If you're depressed, or know someone who is, here's important news: It's no one's fault. And there are many things that can help. Clinical depression is a serious, life-threatening disorder that will affect as many as 20 percent of women and 10 percent of men at some time in their lives. It's the leading cause of disability, not only in the United States but also around the world. At any given time, 5 to 10 percent of women and 3 percent of men are depressed. And although there are more effective treatments today than ever before – everything from Prozac and Paxil to cognitive and behavioral therapy and from exercise to nutrition to spirituality – a staggering 80 percent of women and men who are depressed go undiagnosed and untreated.
Unfortunately, most depressed people think that they themselves are the problem – that something's wrong with who they are or how they're made. And actually, they're half right. Scientists suspect that depression is caused by misguided genes that make you vulnerable, combined with stress. While you can't talk yourself out of depression, you can take steps to free yourself from its grip.
When Anger's Just a Symptom
Striding into the conference room full of writers, artists, and editors, 49-year-old James Clay whipped off his jacket, draped it around a chair at the front of the room, and picked up a big black marker.
"Okay, people," he announced as he moved toward a giant pad of paper on an easel. "Let's get this project started." And with an irrepressible grin that told everyone in the room just how much he loved what he was doing , Clay, a man who had been reserved, depressed, and impotent just months before, began to outline an innovative strategy that might well set the publishing industry on its ear.
Five, 10, or 15 years ago, James Clay would never have had the energy, the will, or the guts to stand up in front of a room full of people.
"I just couldn't do it," he admits with a steady look from behind his round, wire-rimmed glasses. "I was always an observer, a listener. I couldn't be positive about anything. I just couldn't get going. I was angry a lot of the time, and because I couldn't do much about it, I thought I was a weak person."In fact, Clay is anything but weak. He's a bright, energetic man with a passionate heart and a briefcase full of ambition. But he didn't know it until he was diagnosed with clinical depression – and got the right treatment.
"The first time I really heard the word depression, I was in my thirties, and my wife and I went into marital counseling," he says. "I'd been to three shrinks before that, but none of them had actually said I was depressed. It was like, 'Well, I had to put something down on your medical forms, so I put down depression.'"
Then one day while he was attending a therapy session with his wife, Clay erupted into a white-hot rage, lambasted his wife and the therapist, told them to go to hell, and ran out of the room. When he got himself together enough to talk with the therapist several days later, the therapist bluntly told him that such exteme rage was an indication of clinical depression – and that his anger was not just a problem but a symptom.
It was so hard to recognize,"Clay says. "All my life, there had been so much in the world to really be angry about – the Vietnam War, the upper-class social crap around me, the corporate bull I had to put up with ever day. The anger hid my depression."
His Solution The Right Antidepressant
Clay's therapist sent him to a psychiatrist with the recommendation that he start paroxetine (Paxil), a popular antidepressant that not only didn't work but also caused many side effects, including impotence. So he asked for something else.
The something else was sertraline (Zoloft), and it worked fairly well. Clay was tired of most of the time, and he had trouble generating enthusiasm for anything, but at least his sex life was back.
He tolerated the fatigue and emotional blandness for 3 years. Then a new therapist suggested that he might have more energy with fluoxetine (Prozac). "I started on 20 milligrams every other day. It worked wonders," says Clay. His energy is high, his sex life is intact, and his anger is under control.
Depression, from the Inside Out
At he University of Wisconsin-Madison, research psychiatrists at the HealthEmotions Institute have been using new imaging technology to literally peer into the brain to understand the biology of depression.
"We don't have all the answers," says Ned Kalin, M.D., chairman of the psychiatry department at the university and director of the HealthEmotions institute. "But at this point, there are two areas of the brain we are focusing on. One is the prefrontal cortex, which is the part of the brain that sits behind the forehead. The specific region that we think is important is the orbital frontal cortex." Its job may relate to maintaining positive feeling and inhibiting negative emotions. "Parts of this area may be under-active in people who are depressed.
"The second area that we think is important is the amygdala, a structure that is deeper in the brain," he says. "We think that this structure, which processes negative emotion and deals with more primitive feelings, is overactive in people who are depressed."
People who are clinically depressed also tend to have a number of brain chemicals that are out of balcnce, says Dr. Kalin. The result is that they become stuck negative emotions and behavior patterns.
Are you stuck- and stuck enough to call it depression? If you experience five or more of the following symptoms for more than 2 weeks, or they're sever enough to interfere with your daily routine, seek professional help.
- A persistent sad, anxious, or empty mood
- Sleeping too little or too much
- Reduced appetite and weight loss or increased appetite and weight gain
- Loss of interest or pleasure in activities one enjoyed
- Restlessness or irritability
- Persistent physical symptoms that don't respond to treatments
- Difficulty concentrating, remembering, or making decisions
- Fatigue or loss of energy
- Feeling guilty, hopeless, or worthless
- Thoughts of death or suicide
Hope Comes in Many Packages
Fortunately, says Dr. Kalin, lots of things can help. "We have better drugs now and with fewer side effects than we've ever had before.
"By the same token," he states, "cognitive therapy and interpersonal therapy seem to help a lot of people even without medication. What's more, there are a number of studies that indicate that a combination of medication and psychotherapy is even better than medication or psychotherapy alone.
"Other things help as well. For sure, meditation helps some people. For others, exercise helps. One of the challenges we're working on here at Wisconsin is trying to understand what the common pathways in the brain are that these different treatments affect. It is very likely that when these treatments work, they're affecting the same chemicals and structures in the brain."
