But when the melancholy fit shall fall Sudden from heaven like a weeping cloud, That fosters the droop-headed flowers all, And hides the green hill in an April shroud…

—John Keats, Ode on Melancholy, 1819

This evocative image painted by Keats reminds us that, in another time, romantic poets found great beauty in the suffering experienced while in the throes of “melancholy,” a state we now refer to as “major depression.”

Today, we have become much more aware of the fact that depression is an illness and occurs at epidemic proportions in the United States and elsewhere. The National Institute of Mental Health estimates that 20 percent of the U.S. population experiences symptoms of depression at any one time. The cost to the country in terms of time lost from work, visits to doctors’ offices with physical complaints that reflect emotional concerns, and the abuse of drugs and alcohol in an attempt to self-medicate is significant.

More important, the cost in human suffering as a result of depression will never be fully tallied. Depression leads to loss of sleep, irritability, the tendency to quarrel, and even divorce and alienated relationships with children. The symptoms have been described as despair, despondency, profound sadness, and hopelessness. There really is nothing romantic or appealing about this illness.

In addition, no one is exempt from the possibility of suffering depression at some point in his or her lifetime. For some, there may be a single experience of depressive symptoms, but for others it can and often does become a chronic problem, with no relief in sight. At worst, the cost of depression can be life itself. Suicide is always a possibility when an individual is in the clutches of depression.

More Than the Blues

The difference between feeling occasionally blue and feeling depressed is enormous. The blues are transitory and pass within a few hours to a few days, while depressed feelings and thoughts persist for weeks, months, or even years at a time.

The depressed person suffers from low self-esteem. He or she feels worthless and hopeless. Other people’s small slights become proof to the sufferer of how he or she is disliked and rejected. Successes are dismissed as accidental, while errors and mistakes become irrefutable confirmation of being a failure.

Relationships Suffer

Depression greatly complicates relationships. The individual both withdraws from others and self-isolates or becomes irritable. The irritability is expressed through an endless number of complaints about minor things. However, the chronic complaining and irritability serves to alienate those closest to the depressed person. The result is further isolation, guilt, and self-hatred. This sets up a vicious cycle in which isolation feeds depression, leading to anger and resulting in further isolation. The depressed person then finds evidence to fuel self-hatred by pointing to the ways in which friends and family avoid or minimize contact.

Another scenario that breeds isolation and loneliness is the apathy and exhaustion felt by individuals with this illness. The sluggishness experienced in depression robs people of the desire to go out and enjoy social events. The tendency is to want to remain at home. At worst, an acutely depressed individual will not get out of bed for most of the day.

The Anger Beneath

The depressed individual has a depleted sense of inner well-being and pride. Consequently, he or she must look to external sources for validation. This makes it difficult for the individual to make decisions; he or she fears the wrong decision might result in disapproval from others.

In an effort to please others and to win love and acceptance, the depression sufferer buries feelings of anger and annoyance. Wearing a mask of good will and gladness, he or she is unaware of how small angers are building and getting ready to erupt in a torrent of rage. Should this happen, the sudden outpouring of rage shocks everyone, including the sufferer.

Coming Forward

It is very difficult for many people to acknowledge the fact that they are feeling depressed. To add to this, medical doctors, employers, and teachers often fail to recognize the symptoms of this problem and, therefore, do not refer people to the mental health system for evaluation and treatment.

The stereotyped view is that depression is a sign of weakness and that seeking help marks one as “crazy.” Consequently, people experience profound feelings of shame associated with this illness, along with a lack of empathy on the part of family and friends. People would rather deny their depression and engage in drinking and drug use than to admit experiencing it and seeking help.

This issue is of particular relevance to men. National statistics indicate that many more women than men suffer from depression. And yet, because men are taught from their earliest years to hide their deeper feelings and to be “tough” and independent, it is probable that depression in men is underdiagnosed and underreported. Acknowledging the need for help of any kind may be experienced as a loss of face. “Masculine” aggression does, however, provide a sad counterpoint when it comes to depression, for while many more women than men attempt suicide during a depressive phase, men tend to choose more lethal means and, therefore, succeed more often in killing themselves.

How Treatment Can Help

It is said that depression is an illness in which people cannot identify what they feel or why they experience what they do feel. In either case, events occur and feelings are pushed out of awareness, or feelings are experienced but the precipitating events are ignored and forgotten. In addition, it is also said that depression is “learned helplessness” because the person is convinced that problems cannot be solved.

Psychotherapy is an effective treatment for depression. It helps individuals identify the reasons for their feelings or what those feelings might be after some precipitating event has occurred. By helping to make this connection between thoughts and feelings, people gain a better sense of understanding and control over their lives. Choices of action become available and the person discovers an entire variety of ways to solve problems.

When feelings are too overwhelming to be helped by psychotherapy alone, antidepressant medication is available. The combination of psychotherapy and medication is extremely effective and makes depression a very treatable illness.

Adapted, with permission, from Dr. Allan N. Schwartz’s Web site, located at: http://www.psychotherapynewyork.com/