The makers of Cymbalta, an antidepressant, have also made commercials. Without saying anything positive or negative about the drug, it must be said that the commercials capture the heart and pain of depression in a way that puts the filmmakers of Cannes and Sundance to shame. View the first twenty seconds or so of this commercial to feel what it is like to have this illness. Their previous ad was even better, but it could not be found online. (Have a link? Post it in a comment!)



What is it like to have depression?

There are people out there with depression. He knows it's something real. He knows it makes them sick. That's not what he has. He is not sick. He is just bad. There is something wrong with him; he is defective; and he tries not to think about it because it hurts, but he knows it is true. He is terrified to admit these feelings because he doesn't want to believe he is bad. But he knows it is true.

I was walking to my therapist appointment. It was fall, and the management at the office building had planted pansies in beds in front of the building. I saw those pansies because I was looking down. I almost never raised my head in those days. And what I felt was guilt, guilt over those pansies -- guilt because I had never planted my garden that summer, that there were weeds there. Oh, what a bad and worthless person I was, because of those pansies. And I had the presence of mind to know that this feeling was utterly irrational and unrealistic. And it didn't matter; I still felt the guilt. Even today I cannot see pansies without remembering that day.

Death becomes your constant companion. The depressed person dies an invisible death a thousand times a day. She knows she will die young; she knows it is inevitable. She feels it. Her mind wanders because depression makes it difficult to concentrate, and it wanders to the manner of her own death. If she is in the car, she know she will die soon in a gruesome accident. If she is walking down the street, she knows she will be murdered in a random killing. If she is at home, she knows she will die alone when a piece of furniture falls on her, and nobody will notice that she is gone until she has been dead for weeks. She is not afraid of it, but she is already grieving it.

My dream was short, because I slept only in short spurts, and woke up four or five times a night. It was a mercy that this dream was short. The bedroom door was closed, and a river of blood began to flow under the door into the bedroom. In the river of blood were the severed heads of babies. Sleep was my refuge from pain, but sometimes it betrayed me.

She knows she is destroying her family. She knows she is causing pain for her husband and devastating her children. She knows they would be better off without her. She knows her suicide is the second worst thing that can happen to them, but the thing that would be worse would be her continued presence. She is held back only by knowing that the life insurance won't pay out for her suicide in the first two years, so she has to wait six more months. Her husband doesn't even realize that she has just six months to live if they don't find a successful treatment.

That is what it is like to have depression.




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No illness, not even AIDS, is subject to more myths and misconceptions than mental illnesses. Here are some common myths about depression and anxiety.

Myth: Depression is a chemical imbalance in the brain.
Fact: Certain neurotransmitters, particularly serotonin, norepinephrine, and dopamine, are thought to play a role in depression. However, depression is more than a chemical imbalance. It has psychological factors as well. Depression may have multiple causes, and biological factors may be more important in some people than in others.

Myth: Depression can be cured by taking an antidepressant.
Fact: Some depressed people respond very well to drug therapy. Some people may respond better to some medications than to others. In terms of numbers, psychotherapy (particularly cognitive-behavioral therapy) is just as effective as medication, and the most effective treatment is a combination of both. However, in some cases, depression is resistant to both types of treatment.

Myth: People who seek psychotherapy are weak, selfish, or stupid.
Fact: Depression and anxiety are real, persistent, chronic illnesses with physical as well as emotional and cognitive symptoms. They are recognized as diseases by professionals worldwide, and they have affected people from the beginning of time. They are found in all cultures, all age groups, and all levels of intelligence. People seeking psychotherapy for depression and/or anxiety are suffering from real illness.

Myth: People with severe depression and/or anxiety aren't really disabled.
Fact: Symptoms of depression and anxiety disorders include difficulty concentrating, insomnia, and extreme fatigue. Depressed people may suffer from a severe lack of motivation that is like being "frozen" or "paralyzed." People with anxiety disorders may experience headaches and/or a racing heart. People with panic disorder and social phobias may not even be able to leave their homes, and people with obsessive-compulsive disorder may lose hours every day to their compulsions. All of these symptoms are disabling, and in fact the Social Security Administration recognizes depression and anxiety disorders as valid causes of disability.

