1) What is depression? It is a mysterious illness affecting the entire mind and body, causing a person to feel miserable in many ways.

2)    What causes depression? We used to think it was due exclusively to something unhappy in a person’s life, or to some psychiatric problem. While this can happen, we now know that this is a disease that happens to many people who have no reason to be depressed and who had no "psychiatric" problems before they got depressed. This is a disease often affecting normal and healthy people. There can be a strong genetic component. 40% of those suffering from depression will recover and stay recovered. 40% get a second bout. 20% get recurrent depressions their entire life. For some reason the brain chemistry gets altered.

We deal with stress by "coping" mechanisms. Most people have sufficient coping skills to deal with most of their life’s problems. Sometimes, however, life’s stresses overwhelm one’s coping abilities and this can cause depression. For many people effective coping skills are never learned and life seems difficult virtually all the time. Having ineffective coping skills does not mean that a person has "psychiatric" problems, and this can happen to normal people.

3)    Does having a depression mean that a person is going crazy? No, but it will very often make him think that he is.

4)    Is it a common illness? Yes, it is one of the most common illnesses seen in medicine. However, it is often confused with other illnesses. Many people are told they have chronic fatigue, vitamin deficiencies, immune problems, yeast infections, food allergies, sinus headaches, nervous exhaustion, low blood sugar (hypoglycemia), fibromyalgia, "low blood," menopause, "the change," or a nervous breakdown - when they actually have depression causing their troubles.

5)    What trouble does a person have who has a depression? A person suffering from depression will usually feel most of the following things: (feel free to substitute "she" for "he")

A)    He will feel very tired all the time, even when he has not even worked or exerted himself very much. He will be just as tired on days when he has rested as on days where he has worked hard.

B)    His sleep will usually be off in one or two ways: He will either go to sleep and then wake back up during the night and remain awake, or else he will sleep too much all the time - even during the day.

C)    He will feel very irritable. He will get upset very easily over little things that ordinarily would not upset him.

D)    He will often feel very sad for no reason, and in fact may break into tears without knowing why. Sometimes he might feel like he needs to cry, but can’t.

E)    His sex drive will be decreased or completely gone.

F)    He will suffer from aches and pains. Headaches are the most common - usually feeling like a band around the head and running down the neck, but it can hurt anywhere. These pains are very real and often severe - they are not imaginary.

G)    He will find it difficult to enjoy things. He will feel little enthusiasm, even for things he used to look forward to. He will often feel at his worst on his "off" day, when has leisure time on his hands.

H)    He will often be constipated, or have other digestive symptoms such as abdominal pain or diarrhea. He may lose considerable weight, or may gain weight from overeating in a desperate attempt to feel better.

I)    He will find it difficult to concentrate, to make decisions, to get things done.

J)    He will often feel like he is a very worthless or sinful person. He will feel guilty and unwanted, even though he knows he has no reason to feel that way. Worst of all, in a very severe depression, he will actually not feel like living at all. Almost all depression victims at least have thoughts of suicide, even if they would never actually do it.

6)    Is this a serious illness? It varies. In a mild depression the person will often think he just has a virus, overstressed, or that he is getting a little older. However, in a very severe depression it can be quite serious. This is a disease than can cause a very healthy and happy person to decide to kill himself!!! It also can be as impairing as end stage heart disease.

7)    Does depression do other things? Yes, it can. Depression seems to impair the immune system. Depressed people are sick more often, sometimes more severely as well. It also worsens heart disease.

8)    How are children and senior citizens affected? While they can have many of these symptoms, children usually show severe anger and hostility when depressed. Seniors are often told they are suffering from senility or Alzheimer’s - when depression was the actual problem. Most seniors suffering from dementia, senility and Alzheimer’s Disease have depression as well - which can be safely and effectively treated..

9)    Can a person do anything to fight this disease? Not much. This is a disease over which a person has very little control. While "trying to fight it myself" can help, treatment is almost always required.

10)    Is this disease due to things like "stuffing your feelings," "turning your anger against yourself," or "childhood trauma?" Who knows how much of these things contribute to a depletion of brain chemicals. It doesn’t really matter because that’s all in the past. While your past is important, it is of minimal importance when compared to the present and your future. For example: it doesn’t matter how you break your leg - what matters is how you fix it, how you rehabilitate it, and how you try to prevent breaking it in the future.

11)    Is there effective treatment available? Very much so. There are many medicines that are very effective. They are also quite safe compared to most medicines. Untoward reactions are very rare. Unfortunately it usually takes 1-4 weeks for them to work, and occasionally a different medicine is needed to cure the problem. Counseling alone usually takes even longer, and is most effective when combined with medicine - particularly after the depression has started to lift.

12)    Are they tranquilizers, pep pills, sleeping pills, hormone pills, sex pills, or nerve pills? No, none of these. They are called "antidepressants." Antidepressant medication will not change your life or your problems. They will stop your depressive symptoms so that you can deal with life more effectively and overcome your problems without the burden of feeling depressed.

