Sunday, August 29, 1999
When you just can't go on any more
Depression is often taken lightly, but it can be a killerBy Tanya Talaga
Toronto Star Medical Reporter
NO ONE will ever know what was going through the mind of Jeyabalan Balasingam when he grabbed his 3-year-old son and leaped in front of a subway train last weekend, but one word could help explain his actions: depression.
While depression is a term that is often overused, it is also a serious medical condition that is often misunderstood. How many times have you heard: ``I'm soooo depressed that my jeans don't fit me anymore?'' or ``This job is so depressing?''
The clinical definition of depression is an illness in which a person experiences a noticeable change in mood, in the way they see themselves and the world.
Most of us can pull ourselves out of the blues, but for those diagnosed as depressed, feelings of unrelenting despair can be overwhelming, shrouding them in sadness and self-loathing so dark, it feels like being trapped in a tunnel with no way out.
Depression is an all encompassing feeling, a way of thinking that is quite unreasonable and makes no sense to anybody, says Dr. Joel Sadavoy, psychiatrist-inchief at Mount Sinai Hospital and head of the joint program in general psychiatry for the Centre of Addiction and Mental Health.
Being in a state of depression is often a ``whole-body'' experience - affecting appetite, sleep and the way someone sees the world around them.
``Depression is a physical state, it's not just a mood,'' he says. ``It creates a slowing of thoughts, of movements and sometimes it conversely produces agitation.''
However, feelings of depression vary from person to person.
``Some patients talk about instant feelings of burning. Some talk about a deep weight inside, a blackness, a feeling of not being themselves anymore or something taking them over,'' Sadavoy says. ``We aren't talking about creatures from outer space here, but some state that is inside this person, that feels very unlike anything they ordinarily feel.''
Just like any other illnesses, depression strikes people in different ways. Major depression, dysthymia and bipolar disorders or manic depression are the best-known forms, but there are a host of others. Here is a list from the Web site alt.support.depression, a newsgroup for people with depression.
The Canadian Mental Health Association says one in 10 people will suffer from depression during their lifetime. It can hit all ages, but strikes most often between ages 24 to 44. Unfortunately, only one in three people who are depressed seek treatment, says Scot O'Grady, of the association. ``There is a stigma to having a mental illness - a person doesn't want to believe they have one.''
- A major depression can thrust an individual into a state of total despair where they are unable to work, sleep or eat. Add all these symptoms together and an individual is immobile. This mental state can come on a few times during one's life.
Almost 90 per cent of those with a major depressive disorder also suffer anxiety - such as obsessive preoccupations, panic attacks, phobias. And in extreme cases, delusions or hallucinations can occur.
Sadly, close to 15 per cent of those with major depression take their own lives and this number increases fourfold once a depressed person enters their late 50's.
- Dysthymia is a less severe form of chronic depression that causes long-term feelings of sadness or an inability to fully operate day-to-day living normally. Symptoms for this form of depression include a depressed mood persisting for almost 2 years.
- Manic depression is characterized by a cycle of mood changes - ultimate highs and deep lows. This can negatively affect thinking, judgement and behaviour. Several symptoms are usualy present in manic depression (or bipolar disorder): An elevated sense of self-esteem, no need for sleep, racing thoughts, constant talking and increased goal-directed activities.
- Seasonal Affective Disorder is aptly named for the feelings of depression that usually recur in winter. It can make you lethargic, craving sleep and generally low on energy. This disorder affects almost 5 per cent of Canadians because of poor light during the winter.
- Post-partum depression is common among new mothers. If it lasts for more than a few days, call your doctor.
If a person is diabetic, people don't tell them to `forget that insulin stuff' or to `get off the drugs and just pull your socks up and get on with life' - Scot O'Grady Canadian Mental Health Association
According to the U.S. National Institute of Mental Health, depression affects more than 19 million American adults, making it one of the significant brain diseases in North America.
Symptoms of depression range from a persistent down mood, loss of interest or pleasure in daily acitivies, change in weight - either gain or loss, feelings of guilt, self-hatred and reacurring thoughts of suicide or death.
The feelings of depression are far more serious than the overwhelming angst that can overcome you if you flunk an exam. It's a life altering feeling, Sadavoy says.
``They begin to think, in a hopeless manner, about themselves. They attack themselves for their worthlessness, their inability to do things.''
These feelings can compound to the point where patients become distorted and alienated. ``They begin to experience the world as a place that is no longer welcoming for them,'' he says.
Depression is the most treatable of all mental illnesses. If you feel you have any of the symptoms discussed in this article, consult your doctor or phone the association for assistance. Treatment ranges from a holistic approach to mood-altering drugs and psychotherapy.
Depression is often missed by physicians or it goes unnoticed by friends or family members, O'Grady says. ``I had an aunt with severe, clinical depression in the 1960's and it was always referred to as a nervous breakdown.''
- Counselling - helping the patient, family members and friends to cope with depression can be done by social workers, therapists and self-help groups. The Mood Disorder Association of Metro Toronto runs a number of counselling services.
- Psychotherapy - Conducted by psychiatrists or psychologists, attempts to form new connections between nerve cells in the brain, according to the National Institute of Mental Health.
- Anti-depressants - There are a wide range of drugs to help with mood disorders; the most common or well-known is Prozac. But don't expect treatment to happen overnight. Drugs usually take 4 to 6 weeks to start working and sometimes patients have to try a few perscriptions before hitting upon one that works for them. Existing antidepressants stimulate certain neurotransmitters in the brain.
- St. John's Wort - often referred to as ``nature's Prozac,'' is a plant extract used as a medicinal remedy for the past 2,000 years. It provides many of the benefits of Prozac, one of the most widely prescribed anti-depressants, without the side effects. This holistic alternative should only be used for mild forms of depression.
Society still doesn't weigh mental illnesses the same as physical ailments, he adds. If a person is diabetic, people don't tell them to ``forget that insulin stuff'' or to get off the drugs and just ``pull your socks up'' and get on with life, he says. People suffering depression need treatment and understanding.
But all the blame can't be put on family members who don't see the disorder in their loved-ones. It can be difficult to detect but there are a few warning signs, Sadavoy says.
``When the desparation gets to the point where it cannot be controlled people often will say things to others that reveal the depression, but frequently these messages are not paid attention to.'' People will say things like: ``I've got to the point where I can't take it anymore.'' or ``I've thought about ending my life, Ha Ha Ha'' or ``I can't go to work any more.''
If these signs are ignored the individual's feelings of depression, isolation, of being uncared for and hopelessness can spiral, he says.
``These are the elements or the recipe for deep depression, suicide and sometimes homicide.''
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