In this SERIES of monthly COLUMNS Dr. Stephen will help you:
• Find out more about your depressed mood
• Name that tune: A description of depressive and mood disorders
• Change your depressed mood through action
• Decide if you need medication

COLUMN ONE: FIND OUT MORE ABOUT YOUR DEPRESSED MOOD
Question: Why did the chicken cross the road?
Answer: To prove to the possum that it could be done.

Didn\’t laugh? Two options.

One, you are a dyed-in-the-feathers animal lover and find no humor in
chickens or possums, nor in any irreverent combination of the two.

Two, you\’re depressed.

Now I know this isn\’t a scientific method of diagnosing depression, but
it\’s a place to start. When you are depressed, life ceases to be
funny…or fun, or interesting, or even worth living.

Your life might not have been super to start with, but when you are
depressed, you find yourself bumped down a few notches, even from the
mediocre existence to which you\’ve become accustomed. Your family and
friends make unwelcome comments. “My, Naomi, you\’re looking tired.”
“Gee, Nancy, we don\’t see you much any more.”

Low energy and social isolation—two clear indications that depression
may be lurking about on the fringes of your life and aiming for your
very soul.

Statistics have rarely made anyone\’s life better but they do tell the tale.
• Depression is a common
emotional disorder affecting about 7% (13-14 million people) in any
given year.
• Only 20% of those who experience depression will receive an appropriate treatment plan.
• 16% of all adults will experience depression.
• 97% of those suffering from
depression say their work, home life, and relationships are negatively
affected

Women of all ages suffer from depression in staggering numbers.
• Depression is the leading cause of disability in women.
• Depression in women usually occurs between the ages of 25 and 44.
• 7 million women in the United States are clinically depressed.
• 1 in 5 women will develop clinical depression over the course of her life.
• Only 1/3 of depressed women will seek professional help.
• About 10% of women will experience postpartum depression after childbirth.
• Women are twice as likely as men to develop depression.

So what are women doing about their depression?
A few manage to break down in tears when they see their doctor to
have a mole removed. They walk away with a prescription for Prozac or
Paxil and a referral to a mental health provider. A few blaze their own
trail to a local mental health clinic or private counselor.

The rest…and you may be among them…are suffering in silence. You wake
in the morning with a sense of impending doom. You slog through the
day, drop dead tired. Dishes pile up in the sink. Reports stack up on
your desk. You can\’t think your way out of a paper bag. Your eyeballs
are doing an imitation of Niagara Falls. Sleep comes and goes—two hours
later. You stare at the ceiling from two to four o\’clock in the morning
worrying about all the things you don\’t have the energy to do.

You\’ve become a cross between a banana slug and a snapping turtle—slow
moving but ready to take off the head of the nearest bystander. The
urge to run away has become overwhelming—even worse than when you were
sixteen and wanted to run off and marry Billy Thompson.

Most frightening, thoughts about driving into the nearest bridge abutment no longer frighten you.

You are even having difficulty reading this column. Your concentration
is shot. You can see the words but even on the fifth try; you can\’t
make sense of them.

TIP: Get up from the computer RIGHT NOW and go take a ten-minute walk.

Don\’t feel up to it? Of course, you don\’t. You\’re depressed! But give
yourself a fighting chance to absorb the information you need.

* * * TAKE THAT TEN MINUTE WALK * * *

WELCOME BACK. At this point, you could drag yourself off to your doctor
for an official diagnosis—couldn\’t hurt. But you probably don\’t have
the energy to stay on hold with your HMO\’s call center to make the
appointment. So read through the following checklist and see if it all
adds up. I know you\’ve completed checklists for depression before—in
the newspaper on National Depression Screening Day, in your favorite
woman\’s magazine, on the Internet—but I think descriptive behavioral
examples might make it easier for you to decide if the shoe fits.