Myth: Post-traumatic stress disorder is a normal reaction to extreme situations such as life-threatening experiences or combat.
Fact: PTSD is a common reaction to these experiences, but not a normal reaction.

Myth: Suicidal talk and suicide attempts are just attention-seeking behavior.
Fact: It is never, ever normal for a person to talk about committing suicide, certainly not just to get attention. All talk about suicide should be taken seriously. Suicidal talk and suicide attmepts are a sign that a person's life is in grave danger. Professional help should always be sought when a person's talk or actions turn to suicide, even if they don't seem serious. Everything about suicide is serious.




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What are the symptoms of depression? How do you know if you have it? The DSM-IV-TR, known as the "Bible" of clinical psychology, defines a major depressive episode as having one or both of the following, lasting at least two weeks:

1. Sad, down, or "empty" mood, lasting almost all day, almost every day (dysphoria)
   
2. Loss of interest in activities you once enjoyed (anhedonia)

Other symptoms may include the following:

1. Changes in appetite (either increased appetite or loss of appetite) and/or sudden changes in weight
   
2. Sleep disturbances, particularly insomnia, early waking, or oversleeping
   
3. Physical symptoms such as digestive trouble, headaches, or backaches that do not respond to conventional medical treatment
   
4. Lack of motivation, which in severe cases may be experienced as "paralysis of the will"
   
5. Difficulty concentrating, remembering, or making decisions
   
6. Psychomotor agitation or retardation -- that is, a "speeding up" or "slowing down" of one's movements, observed by others
   
7. Irritability or restlessness
   
8. Low self-esteem and/or feelings of worthlessness, helplessness, guilt, or hopelessness
   
9. Social withdrawal
   
10. Fatigue, loss of energy, feeling run down or sluggish
    
11. Death or suicidal ideation -- that is, thoughts of one's own death, the death of others, or of taking one's own life
    
12. Suicide attempts

Major depressive disorder is diagnosed when a major depressive episode as described above is experienced without a history of mania or hypomania. If there is a history of mania or hypomania, a bipolar disorder is diagnosed.
Symptoms of mania include the following. Hypomania includes the same symptoms but is less severe than full mania.

1. Racing thoughts or "flight of ideas"
   
2. Extremely decreased need for sleep -- this is different from insomnia in that the person does not even seem to need sleep
   
3. Extremely high, happy, and euphoric mood, or a very intense and active bad (dysphoric) mood, perhaps rageful or anxious
   
4. Abnormally high energy levels
   
5. Grandiosity
   
6. Distractability, impulsiveness, and risk-taking, typically greater than what is seen in attention-deficit hyperactivity disorder (ADHD)
   
7. Pressured speech -- meaning that the person talks very fast as if there is a torrent of words pent up and the dam is bursting. A manic person with pressured speech is several steps of intensity beyond, for example, an auctioneer's calling
   
8. Hypersexuality

Take the Quick Depression Screening Quiz at Psych Central. Remember this is only a screening and cannot diagnose depression or any other illness. If you have a positive screening, it's recommended that you seek appropriate help, preferably from a psychologist or psychiatrist, or failing that, from your general physician.




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Anxiety in small doses is healthy, but it can grow out of control, causing significant suffering and disability. A number of different disorders result from anxiety gone awry.

Generalized Anxiety Disoder (GAD) is exaggerated worry about everything or nothing that is present most of the time. People with GAD worry about health, finances, career, family, etc. -- even when there is no sign of trouble. GAD is out-of-control anxiety that is greater than the normal anxiety that everyone experiences. Its prevalence of about 2.8% in the U.S.

