Depression … even the word itself is a real downer.

“But with the slow menace of a glacier, depression came on. No one had any measure of its progress; no one had any plan for stopping it. Everyone tried to get out of its way. ”
Frances Perkins

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“Depression can seem worse than terminal cancer, because most cancer patients feel loved and they have hope and self-esteem.” 
David D. Burns

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“I didn’t know my mother had it. I think a lot of women don’t know their mothers had it; that’s the sad thing about depression. You know, you don’t function anymore. You shut down. You feel like you are in a void.
Marie Osmond

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“I start to think there really is no cure for depression, that happiness is an ongoing battle, and I wonder if it isn’t one I’ll have to fight for as long as I live. I wonder if it’s worth it.”                                                                                        Elizabeth Wurtzel

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“Noble deeds and hot baths are the best cures for depression.”                                                                                                               Dodie Smith

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Recovering from the suicide of a loved one, you need all the help you can get, so I very much recommend a meditation program. The whole picture of how to recover from this has to do with body, mind, and spirit. That’s applicable to any kind of depression.”
Judy Collins

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“Since I was 16, I’ve felt a black cloud hangs over me. Since then, I have taken pills for depression.”                     Amy Winehouse

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“The other thing is that if you rely solely on medication to manage depression or anxiety, for example, you have done nothing to train the mind, so that when you come off the medication, you are just as vulnerable to a relapse as though you had never taken the medication.”
Daniel Goleman

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“The Bluebird of Happiness long absent from his life, Ned is visited by the Chicken of Depression.”                        Gary Larson

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Here is a belfry that is actually separate from its church.  It’s located in the Philippines.  Sort of plain.  Cloudy day.  Not very ornate.  Lonely.  You might even call it a “depressed belfry.”  Even the bats that live inside don’t feel like doing much of anything.  Sad.

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I listed a number of quotes above, obviously all having something to do with depression.   Depression, or “major depression“, as we shrinks like to say, is one of the most complex illnesses known to humandom.  It is most definitely an illness.  It is a disease.  It can strike anyone.  Over 20% of adults in the entire world will suffer from a bout of major depression at some point in their lives.  It is the #1 cause of disability worldwide, measured in Years Lived with Disability (YLD), according to the World Health Organization, and the 4th leading cause of disability burden by “Disability-Adjusted Life Years” (DALYs):  The sum of years of potential life lost due to premature mortality and the years of productive life lost due to disability.  By 2020, the WHO estimates it will move up from #4 to #2 in DALYs, behind only heart disease.

Depression is a killer.  It is a taker of life, both literally and figuratively.  It is unforgiving.  It is merciless.  It has no conscience.  It gives no quarter.  It is a seemingly impenetrable web that engulfs those who fall prey to it, a web that others on the outside very often have to hack their way through to rescue those trapped inside.

In short, depression sucks.

But, there is reason for hope.  For you, for me, for anyone ensnared in the sticky web of depression.  Let’s talk about it.

First, what is depression?  Well, depends on whom you ask.  If you look it up in the DSM-IV (that is, “Diagnostic and Statistical Manual, 4th edition”, published by the American Psychiatric Association), you’ll see a list of symptoms that must be present over at least a 2-week period of time:  there must be either “depressed” (excessively sad, tearful, or empty) mood most of the day almost every day, or the loss or marked decrease in any interest or ability to experience pleasure in any normal activities;  Beyond those, there must also be at least 4 of:  significant weight loss or gain, insomnia or hypersomnia nearly every day, observable motor agitation OR retardation, fatigue or loss of energy, feelings of worthlessness or excessive guilt, diminished ability to think, concentrate, or make decisions, and either frequent thoughts about death or suicidality in some form (thought, planning, or action).  Also, the symptoms cause distinct distress to the person suffering from them, they can’t be caused by alcohol or drug abuse, or by some medication or general medical condition, and they can’t co-occur with bereavement (although, obviously some people with depression at times suffer the loss of someone close to them, which only worsens it all).

You may have noticed that there were no laboratory data or physical exam findings listed.  There are also no X-ray or other imaging criteria in the list.  This is what is called a “phenomenological” method of making a diagnosis:  you look for certain symptoms, certain observations of the person involved occurring over a specified time period, and if there is no other possible cause that would better explain it, then the person has the diagnosis.  This is the way the majority of psychiatric illnesses are diagnosed.  Eventually, there may be more direct and specific ways to diagnose mental illness, but until scientists come up with one of those wonderful wands that Dr. McCoy (from Star Trek’s starship Enterprise) would wave over sick folks and instantly detect the correct diagnosis and the needed cure, we’re stuck trying to read the human brain/mind by what and how the overall person is doing on the outside.

So, what I’ve listed so far is the “textbook” version of depression.  A simple search engine exploration will give anyone that info.  But I’d like to go a little deeper … make this discussion just a little more human.  

What is true about depression that you might not commonly find in books?

Let’s first look at the causes of depression.  And, first among firsts, is the fact that there are many “causes”, many risk factors, many ingredients, many flavors.  It might be helpful to think of depression as the ultimate “human illness”.  This is because it embodies more than any other disease I know of, the mantra that we spoke of recently:  that in humans every sphere of our existence – physical, mental, emotional, social, spiritual – impacts, and is impacted by, every other sphere.    As such, every one of those spheres plays a role in the origins of depression, and every sphere is affected by it.

