Symptoms of Depression

Fatigue. Insomnia. Loss of appetite. Aches and pains. Patients who come to my office with these symptoms usually assume they're suffering from an ailment that's simply physical.
 
Often they're right. But some are surprised when I explain that what may really be ailing them is depression. Even in good times, there are an average of 16 million new cases of depression in the U.S. every year. Yet many of those people--more than a third, according to a recent report by the Substance Abuse and Mental Health Services Administration--never receive treatment, even though nowadays there are more ways than ever to get relief.
 
One reason is simple confusion over what the illness feels like. The popular notion that depression means "feeling sad" has a lot of truth to it. Some of the other obvious symptoms are emotional numbness, a sense of worthlessness, hopelessness, even thoughts of suicide. But for many people, the experience is fuzzier--a series of changes affecting them not just emotionally but also physically and mentally. It may be a gradual increase in irritability, a loss of focus, an inability to complete tasks, a desire to spend more time sleeping.
 
Rather than perceiving these changes as symptoms, many people conclude that "this is just the way I am." Says Dr. David Shern, president and CEO of Mental Health America: "They don't realize that what they have might in fact be a treatable condition.
 
That's because the symptoms can develop slowly and be kind of insidious." For someone caught in that trap who thinks, "It's normal to feel this way," asking for help may seem unwarranted or embarrassing--a sign of weakness. "Depression invaded my life in my mid-40s," says Tom Johnson, who was formerly publisher of the Los Angeles Times and CEO of CNN.
 
"It sapped me of my strength, robbed me of my energy, and brought me, inexplicably, to the brink of suicide. Just the act of getting out of bed and into the shower each morning was tough. I was baffled by the sadness, by the loss of self-confidence, by the feeling of being trapped at the bottom of a deep, dark well." Like many others, Johnson did not seek help.
 
He explains, "I felt that going to a psychiatrist would be a sign that I was somehow defective." Stigma is another trap associated with depression. Dr. Carolyn Robinowitz, former president of the American Psychiatric Association, has seen its effects many times. Those experiencing depression often feel pressure to "pull themselves together," "take charge," "suck it up."
 
That pressure, she says, comes from a society where the "moral expectation" is that we should take care of ourselves. What complicates things is that sometimes sadness is not a sign of illness. Certain life events--the death of a loved one, caring for a sick family member, losing a job, going through a divorce--can make you feel awful. It's normal, Dr. Robinowitz says, when faced with life stresses, "to feel sad, to grieve, and to feel what everybody calls 'depressed.'"
 
That sadness can be entirely appropriate and does not necessarily signal mental illness. Clinical depression is a matter of degree, Dr. Robinowitz adds. "There is a continuum." If you can't function at work or at home, if you just feel like plunking down in front of the TV, it may be time to talk to somebody about it. That somebody doesn't have to be a psychiatrist.
 
It can be your family doctor, a trusted friend, or a member of the clergy. Tom Johnson did finally seek help, but only because his wife pushed him to do so. "The psychiatrist immediately recognized what was going on: 'Mr. Johnson,' he said, 'you have chronic depression, and you need to deal with it.'" The good news is that there are many effective treatments. More than 27 million Americans take some form of antidepressant.
 
Most of these work by affecting the brain's levels of serotonin, dopamine, and norepinephrine--chemicals that influence mood. The most popular are SSRIs (selective serotonin reuptake inhibitors), of which Prozac is the best-known example. But there are dozens of drugs available that work in different ways.
 
Talk therapy or counseling also helps. Studies have shown that, for most people, combining medicine and talk works best. For those whose depression is very hard to treat, there are other alternatives, though most are experimental. "I take my antidepressant every morning the way some people take a megavitamin," Johnson says. At 67, he is doing well and wants others to understand that depression is prevalent but treatable.
 
"It just knocks you to the floor," he says. "And getting up is sometimes very hard to do." So don't try it by yourself. Get help if you need it. Experimental Treatments In severe cases of depression that do not respond to medicine or therapy, electricity or magnets may be used to induce changes in the brain.

• Electroconvulsive therapy (ECT). This treatment--in which electric currents are sent to the brain to trigger a small seizure--has changed dramatically since it was first introduced decades ago. ECT has been shown to be more effective than some medication combinations. The major side effect is temporary memory loss.
• Vagus nerve stimulation. Electric currents stimulate the vagus nerve, which is located in the neck, via a generator implanted in the chest. While there have been some positive results, it isn't yet clear whether the treatment works any better than placebos.
• Transcranial magnetic stimulation. Magnets applied to the scalp create electric fields. A recent review found this treatment effective in some patients.
• Deep-brain stimulation. A pacemaker-like device implanted in the chest sends electric currents to electrodes connected to mood centers in the brain. The treatment is highly experimental, though small-scale studies suggest it may be effective.