Chapter 1: Depression Defined
THERESA: SAD AND AFRAID Theresa's eyes filled with tears. Ever since she had been promoted at work, it seemed that she was too tired to think. She felt so out of her depth in the new position that a fear of being demoted by her boss gripped her daily. She felt that if she lost this job, she would never get another one this good.
In the evenings, she dragged herself home. Her husband, Jeff, had gotten into the habit of making dinner just for himself because Theresa never seemed to be hungry. Her lack of appetite was making her lose weight these days. At one time, her weight loss would have made her proud, but not now. Lately, she had no interest in anything. She used to enjoy her sexual relationship with Jeff, but not now. She was too tired. Yet no matter how tired she was, she still woke up around 3 A.M. every day and thought about her failures. She could not remember when she had last fell happy. And she was beginning to wonder if anything good would ever happen to her again.
ED: GROUCHY AND ACHY Ed poured his nightly glass of wine. He had never been much of a drinker when his wife was alive, but he needed a glass to make himself sleep at night. While he drank, he watched television just to hear the sound of another voice. He did not think of himself as lonely, though. His life was not great, but it was not bad either. It was just ordinary.
If he wanted to talk to somebody, he could always call his son, Steve. Steve seemed worried about him now that he was living alone. He should be grateful for Steve's concern, but instead, he felt annoyed. There was something very irritating about Steve's constant questions and invitations to come over for dinner and suggestions that he join a senior citizens' club. In fact, just about everyone got on Ed's nerves more than they used to. It was easier to be alone.
Ed winced at the familiar pain in his stomach. Maybe the nightly wine was doing damage. His back had been bothering him a lot, too, but that was to be expected at his age. Maybe the stomachache was just another part of getting old.
MICHELLE: HAPPY, HAPPY, HAPPY This was the best time of Michelle's life in every way. She had always wanted to write a novel, and now she was finally doing it. The ideas flowed into her mind so quickly that it was hard to get them all down on paper. She felt inspired; she knew her novel was brilliant. And now she had ideas for a screenplay, too. Finally, after all these years, she was realizing her creative potential.
Her sense of joy spilled into every area of her life. Nothing could put her in a bad mood. She had always been a little shy, but now she found it easy to approach strangers and start a conversation. The other day, she had overheard two neighbors talking about home repairs, and she had happily joined in. She had ended up doing most of the talking. She was more assertive sexually these days, too. She enjoyed letting men know she found them attractive.
Michelle had more energy than ever, no matter how hard she worked. After a couple of hours of sleep, she awoke completely refreshed. Michelle felt that she could accomplish anything. For once, she was so certain of success that she was willing to buy anything she wanted, no matter what the cost. She just charged it, whether she could afford it or not. She deserved good things. Nothing was beyond her.
Theresa, Ed, and Michelle are all behaving very differently, but they all have one thing in common. Theresa's unrelenting sadness and exhaustion, Ed's stomachache and irritability, and even Michelle's endless buoyancy and energy are all signs of one of the most common and destructive disorders in the US -- depression.
WHAT IS DEPRESSION? Depression is a type of mental disorder that disturbs a person's mood. Human moods can be thought of as a kind of rainbow: each mood is distinct, yet each one blends into the next. The shades of this rainbow range from severe depression through mild depression, normal sadness, everyday moods, mild mania, and mania (euphoria mixed with behavior problems). Everyone moves through various shades of the rainbow; it is normal and appropriate to respond to such events as the loss of a job or a loved one with sad, gloomy feelings. When these feelings become inappropriate, extreme, and dysfunctional, however, they are seen as a mood disorder.
Because depression often goes untreated, doctors are not sure exactly how many people have the illness. They know, however, that it is far from rare. In fact, depression is so widespread that it is sometimes called the "common cold of mental illness."