Are there genetic causes?  Yes, in a sense.  Just this past May researchers were able to isolate a segment of one arm of the number 3 chromosome that is solidly linked to familial depression (  http://www.ft.com/cms/s/2/01a23ec2-7f13-11e0-b239-00144feabdc0.html#axzz1lSQfFHg6  ).  In all over 100 gene loci have been associated with depression that so often runs in families.  But, it is also true that not everyone who has one of these gene structures in his or her DNA makeup will automatically and without fail end up with an episode of depression.   Just a matter of raising the risk to a relative degree.

Are there environmental or social causes?  Of course there are.  Many.  Probably innumerable.  As many different traumas, frustrations, disappointments, losses, relational conflicts, patterns of abuse, patterns of neglect, and almost every other negative human experience you can imagine … for each and every one of them there has certainly been at least one of our fellow humans who has become depressed as a result.

There are cognitive, or mental, causes, too.  Actually, this category fits more as an all-around factor:  if, as for many of us, one’s thinking and beliefs are skewed, then once any other causes or risk factors are present depression can more quickly gain a foothold, and will be much more severe, lasting, difficult to treat and to recover from.  It can also serve as a sole cause of its own.  It is definitely possible to “think” yourself into depressive illness.  When we later talk about cognitive therapy, getting back to what we spoke about in the very first post – debunking myths and dispelling false beliefs and notions about life – we’ll see just how powerful our minds can be, for good and for ill, in our lives.

Are there spiritual causes?  No doubt.  So MANY of us are highly vulnerable to the prevailing winds when it comes to measuring our lives’ worth and relative success or failure.  And when I overlay the template of how God may or may not feel about my life’s virtue thus far, any guilt I feel for both real and imagined sins, whether of commission or omission, can become both seed and fertilizer for sprouting and supporting depression.  We’ll talk much more about this when we address the whole issue of how sick we are as a culture in terms of how competitive we insist on being in every possible way.  In addition, sadly, many of those in ministry can often make “spiritual” depression worse when they dismiss depression as an actual illness, or accuse sufferers of simply having too weak or feeble a faith in their Lord.   Friends and family, unfortunately, at times do the same with hasty criticisms uttered in frustration.  Statements such as, “just get over it”, or “why don’t you get up and do something?”, or “you’ve just got to trust in God, and everything will be fine”, well-meaning though they may be, typically serve only to make the depressed person feel greater guilt, less hope.  Trying to talk someone out of depression, especially with misguided appeals to greater faith, greater effort, can be like trying to fill up the Grand Canyon with a shovel.  There are sources and methods of giving someone spiritual help, though, and we’ll look at those soon.

Physical causes?  Sure.  Chronic pain.  Aging, and losing one’s agility, ability, mobility, and memory.  Chronic illness, and all the uncertainty, discomfort, hassle, expense, and treatments it can entail, can wear us down and lead to depression.  Earlier it was noted that if a medicine or medical illness causes a syndrome that seems to mimic depression, you can’t really call it “depression”.  Well, that may be, but in so many of those cases the longterm effects of such a syndrome (such as depression-like symptoms during a bout of hypothyroidism, or the depression-like effects of taking interferon for treatment of Hepatitis C virus) actually take on a life of their own, and the individual unfortunately ends up having both diseases.

You know, it occurs to me that the last sentence in the previous paragraph sums up an awful lot of truth about depression.  As a couple of the quotes above indicate, depression often has a very subtle approach; an insidious development.  It can strike anyone at almost anytime from any angle, but its “strike” is most often at the speed of a snail, soft and silent.  Most folks I’ve come to know have told me they didn’t really see the depression coming beforehand, didn’t realize what was happening to them until it had fully taken hold, but once it took hold it truly did seem to become a “life of its own”, taking complete control of their lives.

And the control is definitely complete.  One of the more frequent descriptions I hear from depressed patients is that it’s like being in a deep, dark pit, from which there is no escape.   “A black hole.”  “Like a thousand pound blanket lying on me, constantly.”  “I feel completely paralyzed.”  “Life is just all gray, always.”  Against such an enemy, can there be any hope of victory?

From years of experience, I can say firmly and with conviction, yes.

However, overcoming depression is never easy.  If we grant that it can be caused by any or all of the physical, cognitive, emotional, social, and spiritual parts of us, and if we grant that, regardless of cause, it most certainly impacts every one of those spheres, then it stands to reason that it must be addressed in every one of those arenas.  And, it can be.  It takes large effort, in some cases huge effort, and typically much of the early efforts must come from others, rather than from the patient.  Why?  Well, as we’ve established, the very nature of the illness known as depression is that it takes away the ability to motivate oneself to do any of the things that could help to eliminate that depression.  That’s why we can say with full conviction, “Depression sucks!”  But, if the sufferer will merely allow someone else to help them get out of the house to come into contact with a helper somewhere, then help can begin.  That help may take many shapes and forms, it won’t be quick, but it can and will genuinely save lives.

There is reason for good hope.  More discussion coming.

At this point I want to give thanks to the many, many human beings who have sat next to me, and have trusted me enough to honor me with their stories, their experiences, with recounts of what helped them, and what did not.  They have let me try to play a small role in their journey toward recovery, and I have learned so very much from them.  Almost all of what I know about overcoming depression I have learned, not from textbooks, drug reps, lectures, journals, or science, but from them.  I am humbled, and grateful.

Craig Meek, M.D.

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