The different faces of depression

Second in a three-part series on depression.

Most depression I diagnose does not start with, “I’m depressed; I need help.”

Some people know they have depression, which begins, like most mental illnesses, in the late teen years and early 20s. People get good at living with it, working through it, smiling, clowning, hiding and toughing it out.

Their problem: they come to me late. What’s late? When minor things like going to the mailbox or answering a social call requires a major mental deliberation.

Others may not recognize depression; it has many faces. Like box jellyfish, depression has far-reaching, wayward tentacles which sting and poison all aspects of one’s mental, physical, social and working lives.

What I hear:

  1. “I need something to help me sleep.”
  2. “My teenager says I’m irritable and moody.”
  3. “My back (head, muscles) hurts and I can hardly move.”
  4. “I feel drained."
  5. “I’ve gained all this weight.”
  6. “Maybe I’m drinking too much.”
  7. “Do I have adult-onset ADHD? I can’t think a sentence to the end.”
  8. “This afternoon, I honked at a student driver.”

Granted, insomnia does not a depressive make. But if I start digging, sometimes I can find more depressive symptoms that people have learned to “normalize.”

Today, depression is the No. 1 cause of ill health worldwide, the World Health Organization reports.

Our rate of depression has shot up 20 percent in the past 10 years. In the November issue of National Geographic, a study showed the U.S. ranks lower on the happiness scale than Guatemala, El Salvador and Somalia. (Yes, we beat Russia. But really though).

One in three women experiences depression in their lifetime. Of the tens of millions of Americans suffering from major depression each year, only half seek medical help; 15 percent receive treatment.

To improve diagnosis, the U.S. Preventive Services Task Force (USPSTF) recommends using the nine-item Patient Health Questionnaire. You can find it by searching "PHQ-9" on the USPSTF website, It’ll only take a few minutes to do.   

Severe depression is easy to spot, almost all have problems with daily activities. But it’s harder to diagnose those with mild to moderate depression. They go to work, cook wholesome meals for their families, are polite to telemarketers, go to kids’ birthday parties and basketball games, pay bills on time. They might be the sort of people to whom you say, “God, I don’t know how you do it!” 

Maybe they’ve asked themselves a similar question: “DP, you have a steady job, college-bound kids, house with a pool, a dog who adores you and a husband who’s fully housetrained. Why can’t you be happy?”

Here’s the thing: unlike grief, depression needs neither a trigger nor a reason. It is the chicken and the egg.

Rob, my brother-in-law, age 48, who’s had depression since he was 8, said, “People think depression is some kind of moral choice. It is not. You can’t just ‘snap out of it.’”

They struggle, and it hurts my bones to see how bravely they struggle. Like my patients who cope with heart failure, hip fracture, emphysema, they’re my heroes. And I tell them so.

Read More on The Medical Insider
Volume 9, Issue 24, Posted 10:02 AM, 12.19.2017