Obsessive-Compulsive Disorder (OCD) disables by stealing time from its victims. It starts with obsessions, or intrusive worries, which can only be mitigated by engaging in compulsions, or rituals that soothe the worries. An obsessive-compulsive person may, for instance, worry that the stove was left on and have to go check it -- over and over again. People suffering from OCD know that their obsessions and compulsions are irrational but are helpless to resist them. Common themes in OCD include a need to check on things, worries about contamination, a need for symmetry or neatness, and a need to count things.

Phobias are extreme, irrational fears that are grossly out of proportion to the thing that is feared. Many phobias involve things that were dangerous in our ancestors' world, such as spiders and snakes. A mentally healthy person may fear snakes, but a phobic person may literally be affected all day by just hearing a conversation about snakes. (Sorry if you are snake-phobic and reading this!) Social phobia, also called social anxiety, is a particularly disabling phobia. Social phobia is far more than shyness; those suffering from it feel they are being constantly watched and judged by others and are petrified of being embarrassed or humiliated, to the point that it interferes with their daily lives. Its prevalence is a whopping 3.7% in the U.S. (that's over 10 million people).

Panic disorder involves recurrent panic attacks that have no apparent cause. In a panic attack, a person may sweat, have a racing heart, have trouble breathing, and may feel out of control. Some people describe panic attacks as feeling like things are "crashing down" on them, or as if they are dying. In fact, a panic attack may be mistaken for a heart attack. Fear of having a panic attack in public may lead to a person becoming homebound, a condition called agoraphobia.

Post-traumatic stress disorder (PTSD) is an abnormal reaction to a life-threatening situation such as a physical or sexual assault, an accident, a disaster, or military combat. It is important to note that the trauma is completely subjective -- PTSD can be triggered by an event that does not appear serious to outsiders, as long as the person experiencing it felt intensely threatened. Symptoms include flashbacks (ranging from dreams to waking hallucinations), hypervigilance, dissociation (a feeling of disembodiment or unreality), sleep trouble, depression and anxiety, feelings of guilt, and irritability. Physical symptoms are common too, such as headaches, digestive problems, chest pain, and immune system problems. Substance abuse is very common in those with untreated PTSD.

Sources and more information

• GAD, OCD, social anxiety, panic disorder, and PTSD (Freedom From Fear)

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This is National Anxiety and Depression Awareness Week, sponsored by Freedom From Fear, an American mental illness advocacy group. All this week, I will be posting about depression.

Facts about depression:

• Depression is an illness that affects one's body, mood, and thinking. It typically has real physical symptoms in addition to emotional and cognitive symptoms.
  
• It is not the same as a "blue mood" and you can't just "snap out of it." It's not an attitude problem, a sign of weakness, or a result of self-absorption.
  
• Women are twice as likely to be affected as men, and the overall prevalence in the United States is about 6-7%. That translates to some 20 million Americans experiencing some form of depression in any given year.
  
• Depression appears in several forms. Major depression is profoundly disabling, with symptoms lasting at least two weeks. Dysthymia is less severe but lasts for years, and may be more resistant to treatment. Bipolar disorders, also called manic-depressive illness, are characterized by fluctuations between depression and extremely high mood (mania and hypomania), and require very different treatment from so-called "unipolar" depressions (major depression and dysthymia).
  
• Depression very frequently occurs along with other illnesses and disorders, ranging from chronic medical conditions such as HIV and diabetes, to substance abuse and other mental health disorders.
  
• Depression can affect people in all age groups, including young children and the elderly.
  
• Up to 15% of depressed people die of the disease via suicide. In addition, people suffering from depression are at higher risk of other medical illnesses.
  
• Depression is one of the most treatable mental disorders. Most people can be helped by either psychotherapy or medication, or a combination of both.

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National Anxiety and Depression Awareness Week falls from May 4-10 in 2008. All next week, I will be posting about these illnesses, including facts, myth-busting, and personal stories. If you would like to share a personal story, e-mail me (check my profile for the e-mail address). You can leave your story anonymously if you like, or you can do a guest post.




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