Bookstores hold volumes on treating depression. But they don't offer much about prevention. As a psychotherapist with depression, I have special insight on this disease. Learn the warning signs and how to get help. Plus, are you depressed? Take the quiz…
When it comes to depression, the emphasis is too often on treatment – after someone has hit rock bottom. People think the illness happens to you without warning.
But there are signs: People lead depressed lifestyles before they feel blue. If they believed they could avoid hitting bottom, their recovery could be much faster.
I wrote Undoing Depression (Berkley Trade) because I want to prevent people from suffering what my family and I did when I was depressed.
Above all, I want to give people hope, something that those with the disease lack. There's good reason to be hopeful: 80%-90% of people recover if they get proper treatment.
Here are answers to 7 questions I'm often asked about depression:
1. Is the incidence of depression increasing?
Yes, it's no exaggeration to call it an epidemic. At any given time, 20% of the population – one in five Americans – suffers from some form of depression.
Take the phone book and start with the letter A. Go on through to the end of the Es. That's how many people from your community are clinically depressed.
Research suggests that more people are depressed, more often, more severely and starting earlier in their lives than ever before.
People born after World War II are more likely to develop depression and get it at a younger age than the previous generation. Baby boomers seem to be at higher risk.
This isn't because of a growing awareness of the disease. Nor is it only a phenomenon of American or Western culture.
It's true growth.
One study comparing the global incidence of depression found that in each successive generation, the ailment was likely to begin at an earlier age. Over a lifetime, the risk increases.
2. Are a lot of people depressed and don't even know it?
Absolutely. Something that touched me deeply at our Connecticut clinic was the large number of people who don't know they're depressed.
People call for help – not because of depressed feelings but because something is wrong in their lives: Their children won't listen; there's a marital problem; they're having trouble at work.
It doesn't take much digging to learn that the person has been depressed for some time. The family or job issue is a manifestation, not a cause, of the depression.
There are millions of people like this. They may go to their doctor for aches and pains, sleeplessness or lack of energy, and they get a useless prescription, medical procedure - or worse, they're dismissed as hypochondriacs.
Depression is a disease, but the word “disease” makes us think about infectious illnesses. Both are caused by a complex set of factors, but depression is more like heart disease. It develops gradually over time.
Because of genetic and biochemical factors, people have different stress levels that, once reached, puts them over the edge into depression.
Childhood trauma, stress and loss may bring us closer to that edge.
3. How has media attention affected the public's awareness of depression?
Depression doesn't receive the attention it deserves. It's the second costliest disease to American society, just behind cancer.
Brave people – Mike Wallace, Joan Rivers, Larry King, Brooke Shields, to name a few – are coming forward to talk about their depression, which is helping to reduce the stigma.
4. Why are more children being diagnosed with depression?
Because of better observation, not necessarily a real increase.
Until 1980, most mental health professionals believed a theory that said, in essence, depression is caused by a punitive superego. (Superego is our conscience and dictates our sense of right and wrong.)
The thinking was that people don't develop a superego until adolescence; therefore, pre-adolescents can't suffer depression. It sounds silly today.
About 10% of children will suffer a depressive episode before age 12, but the disease is difficult to recognize.
Kids usually don't know that the way they're feeling isn't normal and they can't express their feelings as directly as adults can.
Irritability is a key indicator. Children may seem easily frustrated, cranky or moody. Boys may simply appear unusually angry or sullen.
Other signs:
Change in appetite or energy level
Sleeping much more or less than usual
A drop in school grades
Excessive worrying
Loss of interest in things or activities that once gave pleasure
f untreated, depression can be permanently devastating to children.
5. How can you help a depressed person?
What does a depressed person need most? Understanding, patience and acceptance from those close to him or her. Here are some ways you can help:
Try to be considerate, thoughtful and empathetic. If your spouse had a broken leg, you'd expect that his abilities would be restricted, that he'd be in pain and that he couldn't heal himself quickly just because you want him to. Think about depression the same way.
Don't be provocative. Every relationship has hot buttons that can trigger a fight at any time: dirty socks on the floor, a misplaced remote control, an empty gas tank in the car. You know what your partner's buttons are. Don't push them while he or she is depressed.
Be nice. Small acts of kindness are appreciated and do help, even if the person doesn't reciprocate. When I go to bed, my wife makes a point of kissing me goodnight. Even though I sometimes don't act very glad to see her, I'd feel worse, lonely and unloved without her attention.
Remember that actions speak louder than words. Easing your partner's burden in small ways can significantly help. Offer to do the shopping, empty the garbage, do the laundry, or take the kids out for pizza. More than words, these actions communicate that you understand how difficult these mundane chores can seem at times.
Educate yourself on depression. Be willing to talk to the therapist treating your friend or family member. It's amazing how seeing information in print or hearing from an authority can change your perspective. It also shows the sufferer that you care enough to take the time to learn about the disease.
. Create "advance directives," a contract loved ones arrange while the sufferer is not depressed, describing what to do when depression sets in. It can be detailed in stages:
Stage 1: Leave me alone.
Stage 2: Be kind, patient, and attentive.
Stage 3: Insist I call my therapist.
Stage 4: Take me to the hospital. One patient I’ve worked with loses her ability to see color when depression sets in. From experience, she has learned to tell her husband when this happens because otherwise, she won't let him know when it gets worse.
6. Will therapy or medication help?
Therapy and medication are the solution, and anyone seeking treatment should be open to both.
Medication can help faster than therapy alone but can counteract the out-of-control mood swings that will come during recovery.
Therapy can help us resolve the problems that led to the depression and teach us how to prevent future episodes.
Research shows that medication and therapy together are more effective than either alone.
Some people recover with one or the other, but I strongly recommend both. After recovery, sometimes a maintenance dose of medication or a periodic check-in with a therapist is helpful.
7. How does depression differ from manic depression?
Manic depression, or bipolar disorder, is a different animal. Striking 1% of the population, it's more genetically linked than other forms of depression and responds uniquely to a single medication: lithium. People with other forms of depression don't respond to lithium and don't experience the manic highs that are characteristic of the disease.
Sometimes it's difficult to differentiate between depression and manic depression. For a definitive diagnosis, talk to your doctor.
Want more? Get your own copy of Undoing Depression and Happy at Last, or visit UndoingDepression.com.
Have a question for Dr. O'Connor? Email him here. Please be sure to include your first name and last initial. Plus, meet Dr. Richard O’Connor.
Could You Be Depressed?
Depression affects 20 million people in any given year and is a serious enough disorder to compromise one's ability to function normally day to day. You nee to find out if you're just blue or if you might be clinically depressed.
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