Depression now the 'common cold' of mental disorders

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Everyone gets depressed. You can count on it. It is so widespread - 4 to 6 per cent of the population suffers from it at any one time - that it has been called the "common cold of mental disorders."

In that sense, then, depression is quite normal and should not necessarily be cause for alarm. There is no way to prevent some disappointments in life, such as a loved one passing away, a child failing to meet your expectations or an investment going sour.

But it is said each of us will experience a few instances of extreme depression during our life. Perhaps you fought in a war and remember lonely, fearful nights, wondering if you would ever see your family again; perhaps you have been accused of misconduct and spent your life savings trying to declare your innocence and save your job and family name; perhaps your child was killed in a car accident or your spouse left you.

Such depression can be gut-wrenching stuff: when your stomach turns and aches, and you don't know how to stop it; where you can't stop thinking about it, rerunning it, adding more (gruesome) detail each time, until it is all-encompassing; where there is no end in sight, and suicide seems the only escape.

Such anxiety can have many effects. One can become apathetic, listless and isolated; one may tend to say negative things about oneself and others; people and activities usually enjoyed are no longer sought after or fun. One who is preoccupied, listless and unresponsive, may also find that work performance deteriorates and trouble on the job begins.

Similarly, when one does not - for an extended period of time - meet the expectations of family and friends, the marital relationship may suffer, friends may avoid you, family members may become embarrassed, ashamed, even angry. In short, depression can have other, widespread, negative effects, causing additional problems at home and work. It is no longer just a matter of treating depression, but quickly becomes one of reshaping marital, work, social, and family attitudes and activities.

Whether one's depression is mild or excruciating, it has a normal course to run.

Depression will be most severe and constant at the beginning and then will gradually ease in intensity. The passage of time together with a gradual re-emergence in social and work activities and the support of loved ones, will distract you, help you rationalize the loss, and get you thinking more and more about the future rather than the past. In most cases, this need not be planned; it happens quite naturally and it can be somewhat comforting to know that if we can just get over the hump, things will get better.

To get over that hump, it is helpful if family and friends, as well as the depressed person, understand what depression is. It can be pretty frightening to watch someone you know and love all of a sudden act so differently, be so unkind, seem so uncaring.

It is a time to be particularly sensitive, tolerant and loving; it is a time to understand what the person may be going through; it is a time to ease demands, overlook foibles, ignore emotional and irrational outbursts.

It is also, however, a time to keep a close eye on that person. Sometimes, depression does not run its normal course: Sometimes, people get more and more isolated, or down on the world, instead of less; sometimes the depression lasts longer than it should; sometimes people don't know why they're depressed, or else the depression is much too severe for the loss suffered.

In such cases, the depression is not running its normal course, is not easing over time and the individual may need professional help to overcome it. A commonly used guideline is that if the depression lasts more than two or three weeks and interferes with normal activites, professional assistance is recommended.

The treatment of depression remains controversial in scientific circles. Some researchers insist depression has a biological basis. For example, scientists find fewer neurotransmitters (chemicals vital to the regulation of moods) in the brain during depression.

In addition, depression is a common side effect of various medications and of hormonal changes (e.g., premenstrual syndrome). A physical examination should be planned at the start of treatment in order to rule out such possibilities.

Other scientists focus on environmental causes of depression. Traditional psychotherapy tries to ease depression by giving you insight into childhood anxieties and experiences. This involves long- term therapy, usually quite expensive, which has until recently been the only hope for a cure. Over the last 10 years, however, researchers have focused on a client's immediate problems, looking at the current environment and experiences, rather than the past, to understand and treat depression.

The results of these studies are encouraging. They have shed new light on the causes of depression and developed several new, briefer and less expensive treatments, which may also be more effective than long-term traditional psychotherapy. The results of these studies and the nature of these treatments, will be discussed in Part 2 of this series next week.

* Dr. Rincover is a registered psychologist, on staff at Surrey Place Centre in Toronto. The column is not intended to provide treatment or advice and anyone concerned about a psychological problem should seek professional assistance. Readers can write to Dr. Rincover at the Life Section, Toronto Star, One Yonge St., Toronto M5E 1E6. Personal replies cannot be given.