Lesson 2: Are You Depressed?
What is Depression?
Strangely enough, you don’t have to feel depressed to have clinical depression. The Diagnostic and Statistical Manual for Psychiatric Disorders, Fourth Edition (DSM-IV), put out by the American Psychiatric Association, in its criteria for major depression lists either feeling depressed most of the time for two weeks OR abnormal loss of interest or pleasure most of the time for two weeks. The type of depression I experienced growing up was in this latter class, less of exaggerated sadness and more of lack of emotion.
Think of the two alternatives as Column A on a Chinese menu. Now we go to Column B where the DSM-IV lists nine options. The first two (slightly edited) are repeats of Column A. The next seven (slightly edited) deserve our attention, because most of them don’t actually refer to mood:
- Abnormal depressed mood (or irritable mood if a child or adolescent)
- Abnormal loss of all interest and pleasure
- Appetite or weight disturbance, either weight loss or weight gain.
- Sleep disturbance, either abnormal insomnia or abnormal hypersomnia.
- Activity disturbance, either abnormal agitation or abnormal slowing (observable by others).
- Abnormal fatigue or loss of energy.
- Abnormal self-reproach or inappropriate guilt.
- Abnormal poor concentration or indecisiveness.
- Abnormal morbid thoughts of death (not just fear of dying) or suicide.
The DSM-IV mandates having at least five of the last seven symptoms, though in actual clinical practice having only three or four is hardly going to rule out treatment
This is how Peggy refers to her depression in an article on Suite101.com: “There were nights I was not able to sleep, and then there were days when that's all I did. The most frustrating thing was that all the tools I had been using for years to deal effectively with my life just didn't work. I tried to tell myself that, ‘this too shall pass,’ or, ‘look, you've handled worse than this.’ But to no avail ... I ended up in hospital with chest pains. They thought it may have been a heart problem ... just kept getting worse and worse. I had absolutely no energy, and I sometimes would have a hot flash that lasted all day. The doctors began thinking menopause ... It was like I was in this huge black hole and there was no life and no hope ...
“Finally, it got so bad that I decided to try a new doctor. I walked into her office and told her what was happening, and she said: ‘Peggy, I don't think this is menopause. I think this is depression.’ I really believe she saved my life.”
If only depression just made you feel sad. Back to my story: “It's like a cardiac arrest, only it happens in the brain - something responsible for holding the gray mass together abruptly shifts, there is a sickening feeling of something terrible about to happen, and next thing your head is experiencing the awful sensation of being emptied out. From somewhere inside the power goes down and the body seems to collapse into itself like a marionette being folded into a box. You look for a way out, and what's left of your broken brain does its best to oblige with images of high bridges and frozen ponds and nooses dangling from balconies.”
Now we begin to see a commonality in all the stories, replete with jarring descriptions: mushed up bread air, groggy sleepless dragging blood, black hole, in thrall to outlaw hormones, the power going down ...
Depression isn’t the word for it. Brain crash is more like it. It is a total assault of the body as well as the brain, every bit as much a physical illness as mental.
Small wonder people can’t take it. "Well, my own work," Vincent Van Gogh wrote in his last letter to his brother Theo, "I am risking my life for it, and my reason has half foundered." Six days later, he would be dead, a bullet to his chest, an act of suicide.
Virginia Woolf couldn’t bear the thought of going under once more. One cold day in 1942 - her body wasting from neglect, her thoughts racing, and hearing voices - she wrote: “I am certain now that I am going mad again. It is just as it was the first time ..." Then she walked down to the river bank, filled her pockets with stones, and left her walking stick on the ground. Children would discover her body three weeks later.
Check out the items on the DSM-IV menu. You must have at least five of the nine (including one of the first two) to qualify as having major depression. It is an arbitrary figure, but is based on good science. It is not meant to be a substitute for a medical diagnosis, but it should give you a fair indication of where you stand. If you have not seen a doctor or psychiatrist, please make an appointment. Depression may be one of the worst illnesses on earth, but it is highly treatable, with a high success rate. However dismal things may seem for you right now, your mind and body have allowed you one inch of hope that can take you many miles.
For all students, the aim of this course is to help you better manage your illness by arming yourself with the kind of knowledge it takes to make informed decisions. For all the publicity about Prozac, this illness is not as simple as popping one of these pills down the hatch. Future lessons will look at the many therapies and lifestyle choices we can bring to bear on our illness, but first we need to better understand the enemy we’re dealing with.
In our next lesson, we will look at the different types of depression and how the illness affects different populations.
