8 things to know about depression
The death of comedian Robin Williams stunned all of us recently.
The magnanimous man who voiced the hilarious Genie from "Aladdin" and captured the spirit of an inspiring English teacher in "Dead Poets Society" – filmed here in Delaware – struggled with depression and the early stages of Parkinson's disease.
But he's not the only one with depression. After Williams' suicide, Chevy Chase almost immediately texted a message that as a person who battled depression all his life, he was particularly horrified by Williams' death. Millions of others saw themselves or someone they knew or loved reflected in that admission.
Depression is a disease that knows no age, ethnicity or sex.
Lena Dunham, brainchild behind "Girls," tweeted the day of Williams' death: "A tragic reminder that the conversation about mental health CANNOT stop. Money, fame, artistic freedom – none of it is a barrier."
According to data from the Centers for Disease Control and Prevention, about 9.1 percent of Americans lives with depression, based on a surveyed population.
Based on national prevalence rates, about 46,000 Delawareans struggle with the illness.
We asked Dr. Alan Schwartz, director of psychology for Christiana Care Health System, and Jim Lafferty, executive director of the Mental Health Association in Delaware, about depression – what people need to know about its causes and treatments.
What is depression?
Depression is a mental illness that is characterized by significant changes in mood and emotion. It's much more than just "the blues." The persistent low feelings do not go away and can dramatically affect a person's daily life.
What causes depression?
Depression often is two-fold. There is a strong genetic influence, Schwartz said. Entire families can struggle with the disease. But, depression is also caused by psycho-social stressors, like the death of a loved one or being let go from a job. Recently, there has been research that suggests some medical conditions like Parkinson's disease, can also trigger depression. Schwartz said that medical conditions that cause changes in brain chemistry and function can contribute to depression and other mood problems.
What are signs of trouble that should concern someone who has depression, or someone who is around that person?
A tell-tale sign of depression is a lack of interest in things that once brought you pleasure. Lafferty, who struggles with bouts of depression, said that during his last major depressive episode he had no interest in fishing. And he loves fishing. He recalls many days where he planned to go out on the water, but instead he just stared at his boat, shook his head and went back inside his home, rattled with extreme tiredness.
"It was that loss of interest more so than sadness," Lafferty said of his depressive episode.
Lack of energy is also a tip-off, as well as changes in appetite, problems sleeping and withdrawn behavior.
Schwartz said, however, that the most overwhelming signs are persistent thoughts of death or dying – a feeling of hopelessness. It's possible the feeling can escalate to extreme measures. He said that in severe depressive cases, men are four times as likely to commit suicide although women are three times more likely to try. If these symptoms persist for over two weeks, it's recommended the individual seek help and guidance.
Are there different levels of depression?
According to Schwartz, the short answer is no. There are not levels of depression analogous to, say, the five stages of grief. However, Schwartz said, depression can be classified from moderate to severe depending upon the symptoms.
"There are folks that come to see us (at Christiana Care) that are struggling with depression, but they are still able to sleep, eat. There are also people where those symptoms and moods are more significant," Schwartz said.
Everyone has blue days, down days, added Lafferty, even those who are in treatment for depression. But it's not a cause for alarm, the important thing is to gauge how you feel tomorrow, he said.
Can depression be cured?
No.
How is depression treated?
Depression can be treated in a variety of ways. Psychotherapy, known as "talk" therapy, is extremely common. This broad therapy involves meeting with a health professional to discuss any changes in mood or feeling as well as ways to manage depression. It has many structured subsets.
Cognitive behavioral therapy is one of them; this type of therapy encompasses multiple, structured talk therapy sessions in which a psychiatrist or psychologist can isolate the basis of anxiety and depression with targeted questions.
Schwartz said that mental health professionals also pursue interpersonal therapy, another subset of psychotherapy, as a way to help clients rebuild relationships in their lives. The therapy helps individuals cope with past and present difficulties in relationships.
Schwartz said psychotherapy with antidepressant medication is the most effective combination to treat depression.
Medication will help to reduce symptoms' severity so that a person can begin open up about his personal history and emotions, Lafferty said.
There are a few less well-known treatments that have proven to be effective, Schwartz said. One in particular is called transcranial magnetic stimulation therapy, which acts as a substitute for drug treatments. Schwartz calls it a "therapeutic MRI." A machine called the NeuroStar sends magnetic pulse to the brain to stimulate serotonin and dopamine. Patients normally will undergo treatment five days a week for one month.
Schwartz also recommends individuals living with depression incorporate healthy eating and exercise.
"The stuff you put in your body does affect how you feel," he said.
If a person has depression, can it change and get worse or better over a lifetime?
Depression can change over time, depending on how an individual treats the disease and which stressors resurface.
"Unfortunately depression can recur and does recur in people, similar to other chronic conditions, like heart disease, hypertension," Schwartz said. "It's usually something people have in some way for most of their lives."
Consistently working with mental health professionals can help prevent future episodes when psychological stressors appear, he said.
Lafferty said he has had four serious depression reoccurrences.
"The last was 12, 15 years ago; it was the worst," he said.
Sadly, he said, there is still a stigma tied to the disease which makes people hesitant to get help.
"Depression is an illness. It is a disease, not a character failing, not a moral failing. And there are places to go in Delaware for treatment."
Who is most likely to be depressed? Men or women? Young or old? Certain jobs or ethnic groups?
It's unfortunate that the tragedy of Williams' death has ignited the discussion of depression, Schwartz said.
The criteria is the same for adolescents and adults, he said.
However, according to the National Instititute of Mental Health, depression can affect people in different ways. For instance, older adults might have certain medical conditions that might cause or contribute to depression, as in Robin Williams' case with Parkinson's disease. In women specifically, certain biological or hormone factors can trigger the disease, especially just after giving birth.
Even with those differences, depression is a disease that can affect anyone, at any time.
"Depression is an illness that doesn't discriminate. Rich, poor, there's no racial guidelines or discriminations there," he said.
Jen Rini can be reached at (302) 324-2386 or jrini@delawareonline.com. Follow @JenRini on Twitter.
UPDATE: The original version of this story gave an incorrect number of Americans with depression. It has been corrected to better reflect the CDC findings.
WHERE TO GO FOR HELP
Mental Health Association in Delaware: (302) 654-6833 or (800) 287-6423; Crisis Services Adult Crisis Intervention Service, (800) 652-2929; Crisis Intervention Service (Kent and Sussex counties) (800) 345-6785; Children & Adolescents Crisis Intervention, (800) 969-4357
Christiana Care Center for Comprehensive Behavioral Health: (302) 428-2100
National Alliance on Mental Illness Delaware: (302) 427-0787; NAMI Delaware HelpLine, (888) 427-2643; Mobile crisis intervention, (800) 652-2929 or (302) 577-2484
Child Priority Response: (800) 969-4357; telephone listening, crisis helpline, rape crisis services, reassurance program, (302) 761-9100 or (800) 262-9800