Reevaluating Depression

Editor's note: The line between our personal and professional lives is at best a fine one, at least in terms of our health. Hence this fifth installment in our series on women's health issues. In this series we tip you off to the most common medical conditions affecting women and what can be done to prevent, detect, and treat them. In the coming months the series will in­clude articles on thyroid disease and autoimmune disorders. After you read each piece, we encourage you to share them with your coworkers, your clients, your friends. Because the way we see it, your health is your most precious resource both on and off the job.

Sadness. Restlessness. Irritability. Low energy. Guilt. Worthless-ness. Helplessness. Fatigue. Weight gain or loss.

According to the National Mental Health Association (NMHA), each year more than 19 million Americans suffer these and other symptoms of clinical depression. One of every four women — more than twice the reported rate of men — will experience clinical depres­sion at some point in her life. According to the American Psychological As­sociation's (APA) research, only one in five who suffer will get treatment.

It's a natural part of the human expe­rience to occasionally get the blues. The loss of a loved one, a heavy workload, or financial problems are just a few situa­tions that can make someone feel sad or overwhelmed. When the symptoms ex­tend beyond a few weeks and interfere with your ability to function, though, the temporary mood may have become a medical issue.

Other signs of depression include a loss of interest or pleasure in activities you used to enjoy; feeling "empty" or crying excessively; feelings of hopeless­ness and pessimism; sleeping too much or too little; thoughts of death or suicide; and difficulty concentrating, remember­ing, or making decisions. Depression also can manifest as persistent physical symptoms — headaches, digestive dis­orders, and chronic pain — that don't respond to treatment.

In fact, the National Institute of Men­tal Health (NIMH) cites depression as the leading cause of disability worldwide. Yet it's also one of the most easily treated illnesses, with more than 80% of people who do get treated feeling normal in just a few months.

"Basically, the key thing is that you want people to feel better and to be

more productive in their lives," says Bonnie Strickland, Ph.D., a clinical psy­chologist who is a professor of psychol­ogy at the University of Massachusetts, Amherst. Strickland is also a past presi­dent of the APA.

Seek Treatment Early

According to NMHA, the symptoms of depression are caused by imbalances of chemicals in the brain that influence moods, sleep patterns, and energy levels. Because these chemicals are not readily measured, depression is diagnosed by ruling out other causes, observes Connie Fletcher, Ph.D., a clinical psychologist and director of the Southern Virginia Mental Health Institute (Danville, Va.).

According to NIMH, you should have a thorough diagnostic evaluation.

Does Anxiety Seem to Be Winning?

Most people experience feelings of anxiety before an important event such as a job interview or a wedding. Anxiety disorders, however, are illnesses that fill people's lives with chronic, overwhelming anxiety and fear Left untreated, these disorders can dramatically reduce productivity and overall quality of life,

"Fear and anxiety are normal and necessary," says psychologist Jerilyn Ross, who oper­ates The Ross Center for Anxiety & Related Disorders in Washington, D.C. "For exam­ple, if we weren't afraid of not doing well, we wouldn't prepare for a job interview. In some people/though, the fear is totally irrational and disproportionate to any real threat or danger. An anxiety disorder is a fear of having the fear.

"If that anxiety interferes with your life to the point where you find yourself avoiding or manipulating situations or not carrying out your day-to-clay routines, seek help," contin­ues Ross, who also authored Triumph Over Fear: A Book of Help and Hope for People With Anxiety, Panic Attacks, and Phobias.

The most common anxiety disorders include:

• Panic Disorder: Repeat episodes of intense fear that strike often and without warning.

• Obsessive-Compulsive Disorder: Repeated, unwanted thoughts or compulsive behaviors that seem impossible to stop or control.

• Post-Traumatic Stress Disorder: Persistent symptoms that occur after experiencing a traumatic event such as a rape or natural disaster.

• Phobias such as social phobia and specific phobia. People with social phobia have an overwhelming fear of social situations. People with specific phobia experience extreme, disabling, and irrational fear of something that poses little or no actual danger

• Generalized Anxiety Disorder: Constant, exaggerated, worrisome thoughts and ten­sion about everyday routine life events and activities, lasting at least six months.

"We know from a lot of new research coming out that these are brain disorders,"

Ross explains, "They are not so much a disease - more that the wiring is different

in the brain. People are biologically disposed toward developing them, and they are trig­gered by environment."

According to Ross, the average person typically visits 10 doctors over a period of years before finally getting the right diagnosis and treatment. Treatment for anxiety disorder in­cludes a combination of medication and psychotherapy. Cognitive-behavioral therapy and behavioral therapy are two clinically proven forms of treatment that help patients stop unwanted behaviors and understand and change their thinking patterns and, hence, their reactions to certain situations.

