Down but Not Out
No one knows what triggers depression. No one knows for sure why the brain chemistry
becomes imbalanced. One factor is an imbalance in the chemical messengers in the
brain. Age, sex, upbringing and major life stresses, including chronic illnesses,
can also tip the balance. Antidepressant drugs work to restore this balance.
Women suffer depression more frequently than men. Typical symptoms include crying,
withdrawal, inability to experience pleasure, loss of energy and perhaps even feeling
they would be better off dead. Women have to cope with the mood-altering hormonal
effects of the menstrual cycle, pregnancy and childbirth, which produce special
New mothers expect to feel joy and exhilaration after giving birth. But because
of the enormous hormonal changes and the challenges of dealing with an infant, some
women will feel short-lived sadness, often recovering from this on their own. Others
may progress to a full blown postpartum depression that requires medical evaluation
and intervention for recovery.
Some men exhibit the same symptoms of typical depression as women, but many depressed
men exhibit atypical symptoms. Some depressed men have what has been called hidden
depression. They may manifest depression by becoming irritable, pessimistic or critical
of others, having difficulty getting along at work, becoming aggressive or abusing
Depression is not a normal part of aging. It may be a reaction to the loss of physical
and mental vitality; the loss of important others, such as friends, spouse and family;
or having to give up a career. Unexplained crying and persistent sadness are often
clues, as are multiple vague physical symptoms, such as persistent fatigue, headaches,
loss of appetite, chest pain or upset stomach. If medical illness has been ruled
out, depression is often the correct diagnosis.
It's normal to feel blue when you've been diagnosed with any chronic illness. Any
chronic condition can trigger depression, but risk increases in direct proportion
with the severity of the illness and the life disruption it causes. But it's not
normal to stay depressed. Depression is one of the most common and potentially dangerous
complications of every chronic illness. It is particularly common in those with
recent heart attacks, hospitalized cancer patients, recent stroke survivors and
those who have multiple sclerosis, Parkinson's disease and diabetes.
Today we know the link between depression and chronic illness is a two-way street.
Chronic illness is depressing. And the depression often exacerbates the illness.
Treating depression often improves the outcomes in those with other chronic illnesses.
Depression in children often is not recognized. Emotional and physical abuse, personal
loss or having a depressed parent can increase the risk of a child developing depression.
Children often do not show the typical symptoms of depression. They may show their
depression behaviorally. They may become irritable, aggressive, have difficulty
in school, withdraw from friends, or lose their usual playfulness.
Adolescence is a very difficult time in life. Major hormonal changes are experienced
at this time with higher highs and lower lows. Family ties are being loosened, but
the teen has not yet established himself or herself as an individual. Look for problems
at school, difficulty in bouncing back from life's disappointments or any other
sudden change in mood or behavior that is out of the ordinary. Sometimes depressed
teens turn to drugs or alcohol to feel better, which ultimately makes matters worse.
There is good news about depression. Once major depression is recognized, it can
be treated successfully with medication or psychotherapy or both. Not everyone responds
to the same therapy, but if a person doesn't respond to the first treatment used,
he or she is likely to respond to another approach.
Medication compliance is important to the successful treatment of depression. The
goal of treatment is complete symptom remission, not just symptom improvement. All
patients prescribed medication should remain on the treatment through symptom resolution
and then continue treatment for some additional months.
All patients on medication should have follow-up visits with their physician in
the initial diagnosis and treatment phase.
A Simple Tool
The Wakefield Scale is an easy-to-use screening
tool that can help you determine whether you need to contact your primary-care physician
to discuss possible treatment.