Talking about depression can be a weird thing. On one hand, it’s a word we throw around lightly, as in, “Dude, I’m super depressed — I totally missed that T by Alexander Wang giveaway. Why am I always missing the good stuff in life?” But then, when it comes to the real thing — going through long debilitating episodes of despair and isolation — societal stigma and general paralysis can prevent us from speaking up and getting the help we need. And between these two extremes is a great expanse of feelings and moods in which it’s hard to determine whether we might actually be depressed, or just having a crappy week.
What we do know is that across all ethnic backgrounds, depression hits women twice as often as men. Researchers chalk this up to a host of possible reasons that span genetic, biological, and psychological roots, among others. Unfortunately, most people with depression are staying quiet about it: Two out of three people who suffer from the disease are not getting properly treated, according to the National Alliance on Mental Illness.
So how can we begin to get the help we need? And how do we break the silence? By better understanding what depression is, how it hits us, and what on earth we can do about it.
The first thing to understand is how depression differs from a basic case of the blues. We’ve all felt down from time to time, but who of us actually suffers from chronic depression? Some symptoms include sleeping too much or not enough, an inability to concentrate, and not eating enough or overeating. Dr. Edward Watkins, a professor at the UK’s University of Exeter and director of their Mood Disorders Centre, says that depression can also manifest itself physically: “Pre-existing aches or pains can feel worse. Fatigue and tiredness can be so strong that limbs feel heavy and achy. Some people describe the general feelings of depression as being like the effects of a bad flu.”
Of course, in our hectic world where we're overloaded by stimulus, many of us commonly feel these symptoms. “People lead lives in this day and age where they can feel depleted. That’s the kind of routine that can contribute to low depression,” says Dr. Jon Rottenberg, psych prof and author of The Depths: The Evolutionary Origins of the Depression Epidemic. Rotteburg, who is also a depression researcher at the University of South Florida, where he directs the Mood and Emotion Laboratory, says that identifying with these symptoms alone does not necessarily equate to depression.
For those who undergo depressive episodes, these symptoms will be compounded by a more severe condition — what Dr. Madhukar Trivedi, a leading depression researcher at the University of Texas Southwestern Medical Center, has qualified as a sadness that colors everything you think, see, feel and hear. When feeling down affects everything we do (versus a particular situation or encounter), and these episodes last for weeks or longer, then depression is likely at hand. Rottenberg also cites scenarios in which feeling bad can interfere with daily life and relationships, like the inability to get up for work or keep dates with friends and family.
Julie Hersh, author of Struck By Living: From Depression to Hope , which outlines her experience with depression, explains that when she suffered from clinical depression, she was “unable to experience joy or even pain. I felt completely disconnected from my body and my world. My thinking was slowed. I could not appreciate or understand humor and had no appetite. Normally, I'm a pretty fun, positive and active person! It was as though my brain was locked in a negative state.”
One can see how it can be difficult to get help when mental, physical, and emotional fatigue are at play. On top of that, Watkins notes that many suffering with the disease can’t help but perpetuate dark feelings.
“Thinking in depression tends to become negative, pessimistic, and self-critical,” Watkins says. “So there is a constant stream of negative thoughts, often making the person feel worse about herself, and making it hard for her to persist with tasks.”
Finally, social stigma also prolongs the sufferer’s ability to break out of depression’s self-perpetuation. “Many people hold it all inside and are embarrassed,” Rottenberg notes, adding, “breaking that stigma down would be a tremendous benefit to getting people social support, professional help and just having them be okay with themselves, which is another ingredient.”
Given the bleakness of depression, how can the sufferer break the cycle of darkness and seek help?
“There’s no simple advice,” says Rottenberg. “This is a vicious cycle. The feelings people have of wanting to withdraw are profound. People are frightened by the symptoms. They think there’s nothing they can do. And many people have never felt this way before. It’s hard for them.”
But the key, he notes, is in realizing that many others have suffered depressive episodes, and, like Hersh, have come out the other side. “Depression is not self-limited. Episodes of depression do end, and some even end without treatment. Part of what’s so horrifying is that people project and think, ‘If I feel this way forever, I don’t want to be alive.’ (Indeed, according to the American Psychological Association, suicide is most often a result of depression or other mental illness.)
“The hope is that people can understand that depression is real and it’s bad, but it can be managed,” he continues. “People have a lot of tools at their own disposal to get this under better control.”
Such tools include seeing a therapist (and being active in the process, rather than approaching treatment with a cure-me-now attitude) and taking steps to change your life, such as quitting a dead-end job or letting go of an unhealthy relationship, can help, according to Rottenberg.
Watkins suggests being physically active to improve mood, being kind to yourself, and sharing your experience with people you trust to have a big impact.
“It is much more helpful to share difficulties and to seek help and another perspective from close friends and family than it is to try and pretend everything is okay and keep a mask or front on. This tends to be exhausting and makes it harder to solve problems,” Watkins says. “Often when difficulties are talked through with another person, this can help to put them into perspective — when people keep to themselves and dwell on their problems they can spiral out of proportion.”
Hersh, who has survived three episodes of depression herself, many lasting six months or more, agrees and offers another tool for recovery: “It is easier to maintain mental health than recover from mental illness. Everyone reacts to stress differently and has different ways of relieving stress. I always encourage people to look at their lives and try to determine those things they need to do to stay well, write them down, and protect them.”
Finally, if you want to try psychotherapy and can muster the courage, motivation, and resources to see a doctor, try to be an advocate for your own care. According to a 2011 National Center for Health Statistics report, antidepressants account for the most commonly taken prescription drug for American adults aged 18 to 44. And over a 20 year span, from 1988 to 2008, antidepressant use in the U.S. among all ages has increased nearly 400%.
Whether or not antidepressants are overprescribed is a hot-button issue in the medical community. And these drugs may or may not be right for you. Regardless, Rottenberg suggests being an active participant in your wellness plan, asking your doctor questions such as, “What’s your approach and overall plan?” “What else can I do to assist this plan,” and “What should I be looking for in terms of knowing whether this plan is having an overall benefit?”
He recognizes that this is especially challenging for those who are suffering from depression, noting that, “When you’re depressed, you’re probably feeling that you can’t change anything in your situation,” and that, “people become more passive when meeting with a doctor.”
But the payoff is invaluable, Rottenberg contests. “Asking any questions at all is telling the person, ‘I’m here. I’m going to hold you to what you’re saying. I’m active in this process.'”
And that’s a pretty powerful stance, for any patient to take.
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