Demystifying Depression

When Barbara*, now forty-four, was in high school, her parents considered her a crabby teenager. In college, she was labeled homesick. It wasn’t until graduate school when her anxiety worsened and she was spending a lot of time alone in the library that she realized something deeper was wrong. “I didn’t particularly feel sad,” Barbara says. “I was just worried I was heading off the rails.” Barbara’s agitation, isolation, and anxiety are common symptoms of depression. However, because Barbara remained functional through her school years and highly successful in her career as a communications consultant, it wasn’t until she was thirty-seven that a psychiatrist finally diagnosed her with major depressive disorder. “I tended to cry a lot,” she says. “Things upset me more than I thought they should.” When her psychiatrist asked her if it felt as if she were living in molasses, a light bulb went off. That was exactly what it felt like. “Things were just more difficult than they needed to be,” she notes.

*Name has been changed.

The Big Picture

Barbara is not alone. According to the National Institute of Mental Health, the median age at onset for major depressive disorder is 32, and in any given year, it affects nearly 14.8 million adults, or 6.7 percent of the U.S. population over the age of eighteen. And nearly 3.3 million adults experience a milder form of depression, called dysthymia. If you take into account situational depression, seasonal affective disorder, bipolar disorder, and postpartum depression, the number of people experiencing depression soars. Sandra Wick, Ph.D, a licensed clinical psychologist and marriage and family therapist at Maplewood Psychology, estimates that at least 10 percent of people struggle with depression in any given year. She believes the published statistics for depression are too low and estimates that as many as 80 percent of cases, maybe more, go undiagnosed because “people often don’t recognize the symptoms of depression.”

Depression:
+ Crosses all socioeconomic, race, and gender lines
+ Women are twice as likely as men to develop depression
+ Men are more likely to go undiagnosed and untreated

Symptoms:
+ Overwhelming feelings of sadness
+ Loss of interest in activities once enjoyed
+ Feelings of guilt or worthlessness

“Major depression differs from normal sadness,” says Alexandra Stillman, Ph.D., a therapist at Maplewood Psychology. “With normal sadness, people can be distracted from it by engaging in activities they typically enjoy. Depression is a pervasive state. It is not easy to break, and it spreads through all of your life activities.”

Dysthymia, on the other hand, is a less severe but more chronic form of depression where periods of depression are often interspersed with periods of feeling normal. There is also situational depression, sometimes called adjustment disorder. This is triggered by an event such as the loss of a loved one or a diagnosis of a major health condition, such as cancer. Sometimes, these depressions become more chronic.

“We expect after an event like a death that people will go through a normal period of depression,” Stillman notes. After about six weeks, however, if someone is still preoccupied with past memories of the event, having trouble sleeping, or isolating, he or she may be falling into a more pervasive depression. “Those are the people we start to worry about,” she adds.

Getting help

One of the first steps in overcoming depression is finding out exactly what is wrong. Before obtaining a definitive diagnosis, Barbara searched for years in many different places for help.

She first sought guidance through a counselor. “I didn’t trust the first counselor,” Barbara says. “I was getting more upset with each visit.”

She then tried self-help books, but that wasn’t enough. And, according to Wick, that isn’t surprising. Although bibliotherapy can often help those with depression, she says, “It is not going to be enough for those with full-blown depression. Depression is a body-mind illness.”

Barbara turned to a doctor who tried anti-depressants, but nothing seemed to work. So she made an appointment with a psychiatrist, who prescribed a combination of medications. “The drugs removed the stickiness (of the molasses), and now I react more calmly to things,” she says.

Fortunately, for those suffering from depression, such as Barbara, or who have a loved one who is showing signs of the disease, the Twin Cities have a wealth of resources available to help. These resources range from one-on-one counseling to inpatient hospital treatment depending on the severity of symptoms. Although health professionals stress the importance of seeking help—particularly if your thoughts, or those of someone you love, turn to self-harm—Stillman cautions, “It is difficult for family members to insist that a loved one get help. They can gently say to the person, ‘It seems like you’ve changed. You are isolating. You seem unhappy, and we are concerned about you.’” But they can’t force an adult into treatment unless he or she is a danger to self or others.

“The logical first step is one-on-one counseling,” Wick says. Psychotherapy can range from a few visits with a psychotherapist to longer-term therapy that lasts months or years to group sessions, and it can be used in combination with medication. But, as Barbara learned, finding a therapist you feel comfortable with is extremely important to the success of treatment. Wick recommends that people seeing a therapist ask themselves whether they feel listened to, heard, and respected by their therapist.

For those who need a more intense form of outpatient therapy, Prairie St. John’s offers partial-day treatment. This intensive outpatient program offers structured support, including group sessions, for six or seven hours each day; but at night, patients return home. Day treatment is typically less intense than inpatient treatment, but it lasts longer.

The next level of care is in-patient therapy. Whatever path people take, they need to feel comfortable with the professionals they turn to for help. “Ask for recommendations,” Barbara says. “You need to search out your options as you would for any other illness.” Depression is treatable.

This article has been adapted from the original, which was published in the February 2008 issue of Mpls.St.Paul Magazine.