13)    Are they addicting? Absolutely not. A person cannot become addicted even though he takes theses medications for months or years. Sometimes you must get off the medicine slowly to prevent adverse effects, but no addiction occurs as is seen with nicotine, narcotics, tranquilizers, amphetamines and other addicting drugs.

14)    Do they have undesirable side effects? The older antidepressants caused drowsiness, constipation, dry mouth, blurred vision and difficulty urinating. The new ones don’t - some can cause drowsiness, but the more common side effects include nausea, insomnia and shaking which can usually be minimized or stopped by lowering the dose for a while.

15)    Are these not the same as the "pep pills" or "uppers" that I hear about? Absolutely not. Pep pills give anybody a sudden boost of energy, whether they are depressed or not. They are all dangerous and physicians rarely use them. Sometimes safer stimulants are used for a very short time (especially in the elderly) to help move the depression along - but this is not common. Antidepression pills on the other hand will do nothing to a person without depression, but will greatly help a person who has a depression. They are among the safest pills in medicine - much safer than medicines like aspirin and penicillin.

16)    How long will I have to take them? Usually for at least 4 months. Sometimes as long as a year, and sometimes for life if recurrent depressions are a problem. The medication is much safer than the illness - they can be taken safely for as long as needed.

17)    You say that this disease happens to a person without anything in his personal life causing it? In many cases this is so. However, many people will have things in their personal life that are bothering them a great deal, and if they happen to get a depression while these things are bothering them, then everything is much worse. For example, if they are having difficulty with their marriage or their job and are unfortunate enough to get a depression also, then the difficulties with the marriage or job will get much worse!

18)    What other types of depression are there? Sometimes depressions occur during the short daylight winter months - and can be treated by using bright lights for many hours during the day - especially in the morning (it’s called "seasonal affective disorder"). Sometimes depression is part of the bipolar illness (formerly known as manic depression) - and this is not discovered until the depression is treated and the person’s mood swings too far the other way. Rarely depression is associated with losing touch with reality ("psychotic depression") - this too is treatable with medication.

19)    I have heard of "electric shock" treatment - is this used in depression? Yes, but only for the most severe depressions where suicide is a great danger. It can cause memory loss, and is reserved for special cases, but sometimes it’s the only thing that works - and it usually works very well. Most depressions respond to medicines and don’t need electric shock treatment.

20)    Is this disease catching? Not really, but it is such a common disease that it sometimes appears as though it is. For example, it is common for a man and his wife to both have depression at the same time. Being around a person suffering from depression can be depressing and stressful.

21)    What should I tell my spouse about all of this? I STRONGLY RECOMMEND THAT YOUR SPOUSE READ THIS NEWSLETTER TOO!!! A person with depression will almost always find that his spouse is very much affected by the way he feels. Very often your husband or wife will not realize that your symptoms are due to a disease, and think that you simply do not love them anymore! They will often think the fault is somehow theirs. It is very important that they know that this is simply an illness, just as pneumonia or diabetes is an illness, and that neither you nor they are responsible for it. I would also welcome your spouse to come back with you on your return visit and get more information. Even though they do not really cause your depression, it is still a great help to have your loved ones understand what is happening, why you need medication, etc.

22)    Will I need counseling? Sometimes new coping skills and ways of "looking at things" need to be learned. Occasionally a depression is severe enough to require consultation with a psychiatrist or even a stay in a psychiatric hospital. Most of the time antidepressant medication alone will solve the depression, and you can get on with solving your own problems.

23)    Will there be lasting effects from the depression even if I don’t get depressed again? Yes, but you can do something about it. It takes about 3 weeks to develop a habit - especially thinking habits. After suffering from a depression for 3 or more weeks you start to think like a depressed person - and you have to learn to think properly again or you will never totally recover from your depression episode. I will be happy to recommend some books, tapes and affirmations that can bring you back to what you were before or better. This is an illness that can actually result in a better life if it inspires you to learn how to be the happiest and best person you can become - but it does take some effort.

24)    How will it affect my children, or what should I do when my child’s depression is better? If you have minor children who are depressed or have experienced your depression , you will need to develop a new relationship with them. We live in a very negative society that complicates the process. I highly recommend the book and tape series by Zig Ziglar: "Raising Positive Kids in a Negative World" - they are available at 1-800-527-0306.

25)    Will I need to visit the doctor a lot? Some follow-up visits will be relatively frequent until the depression is over - particularly if suicidal feelings are strong. Once the depression lifts and you continue to take the medicine properly you won’t need to be seen so often.

26)    What else should I know about antidepressant medication? This medication must be taken regularly, not just when you feel like it - don’t stop the medicine because you feel better and think you no longer need it!!! Most of the good effects of this medication will not show themselves for a few weeks - although some patients feel better sooner and some take longer. You cannot get hooked on these medicines - they are not "dope." With most of the newer antidepressants you will be able to drive and work normally. The safety of these medications lies in the fact that you cannot hide from troublesome life situations with them - they will not make you feel better unless you are depressed or need them for some other medical problem.

October 22, 1999