Depression: A dark and dangerous place

By WALKER MEADE Correspondent

Published: Tuesday, June 30, 2009 at 1:00 a.m.
Last Modified: Monday, June 29, 2009 at 4:10 p.m.

Can't remember when you last had a good night's sleep? Been feeling edgy and short-tempered? Cry sometimes while you're making lunch? Feel that everything that matters is somehow out of your control?

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MANY FACES OF DEPRESSION
Major depressive disorder is a combination of symptoms that interfere with your ability to work, sleep, study, eat and enjoy once–pleasurable activities. Major depression is disabling and may occur only once in a person’s lifetime, but more often, it recurs throughout life.

Dysthymic disorder lasts two years or longer but its severe symptoms may not disable but can prevent you from functioning normally or feeling well. People with dysthymia may also experience one or more episodes of major depression during their lifetimes.

There are other forms of depression that can develop because of unique circumstances, such as the present economic recession. Not all scientists agree on how to define these forms of depression.

They include:

Psychotic depression, which occurs when a severe depressive illness is accompanied by some form of psychosis, such as a break with reality, hallucinations and delusions.

Postpartum depression, which is diagnosed if a new mother develops a major depressive episode within one month after delivery. It is estimated that 10 to 15 percent of women experience postpartum depression after giving birth.

Seasonal affective disorder (SAD), which is characterized by the onset of a depressive illness during the winter months, when there is less natural sunlight.

Bipolar disorder is not as common as major depression or dysthymia. Bipolar disorder is characterized by cycling mood changes — from extreme highs to extreme lows.

—National Institute for Mental Health

You may be on the slippery slope to depression. And if you don't do something about it, your world may become a very, very dark place.

First, "it is terribly important that you know if your sense of discouragement and demoralization is a clinical or real depression," says Sarasota psychiatrist Dr. Robert Mignone. "People can also be demoralized, which is different from depression. In depression, day in and day out, it's a dark and rainy place. Demoralization, on the other hand, doesn't necessarily have a continued loss of sleep, appetite, focus or concentration. It's more a sense of despair and loss of meaning and purpose."

Major depression, which affects about 8 percent of the population and tends to run in families, is treatable with antidepressants, says Mignone. Other depressive disorders may respond to tranquilizers, but will not respond to antidepressants.

Major depression is "the big gun," Mignone says. "If you come down a notch, you have an adjustment reaction with depressive symptoms. If a hurricane hits and takes your house, you may have a situational depression. It comes on immediately and is exquisitely related to the event. It will tend to run a course, especially for people who have strong support, faith and other resources that they can mobilize. It will diminish within four to six weeks. For people who are not resilient or can't bounce back, it will become an ongoing stress."

Mignone believes that the incidence of situational depression has increased since the economic downturn and so have other kinds of acting out.

"Drinking has increased. Suicidal thinking and attempts have increased. Anxiety has remarkably increased," he says. "I not only read about these things, but see them in my own practice. Our current economic situation is clearly not like a hurricane or a fire. It is ongoing and has no certain end. The fallout directly affects all of us."

Because the current situation is very socially destructive, we need to understand that we can't change the fact of what we are going through, but we can change our response. "The financial crisis is not changing our emotional state. We are doing that," he says. "You don't look to the facts to get a handle, you look to yourself. You find a way to get a handle on the situation. I think when we are delivered an emotional blow we are designed to heal. Even when no intervention is given, most of us will heal over time. Healing wants to happen."

Miriam Lacher, the manager of referral development at Sarasota Memorial Hospital's Bayside Center for Behavioral Health, says that although total patient volume is down because people can't afford to come to the center, the diagnostic profile of people with depression-related problems is up.

"What we are seeing are people who are profoundly depressed who are looking for some way to find something that can be back in their control," she says. "We now see people at Bayside that we have not seen before. We had a gentleman ... who attempted suicide. He had never had any mental illness but he lost everything in the market and could not figure out how he was going to sustain himself because this was his retirement."

What can we do to help?

When we see a friend or family member begin to withdraw, there are things we can do to intervene. "We must be more mindful of people in our lives and be aware if they change their daily routines, the way they interact, the things they say, or they allow their personal hygiene to deteriorate," says Lacher. "We are our brother's keeper after all. People just cannot pull themselves up by their bootstraps. We need to say, 'Hey, there is something not right here. Can you talk to me? And if you can't, then let's go get some help.' "

The primary breadwinner in a family is likely to have more symptoms of depression, says Lacher, "because when the world is out of control, it is not just about them, but about the people who depend upon them." Depression in a family also profoundly affects children. "If children are upset, or angry or depressed, you often see acting-out behavior," says Vicki Klein, a clinical social worker in Sarasota. "Children don't have the skills to express themselves with words, so they act their emotions out. They may pick on other children, they may turn it inward on themselves and become withdrawn and have trouble sleeping. They are not likely to discuss these things. "As a parent you would want to have them express what they feel with words and you may have to give them the words," she says. "You might say something like 'It looks like you're sad' and get them to talk about that."

Sometimes, just the act of talking problems out with a therapist can help get people on the road to recovery. "People heal in the very act of sharing what it is that they are struggling with," says Lacher. "You must have a genuine trusting relationship with a patient in order for them to change and take a different path in life. You have to hear the client, hear what their struggles are, validate those struggles, believe that they are struggling before they begin to make changes. Because then you can begin to work with the patient so that they can begin to see if there aren't other ways to perceive what can happen next. You want to see what they are thinking about and not just responding to the emotional part of the problem."

When should you get help?

But how do you know when your emotional problems have gotten so serious that you should reach out for professional help?

The important thing is to be able to "read" yourself -- to know what you are feeling. "Symptoms reach thresholds," Mignone says. "You get to a place where you realize you are not your old self. And, by and large, when the pain gets too much, you will go for help, whether it is a physical problem or an emotional one. Sometimes a patient's inability to function becomes so apparent it can't be denied. They get negative reports at work. A spouse or friend says, 'What's the matter. You're just not yourself.' There is a symptomatic expression of illness that either the patient recognizes or other people do."

There is no point in living in pain when the condition you think is hopeless is not, when the suffering you think will never end can be overcome because of the advances in treatment available to you now.

"If you have no resources and need professional guidance, you will find the churches in Sarasota County a great help," says Mignone. "They will often have an active counseling service where you can get some help. And there are services like Jewish Children & Family Service that can and will help out."

This story appeared in print on page E10

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