For those who have never experienced clinical depression, it can be hard to understand. For most people, it is just a depressed mood, something most of us get over in a brief period. With a bad mood, most people can function with a pretty clear mind. It can be painful, but no big deal.
But for about 20 percent of us who have or will experience clinical depression, it's a very big deal. Clinical depression affects the way we think and the way we experience ourselves in the world. It affects relationships and our ability to accurately interpret information.
A young woman I treated years ago said that she felt like a diamond inside a malignant tumor and didn't know if she would live or die.
A recent colleague said he felt as if his brain were oatmeal and that he couldn't think properly.
When I suffered clinical depression, I felt like a frightened, confused child pretending to be a psychologist. And feeling like a sham made the anxiety, depression and shame so much worse.
Steve Newman had his first episode of depression when he was in seventh grade. A good student, he had a precipitous drop in grades and felt lost for much of his youth. Although his IQ was measured in the top 10 percent nationally, he graduated high school in the bottom five percent of his class.
When I spoke with him, he said his poor transcripts reflected the efforts of someone who didn't expect to live more than a few more years. Somehow, his father got him into a local college which is where he first heard the word "depression."
He said his depression felt like climbing a mountain when a storm hits. Any thoughts of going upward were beaten down by cold rain and wind. Going down was also impossible because of the same elements. He said his goal in life was just hanging on.
A colleague once told me that depression is experienced from the outside in, that people on the outside can see it before the depressed person knows it.
Such was the case with Steve. That was true for me too.
Mine started several years after I became a quadriplegic as I felt my wife pulling away. My mind began to race and I worried all the time. I felt increasingly insecure and said almost nothing in meetings, fearful that what was occurring inside would become visible on the outside.
But I didn't even know I was depressed until one of my nurses told me that I looked as if I had the weight of the world on my shoulders. Once I realized that what was going on inside my head was visible on the outside, I knew I was depressed and sought treatment.
Depression can affect a litany of things from sleeping and eating patterns to concentration and memory. It can induce guilt and a feeling of worthlessness.
And although only a small minority of those with depression attempt suicide, it's not unusual to think about wanting to die. I recall thinking that life was just too difficult and painful to go on. I didn't want to die, but my suffering was unbearable.
There are many types of depression. The causes, too, are varied, but most have a genetic link. I had a mild predisposition as there was dysthymia, a low grade form of depression, in my family. Steve had bipolar disorder in his family.
Most people with depression get better with treatment. And gold standard care for depression is a combination of medication and psychotherapy.
Prognosis is tied directly to the duration and frequency of episodes. That's because depression has a powerful negative effect on the brain and the longer it lasts, the more likely one is to have a second episode. And once that happens, patients are at far higher risk for even more episodes.
My depression diminished significantly with medication and psychotherapy. And when I see the first sign of depression, I'm on the telephone with my psychopharmacologist.
Steve has not been so lucky. He has what is called a drug resistant depression and although he has tried almost all medication and several kinds of psychotherapy, he still suffered.
In 2005 he heard about the Transcranial-Magnetic Stimulation program run by John P. O'Reardon at the University of Pennsylvania. This program has recently been approved by the FDA and uses magnets strategically placed near one's scalp to diminish depressive symptoms.
It's another promising treatment for an illness we're all still struggling to understand.