The term depression is often used to describe feelings of deep sadness. Almost everyone experiences sadness at one time or another. But people with depressive illness -- sometimes called major depression, major depressive disorder, or clinical depression to distinguish it from ordinary sadness -- experience an overwhelming and debilitating despondency that is long lasting and typically interferes with a person's life at home, in the workplace, or in social situations. When healthy people feel dejected by everyday events -- a fight with a loved one, a rejection for a job promotion, a move from a familiar home -- they may say, "I feel depressed." But the feeling they call "depression" is distinct from the clinical disease of depression. Normal sadness, no matter how painful, usually goes away over time without special treatment. People who are sad can live their everyday lives despite their sorrow. By contrast, depressive illness does not fade so easily and can seriously interrupt a person's ability to think and act.
Left untreated, major depression can be dangerous. Suicidal thoughts are a common part of this illness. Although deeply depressed people rarely have the energy to commit suicide, they may be more likely to do so as their depression begins to subside. Untreated depression is the most common cause of suicide in the US.
In some people, periods of depression alternate with periods of extreme joy and dysfunctional behavior known as mania. Such people have a kind of depressive illness called bipolar disorder or manic depression, or manic-depressive illness. This illness can make you hyperactive, irritable, and excessively self-confident. In addition, it can destroy your normal judgment and cause reckless behavior. Michelle's feelings of invincibility and wild spending habits, for example, are all symptoms of her mania.
Cyclothymia, also called cyclothymic disorder, is a milder but more lasting form of bipolar depression. People with cyclothymia have moods that swing between hypomania (a mild form of mania) and mild depression.
Like major depression, bipolar depression can be dangerous. During the depressed phase of your illness, you may be haunted by thoughts of suicide. During the manic phase of your illness, your good judgment may evaporate and you may not be able to see the harm of your actions. You may incur huge credit card debts, for example, or become sexually promiscuous. In some cases, people with mania lose touch with reality.
Milder, less common forms of depression include dysthymia, also called dysthymic disorder or depressive neurosis, and minor depression, also called minor depressive disorder. Recurrent brief depressive disorder feels like major depression but lasts for only a brief time. Postpartum depression is a depressive illness that develops in new mothers about 1 week to 6 months after the birth of their babies. Premenstrual dysphoric disorder is a cyclic illness that affects 3 percent to 5 percent of menstruating women. Women with this illness feel extremely depressed and irritable for a week or two before menstruation each month. Seasonal affective disorder (SAD) is a type of depression that occurs only at certain times of the year. People with this illness typically feel lethargic and depressed during winter months, yet their moods are normal during the summer months. Atypical depression has a mix of depressive symptoms that do not fit in perfectly with any of the existing categories.
In all its guises, depression distorts the way people view themselves, others, and the world. Theresa's thoughts are warped by self-loathing. Ed's irritability is damaging his relationships with other people. While Michelle's illness may seem to have positive aspects, it is clouding her judgment and making her act recklessly. In each of these cases, depressive illness is preventing people from leading their everyday lives.
No matter how their symptoms may vary, people with depressive illness find it affects almost every aspect of their lives, from how well they concentrate at work to how deeply they sleep at night. Eventually, it can make ordinary life impossible. But depression, in all its forms, can be treated. Major depression is one of the most treatable illnesses. Bipolar depression has no cure but can be controlled with medication. Other types of depression are also treatable.
The different types of depressive illness are discussed more fully in Chapter 2. Treatments are discussed in Chapters 5 and 6.
Am I Depressed or Just Blue?
If you are coping with a major loss, such as the death of your spouse or partner, you will experience some symptoms of depression. For example, you may find it hard to fall asleep, you may have no appetite for food, and you may have difficulty concentrating during the day. During a period of mourning after a major loss, such symptoms of depression are normal. Chances are you are enduring normal grief which, though difficult, is healthy.
Normal grief tends to go through stages, during which you react to your loss by first denying it, then coming to terms with it, and eventually accepting it. Immediately after the death of a loved one, for example, you may react with tears or pretend that he or she is still alive. You make funeral arrangements but your actions feel unreal, as if you were watching a movie. You cannot believe this h...
