is hypersomnia. Hyper, for lots, and somnia, for sleep. People with hypersomnia can sleep ten to fourteen hours at night and still take daily naps.
Both insomnia and hypersomnia can indicate depression.
Unfortunately, insomnia caused by depression is sometimes inappropriately treated with sleeping pills, which do not treat the underlying depression and can make the depression worse. Anyone who regularly takes sleeping pills should discuss the possibility of depression with his or her physician.
F. SCOTT FITZGERALD
The most common symptom of depression presented to doctors is fatigue. Certainly, fatigue has any number of physical and mental causes (mononucleosis, hepatitis, excessive workload, profound boredom), but when fatigue persists, depression should not be overlooked.
Fatigue is more than just being occasionally tired. Tiredness is a natural phenomenon and a signal to rest. Many people with fatigue, however, awaken from a full night's sleep and still feel exhausted. Or, they may have only a few productive hours in the day.
Procrastination, distraction, and lack of motivation are often manifestations of fatigue.
Depression also brings a mental fatigue--the mind is simply "tired," and one has difficulty thinking, concentrating, or making decisions.
Emotional fatigue is often felt as "I can't take any more," "Leave me alone," and often manifests as irritability or withdrawal.
For many, the lifting of fatigue that follows the successful treatment of depression can transform their lives.
Depression impairs the ability to care and be cared for, give and receive, love and be loved.
Depression can significantly interfere with all relationships--with friends, co-workers, bosses, employees, children, parents, spouses, lovers, and even one's relationship with self, God, and life.
Relationships are an excellent mirror as to how we are doing. If the relationships in one's life seem deeply troubled, perhaps it's because that person is deeply troubled. The trouble may be depression.
SYDNEY J. HARRIS
In days of old (prior to the mid-1950s) there were few effective treatments for depression. People, however, knew depression well.
Depression is as old as humankind. "The Man Who Was Tired of Life" is the title of a poem written in 1990--that's 1990 B.C.
What can poets and philosophers do when they have a malady that has no treatment? Romanticize it, of course. Thus sprang the belief that depression was essential to the development of a human being.
"All artists today," said Lawrence Durrell, "are expected to cultivate a little fashionable unhappiness."
In 1621, Robert Burton observed that nothing was "so sweet as melancholy," and Maurice Maeterlinck mused in 1896, "The value of ourselves is but the value of our melancholy and our disquiet."
Some artistic or intellectual people avoid treatment for fear of losing their creative sensibilities. It may be difficult to communicate to them that ongoing suffering does not bring about deepening wisdom, perception of life's "true reality," or creative achievement.
Depression is an illness, and it is no more noble today to suffer from it than it would be to suffer from untreated scurvy, syphilis, or goiter--three illnesses that, like depression, had no known cure a century or so ago.
The flip side of romanticizing depression is the enormous social stigma of depression and the treatment of depression itself.
Some believe that depression is the first step on a short walk to the loony bin. Others believe that the treatment of depression is just too hip to be true.
Newsweel stated on it's February 7, 1994, cover, "shy? Forgetful? Anxious? Fearful? Obsessed? How science will let you change your personality with a pill." Newsweek suggest that shyness, forgetfulness, anxiety, fear and obsession are part of one's personality. They are also possible symptons of depression.
As long as people identify with their depression as though it were some part of their self, ("it's just the way I am"), they're not likely to seek diagnosis and treatment.
The major problem by far with treating depression in this country is undertreatment.
Nevertheless, some people mock antidepressant treatments as a trendy fad, making snide comments about "Vitamin P" or the "Prozac personality". (In fact, people successfully treated for depression report they feel more themselves.)
Please don't let any of this media chatter interfere with your seeking a diagnosis, treatment, and healing.
JOSÉ M. SANTIAGO, M.D.
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Copyright © 1994-1996 Harold H. Bloomfield, M.D. & Peter McWilliams