Depression can hit with the force of a tornado, tearing down lives and wrecking stability, but treatment is effective in four out of five cases.
It’s almost as prevalent these days as the common cold. Nearly everyone claims to have suffered it at some point in life. Children as young as 2 may develop it, as may mothers with newborns or men in the midst of life.
You guessed it: I’m talking about depression, the No. 1 mental health problem in America.
At any one time, more than 10 percent of the population is being treated for some form of depression. That means about 22 million people are spending millions of hours on therapists’ couches and popping millions of antidepressants daily. Little wonder that Elizabeth Wurtzel—beautiful, clever and for many years depressed—titled her best-selling treatment memoir Prozac Nation.
Conditional vs. organic
The chief distinction physicians like to draw is between exogenous and endogenous depression. The first kind has external and contingent causes that people can easily relate to, such as the death of a parent, divorce, job loss or a stillborn childbirth.
People who’ve always rocketed through life, taking problems in stride, are particularly vulnerable. A traumatic event may well trigger their depression because it’s probably the first time they’ve faced a situation in which they are unable to cope. They can become overwhelmed by feelings of loss, grief and disappointment and not know where to turn.
In such instances, depression can hit with the force of a tornado, tearing down lives and wrecking stability. In its wake, people simply lose their taste for life, their capacity for joy and their hope.
Endogenous depression is by contrast chemical in origin. It’s harder to diagnose, especially in children and adolescents. And, unlike exogenous depression, it’s often a lifelong condition. Its symptoms are much the same as depression brought on by trauma, and they include sudden and violent mood swings, fatigue, loss of appetite, low self-esteem, a tendency to withdraw from social activity and insomnia.
Given the incapacitating effects of depression, it’s hardly surprising that depressives often look to death to release them from their misery: Suicide attempts are sadly all too common.
“The good news is that with treatment, nearly 80 percent of people with depression show an improvement in their symptoms within four to six weeks of beginning medication, psychotherapy, attending support groups or a combination.”
The causes of endogenous depression are still hotly disputed among research scientists. Some argue that hormones are to blame, and clear links certainly exist between the onset of depression in teenagers and the start of puberty, and between depression and menopause.
Other researchers argue that genetic factors are prevalent. To back this up, they cite the way depressive disorders tend to run in families. But the possibility also exists that a depressed child can learn depressed behavior from a parent.
Finally, there’s the school that cites neurochemical causes, or at least correlations. Time and again researchers have discovered patterns between depression and low levels of seratonin, which is why drugs like Prozac, which restores seratonin to normal levels, have generally been so effective.
With such wonder drugs in general use, it’s easy to forget that not so long ago, people were routinely institutionalized for depression. Think of the terrible electric shock therapy that Sylvia Plath described in The Bell Jar. Or the miserable listlessness that novelist Jenni Diski documented in Nothing Natural, where she revisited the gray-walled hospital she was incarcerated in during the early ’70s. It’s enough to make anybody depressed.
Last reviewed: By John M. Grohol, Psy.D. on 9 Feb 2006
