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.

Dan's guest for this chat will be Kim Fendrick. She is a clinical social worker in private practice in Haddonfield and she is a Holocaust survivor.  During the seizure in Poland, she and her family spent many months in the darkness of a secret basement under the barn of a courageous farmer in Poland.

For part two of our chat on relationships between parents and adult children Dan will be joined by Jane Isay, author of“Walking on Eggshells: Navigating the delicate relationship between adult children and parents”.

Isay traveled the country interviewing adult children and their parents.  She found that adult children want the same things younger children do; they want their strengths acknowledged, they want to know that you are proud of them and that your love for them is unyielding. And there is two things our adult children don't want.  They don't want our guilt and they don't want to hear our lectures anymore.

Poll: Are you struggling with your relationship with an adult child? (52 votes)

Dear Dr. Dan, 

I just have to say I have struggled with my own relationship with our only daughter who is married, independent and happy. But after feeling invisible and no longer needed we began to really clash and I sensed a distance I never expected to have with her.  After having a few days together this past summer it exploded with tears of frustration and sadness with me. I also felt a lack of respect and consideration while spending time together.  I was missing the friendship we once had and wondered "what happened"?   There was even a smugness and just disregard that I was even present. It hurt and pissed me off.We did finally sit down and I was able to share all of this with my daughter, things have changed for the better and I think because we really honestly made each other aware and expressed what we were feeling made the difference.  She's married,  and like it or not, our son-in-law has her attention,evolving mother 

Dear evolving mother,

this stuff used to be so easy, didn't it?  they wear the children and we were the parents.  We've made the rules and they listened or not.  And we reprimanded or punished or nagged, but whatever we did, we were still the parents.  But there is a certain subtle point in these relationships where those two dimensional rules no longer work.  Children become adults and we become more than parents, we become people.  We get into difficulties when one or both parties clutch throws old roles.  Parents continue the old-style of lecturing and children continue to, well, act as children.Complicating things are different styles of parenting.  Most boomers were raised in the "children should be seen and not heard" family-style.  We raise our children quite differently.  Our relationships with our children were more intimate and involved.  So don't we have a right to expect that going forward? Not so fast.  Our adult children are adults.  And have their own values, expectations and loyalties that may or may not conform to yours.When my grandson Sam was a infant, my daughter Debbie put him on my lap while she went to do something in the other room.  He started to squirm and slid off my lap and onto the floor.  He wasn't hurt, but he was pretty startled and screamed.  This was the first time anything like this had happened, so to became racing into the room scooped him up and walked away leaving me alone feeling guilty and helpless.  What she did was appropriate and understandable.  But I didn't know if she was angry at me or even if she would ever let me hold him again.  Of course, my thoughts are not rational, but it was then that I fully realized the lines of authority in our relationship had just shifted radically.I can almost picture you nodding your head as you read this story has this is exactly what has happened to you.  In this case, your daughter was making a statement that she is an adult now and your feelings, although important, are not the only feelings she cares about.  Of course that is hurtful to you.  And behind that hurt, there is a sense of loss that many of us feel.  But trust me, this new relationship can be wonderful if both generations release their grasp on the old one.

Jane Isay, author of“Walking on Eggshells: Navigating the delicate relationship between adult children and parents”, traveled the country interviewing adult children and their parents.  She found that adult children want the same things younger children do; they want their strengths acknowledged, they want to know that you are proud of them and that your love for them is unyielding.  And there is two things our adult children don't want.  They don't want our guilt and they certainly don't want to hear our lectures anymore.

Q: Our first child, Allison was born at 38 weeks and died within days. We have 3 children now, 9, 6 and 4 years old and have never discussed their sister Allison with them. I feel torn as to tell them about their sister or to shield them from such a sad experience. Even after 10 years our loss is still difficult to talk about without crying. Thank you for any thoughts you can offer.
Conshohocken, PA

dear Brigitte,

I am so sorry for your loss and how painful that ache in your heart must be.    

First, bear in mind that your grief has probably already been felt by your children as they are quite skilled at sentencing the emotions of their parents.  But this is not necessarily a problem as children are rarely upset by their parents’ sadness or even tears.  What has the potential to harm children is when parents swallow their feelings and they come out sideways like over protectiveness toward creating a terribly busy life to avoid the sadness.  So with that as the background.

 Begin any discussion about death with children by asking questions about your child's understanding of what it means to them.  Almost all young children have some experience with death even if it is only seeing a  dead bird or hearing about a friend's grandparents.  If you ask them if they have any questions of you, you will get a sense of how ready they might be. Now you can give them the information they are ready for.

Of course, what information you give them depends on their age and your own emotions and beliefs.  I doubt that you would do this, but you don't want to overload children with your emotions.  So it's okay to show sadness and even talk about it.  But it's not okay to ask children to behave in a certain way so that you can feel better.  That gives them too much power and too much burden.

Whenever you have this discussion, answer all of their questions honestly. And, in keeping with being honest, please don't pretend to have all the answers.  Keep your answers brief and simple.  And most of all, don't let your own anxiety interfere with your ability to listen to their questions and their emotions.