"Many people suffer in silence because they are embarrassed." she says. "We can suc­cessfully treat 90% of people with anxiety disorder. The only ones we can't treat, are those who don't come forward."

If you experience three or more of the symptoms named above for more than two weeks, of if they interfere with work or family life.

Fletcher recommends starting with your primary care physician to rule out other conditions such as thyroid disease. Both psychologists urge patients to get actively involved in di­agnosis by providing their doctors with as much information as possible about the range of symptoms, the time of onset, and external factors such as a family history of depression, a lost job, a death in the family, weighty responsibilities, or abuse.

"Due to the range of symptoms, depression is likely to be misdiagnosed," Strickland adds, NIMH recently made a big push to educate primary physicians on depression, and Strickland believes they're more sensitive to depression now, but adds that the symptoms can be confusingly vague.

Don't allow yourself to be dismissed. "If you don't feel 'nor­mal' — and most of us have energy and a zest for life — get to the bottom of it," Strickland advises. "Diagnosis of depres­sion requires ruling out physical causes of the symptoms. Your doctor should run tests and investigate the causes."

Whatever you do, don't try to "wait it out" — depression is a medical condition that requires treatment just as other con­ditions like high blood pressure do. "Some people can tough it out, but the depression will probably come back unless their life conditions change," she adds. "Nor can you always kick it out; in some instances, the body chemistry has changed." Stud­ies show that the longer a person's depression goes untreated, the more likely it is to recur.

Get Fast and Effective Treatments

The most common treatments for depression are anti­depressant medications, psychotherapy, or a combination of the two. According to Fletcher, primary care physicians often prescribe antidepressants as a first course of treat­ment to patients.

There are a few types of antidepressants, all of which act on different chemical pathways of the human brain related to moods. According to NMHA, antidepressants take as long as eight weeks to show results, but they are not habit-forming. Furthermore, the association recommends that the medica­tions be taken for as long as four to nine months after symp­toms have improved. Fletcher and Strickland agree, noting that people with chronic depression may need to remain on the medication long-term to prevent a recurrence.

St. John's Wort has gained much attention in the past few years as a natural herbal remedy for depression — so much so that the National Institutes of Health currently is sponsor­ing a study to evaluate the safety and effectiveness of hypericum, an extract of St. John's Wort, in treating depression.

In Fletcher's opinion, supplements such as St. John's Wort shouldn't harm anyone, but she emphasizes that you should discuss the supplement with your doctor. "You need to know what's in it and how it could affect you," she says. "If you don't check with your doctor then at least check with your pharmacist."

Both psychologists also recommend people with depression to consider psychotherapy. While that may seem self-serving, scientific studies demonstrate that short-term — 10-20 weeks — courses of therapy have long-term re­sults by helping to change negative thought patterns and teaching people to deal more effectively with others. "In combined treatment, medication can relieve physical symptoms quickly, while psychotherapy allows the oppor­tunity to learn more effective ways of handling problems," NIMH states.

Get a New Outlook

The APA's research shows that women experience depression two to three times more than men. Researchers acknowledge that women share a vari­ety of unique factors-reproductive and hormonal issues, personality styles, sexual and physical abuse, marriage and children, poverty and minority status. They don't yet agree, though, whether these factors lead to depression, or whether men simply have different cop­ing techniques.

Based on their practical experiences, Fletcher and Strickland believe that women put too much pressure on themselves. "In our society there's a tremendously high percentage of dual-career families, and women still believe in the myth of the superwoman," Fletcher says. "Even those women who have accepted that they can't do it all still feel guilty about it.

"Focus on yourself and have balance in your life. For example, my nail tech works 50 hours a week, but she knows to get exercise and rest, and to do fun things in her downtime. If you have a mate, get that person involved in family responsibilities. And accept that some things will not get done."

Above all, she says, don't cancel "you" time. "I'll see women who set aside an hour a day for exercise on their sched­ule, but then it's the first thing to go when they get busy," she notes.

Strickland also emphasizes the power of positive thinking. "Negative thinking is a bad habit we fall into," she observes. "A key descriptor of depression is a feel­ing of helplessness. Take control of your life and look for the positive in everything." Women can also borrow a page from men, whom researchers have found tend to ignore depression. While not necessarily healthy behavior, Strick­land notes that women tend to brood about their problems and feelings, whereas men are more likely to push their feelings to the side and to focus on other activities.