Chapter 1

Demystifying and Defeating Depression

IN THIS CHAPTER

Defining depression

Calculating the costs of depression

Treating depression

Going beyond depression

Like solitary confinement, depression isolates those who experience it. Alone, fearful, and feeling powerless, sufferers withdraw. Hope, faith, relationships, work, play, and creative pursuits - the very paths to recovery - seem meaningless and inconceivable. A cruel, inhuman punishment, depression incarcerates the body, mind, and soul.

Though depression feels inescapable, we have a set of keys for unlocking the jail cell of depression that confines you or someone you care about. You may find that the first key you try works, but more often than not escape requires a combination of keys. We're here to help, and we have a ring of keys for you to try out. We also tell you how to choose a great locksmith (mental health professional) if you can't find the right key.

In this chapter, we clarify the difference between sadness and depression; they're not the same. Next, we show you how depression looks among various groups of people. We calculate the costs of depression in terms of health, productivity, and relationships. We tell you about the treatment options for depression. And finally, we offer a glimpse of life beyond depression.

Just Singing the Blues or Depressed?

Life delivers death, divorce, disaster, disease, disorder, disgrace, and distress. Inescapable and inevitable. Even if nothing else goes wrong, you're eventually going to die. Expecting to live a life absent of sharp episodes of sadness, despair, or grief is unrealistic. In fact, without times of sorrow, how would you truly appreciate life's blessings?

Yet, misfortunes and loss need not lead to depression. What's the difference? Sadness and grief lessen in intensity as time passes. (See Chapter 2 for more information about grief and types of depression.) Sadness and grief may seem fairly overwhelming when they occur. But time does eventually heal (unless the grief turns into depression over time).

Unlike episodes of despair, depression involves deep feeling of guilt and loss of self-esteem. People suffering from depression feel hopeless, helpless, and unforgiving of themselves. Depression disrupts the body, often impacting sleep, appetite, concentration, energy, and sex. And depression profoundly diminishes the ability to love, laugh, work, and play.

Depression is a mood disorder in which a person feels profoundly sad, joyless, despondent, and unable to experience pleasure. Depression comes in various types that have somewhat different symptoms. We describe these categories of depression in Chapter 2, but all involve a low mood or diminished sense of pleasure.

The Varying Faces of Depression

Depression doesn't discriminate; it can affect anyone regardless of race, social class, or status. Typical symptoms of sadness, loss of energy and interests, low self-esteem, feelings of guilt, and changes in appetite and sleep appear in men, women, children, and the elderly. Such symptoms also manifest themselves across different cultures. However, a depressed preschooler may not exactly look the same as a depressed 80-year-old.

In Chapter 2, we dissect the various categories of depression. In this chapter, we show you how depression looks in different people at different life stages. The cases we present in this chapter, and throughout this book, don't represent real people. However, they're loosely based on the people we've worked with in our collective careers.

Young and depressed

Depression can be found among children of any age, from preschool through young adulthood. However, preschoolers have relatively low rates of depression. Depression increases throughout childhood and is most common in adolescence.

The rates of depression in children are likely underreported because parents and professionals often fail to recognize the problem. Children rarely spontaneously report depression to others. Instead, they more typically remain unaware of their feelings, which manifest themselves through changes in their behavior, appetite, and sleep.

• Mackenzie's mom surprises her by bringing cupcakes to school on her eighth birthday. The teacher leads the class in singing "Happy Birthday," but Mackenzie barely smiles. After quickly devouring the two overloaded trays of cupcakes, the kids all race out to the playground for recess. Mackenzie trails behind.
• Mackenzie's teacher approaches her mother, "I'm concerned about Mackenzie. She seems quiet and less interested in her schoolwork. I often see her alone on the playground. She doesn't raise her hand in class like she used to, either. Is something wrong?"

When children are depressed, they lose interest in activities that they previously enjoyed. If you ask them if they're sad, they may not be able to connect their feelings with words. However, they will show various signs of depression, such as low energy, sleep problems, appetite changes, irritability, and low self-esteem.

KIDS, DEPRESSION, AND OBESITY

In a study reported in the journal Pediatrics, more than 9,000 teens participated in a study on the relationship between depression and obesity. The researchers gave the kids a questionnaire that measured depression and calculated their body mass index (BMI), a measure of obesity. They assessed the kids once again a year later. Kids who were obese and depressed at the first assessment tended to become more obese by the second assessment. Kids who were not obese at the first assessment, but were depressed, had double the risk of becoming obese a year later. Much remains to be discovered about exactly how depression may increase this risk of obesity; however, these findings underscore the importance of addressing depression when it occurs.

Watch children at play for subtle signs of depression. Depressed children may weave themes of death or loss into their play. All children's play includes such themes on occasion, but dark topics show up more often in kids who are depressed. You may need to observe kids over a period of time because their moods change. They may not look as continuously depressed as adults with depression. Their moods may fluctuate throughout the day. Consult a professional if you have any doubts.

Depression in seniors

Some people view old age as inherently depressing. They assume that upon reaching a certain age, quality of life deteriorates. In fact, there is some truth to these assumptions: Old age brings increases in illness and disability and losses of friends, family members, and social support. Therefore, some sadness is to be expected.

Nevertheless, depression is absolutely not an inevitable consequence of old age. Most symptoms of depression in the elderly mimic those of depression in anyone. However, the elderly are a little more likely to focus on aches and pains rather than feelings of despair. Furthermore, they commonly express regret and remorse about past events in their lives.

Depression interferes with memory. If you notice increased memory problems in grandpa or grandma, you could easily chalk the problem up to the worst-case scenario: Alzheimer's or dementia. However, such memory problems also occur as a result of depression.

And depression in the elderly increases the chances of death. Yet, if asked about depression, elders may scoff at the idea. Denying depression, the elder person may not get needed treatment.

Elderly men are at particularly high risk of suicide. Men older than 60 are more likely to take their own lives than any other combination of age and gender. If you have any doubts, check the possibility of depression with a doctor or mental health professional.

Real men don't get depressed, or do they?

Most studies show that men get depressed about half as frequently as women. But then again, men tend to cover up and hide their depression; they feel far more reluctant to talk about weaknesses and vulnerabilities than women do. Why?

Many men have been taught that admitting to any form of mental illness or emotional problem is unmanly. From early childhood experiences, these men learn to cover up negative feelings.

• Scott looks forward to retirement from his job as a marketing executive. He can't wait to start traveling and pursuing long-postponed hobbies. Three months after he retires, his wife of 20 years asks for a divorce. Shocked, yet showing little emotion, Scott tells his friends and family, "Life goes on."
• Scott starts drinking more heavily than usual. He pursues extreme sports. He pushes his abilities to the limit in rock climbing, hang gliding, and skiing in remote areas. Scott distances himself from family and friends. His normal, even temperament turns sour. Yet Scott denies the depression so evident to those who know him well.

Rather than own up to disturbing feelings, men commonly turn to drugs or alcohol in an attempt to cope. Some depressed men express anger and irritation rather than sadness. Others report the physical signs of depression, such as lack of energy, poor sleep, altered appetite, and body aches, but adamantly deny feeling depressed. The cost of not expressing feelings and not getting help may account for...