CHECKLIST FOR DEPRESSION:
√ IRRITABILITY
Irritability may seem to you an odd place to start in determining
if you are depressed. But snapping at your husband, yelling at your
children, insulting your boss, going off on your best friend—all of
these can be signs of the increased irritability that signals
depression. Your frustration tolerance is at a very low ebb. When your
anger emerges, you feel and act like a three-year-old throwing a
tantrum. Irritability feels physical—your skin crawls, your muscles
twitch. For some women, irritability feels like too much caffeine
without the lift or being shrink-wrapped too tight. For others, only
feedback from loved ones tells them that they are on the edge or over
the brink more frequently.

√ TIREDNESS
Feeling drop-dead tired regardless of the amount of sleep you get
has a fancy name, anergia, which means the absence of energy. Note that
I said absence of energy, not reduced energy. It\’s gone, honey! You
feel your have to force your body to perform every action, to think
every thought. The nerve pathways from your brain to your arms and
legs, to your fingers and toes, even to your sex organs are filled with
sludge. The couch and you are on intimate terms—you can\’t tear yourself
away from its voluptuous cushions. Your nickname is slo-mo. Motion,
activity, walk, jump—all have been banished from your vocabulary.

Note: Even when tired, you can feel restless or agitated at the same
time. When you have an agitated depression, you can\’t sit down, you
can\’t rest, but you can\’t accomplish anything because the agitation
interferes.

√ SLEEP INTERRUPTION
You can fall asleep, although there are exceptions to this rule
when anxiety is mixed in, but you can\’t stay asleep. You typically wake
every hour or two and have difficulty falling back to sleep. What sleep
you do get is restless and agitated. This is called mid-insomnia.
Sometimes you wake early in the morning, at three or four am, and can\’t
get back to sleep at all. This is called terminal insomnia. Your total
hours of sleep decreases. You try over-the-counter products to little
avail. You\’ve turned to a glass of wine or two at bedtime but the sleep
disruption has only become worse. The bags under your eyes are drooping
to your chin.

Note: You may experience just the opposite—that you are sleeping
constantly, night and day. Over sleeping or hypersomnia occurs less
often than insomnia but is also a sign of depression.

√ TEARFULNESS
You find that you\’re not only crying about something, you\’re
crying about nothing. You feel on the verge of tears constantly. Tears
well out of your eyes and drip off your chin with the least
provocation. You find yourself sentimental, crying during the Hallmark
commercials. You begin avoiding friends and family, and especially
strangers, for fear of breaking into tears in their presence. Even if
the floodgates haven\’t opened yet, you feel as though a tidal wave of
tears is rising up behind your eyeballs. Once you start crying, you
find it difficult to stop. Whimpering turns to sobbing, which turns to
hysteria until you can\’t get your breath.

Note: Crying to this extent is common and normal in the early stages
and often sporadically in the later stages of bereavement. When you\’ve
suffered a significant loss have symptoms similar to those presented in
this checklist that persist longer than expected, you probably need the
help of a mental health professional to gauge whether you\’ve crossed
the line into depression.

√ IMPAIRED CONCENTRATION
Your ability to think clearly and remember most everything
becomes severely impaired when you are suffering from depression. You
find it difficult to make even the simplest decision. You don\’t go out
because you couldn\’t decide whether to wear the pink underwear or the
blue and, therefore, are still in your jammies. You walk from room to
room wondering where you left your brain. Your thought train runs off
track mid sentence. Your spouse is becoming more annoyed, and doesn\’t
mind telling you about it, because you\’ve forgotten to pick up his blue
suit at the cleaners for the third day in a row. Now, don\’t get me
wrong, if you\’re trying to take better care of yourself by NOT picking
up his suit, you go girl. But if the memory slips are mounting and it\’s
bothering you, it may be depression.

√ WORTHLESSNESS
Even if you have never had sterling self-esteem, when depression
hits, any kind thought about yourself evaporates. You feel quite
helpless, as if you had never learned a thing about how to care for
yourself or others. The future looks bleak; there is no hope on the
horizon. It feels as if your current mood is permanent. You brush off
suggestions for change as easily as a horse flicks flies off his
hindquarters with a sweep of his tail. It\’s as though a whale has
swallowed you up and is not about to spew you back on land. You nay-say
every compliment. Even with the kind ministrations of family and
friends, you feel unloved and unimportant. What\’s worse, you have no
recollection of past accomplishments and the love you\’ve given to
others. Bright moments seem to belong to the rest of world, not to you.

Note: You can certainly experience low self-esteem without being
depressed. This type of poor self-image may have been with you most of
your life. With depression, feelings of worthlessness come on quite
suddenly and are at odds with how you\’ve felt about yourself in the
past.

√ APPETITE AND AROUSAL CHANGES
This is the one time in life when you lose weight without even
trying. Unfortunately, you lose your sex drive or libido at the same
time—so it\’s hardly worth it. Your robust appetite has flown the coop.
You forget to eat for the entire day. As you stand in front of open
cupboards or the refrigerator, nothing looks appealing. Occasionally a
morsel of chocolate finds its way into your mouth, offering a temporary
taste treat. Your favorite meal gets shoved around on your plate and
scraped into the disposal. Along with your physical appetite, your
sexual appetite suffers a similar decline. Arousal becomes a thing of
the past. Your husband (who doesn\’t understand depression and has
problems of his own) suspects you of having an affair.

Note: Compulsive overeating, especially of sweet or fatty comfort
foods, is often paired with lack of appetite and the result is weight
gain instead of loss.

√ LOSS OF JOY AND MOTIVATION
The fancy word to describe loss of joy and motivation is
anhedonia—the absence of pleasure. Activities that you absolutely loved
have acquired a lackluster hue. The world has become, not blue, but
gray. You don\’t FEEL like doing anything. That golf game you loved, the
antiquing that had become an obsession, sitting down with a good
mystery—all have fallen by the wayside. Not even your closest friend
can talk you into high tea at that darling new English tearoom. Weeds
are strangling the roses, green slime is creeping out of the vegetable
bins in the refrigerator, and Fred\’s suit is still at the cleaners. You
want to care, but you don\’t.

√ DEPRESSED MOOD
You may find it odd that depressed mood itself is near the end of
the list. Frequently, the above symptoms are so severe that you don\’t
even recognize that you are in a blue mood. Depression often feels more
physical than psychological. That is why a majority of cases of
depression are diagnosed and treated by family doctors, not by mental
health professionals.

√ SUICIDAL THOUGHTS AND PLANS
You are not alone if at some point in your life, you\’ve had the
thought that things would be better if you weren\’t here anymore. It was
probably a fleeting thought—hoping you wouldn\’t wake up in the morning,
thinking it would be okay if God took you now, wondering if getting
accidentally hit by a truck wouldn\’t be so bad. These are passive
suicidal thoughts with no specific plan or current intention to harm
yourself. You can talk yourself down. You know you couldn\’t do this to
your children or spouse or other family members. You have a strong
spiritual conviction that suicide is not an option. Or, you simply know
that you\’re too chicken to do anything to harm yourself.

Suicidal thoughts are almost a sure sign that you are suffering from
depression. When your depression is treated properly, these thoughts
will subside or disappear.

CAUTION: When suicidal thoughts become persistent, especially when they
become tied to a plan and you begin acting on the plan by:
• Collecting pills to take later
• Holding handfuls of pills
• Taking the razor blade out of the razor
• Making a noose
• Checking out bridges
• Trying to veer your car off the road
• Purchasing a weapon
• Loading a weapon already in your possession
• Rummaging through your cleaning supply closet in search for poisons

OR…

When you tell yourself:
• The children will survive without me
• God will understand if I take my life
• My family is better off without me
• I can\’t bear the pain another second

YOU NEED TO SEEK IMMEDIATE HELP. GO DIRECTLY to a family member, a friend, your physician, your pastor, or the nearest hospital emergency room and TELL THEM YOU NEED HELP. Don\’t have the energy to do even that? Call 911 or one of these numbers:

1-800-SUICIDE or 1-800-784-2433
1-800-273-TALK or 1-800-273-8255
For a Suicide Hotline in your state: www.suicidehotlines.com

Suicide is a permanent and tragic solution to a temporary
problem—even though your depression feels far from temporary right now.
Your depression is treatable—GET HELP.