Sometimes sadness is more than a feeling; sometimes it’s a sign of depression. People who feel pervasively very sad for two weeks or longer, who find they are having trouble sleeping or are sleeping too much, who notice their appetites have decreased or increased, who have trouble having fun, and who feel hopeless or suicidal are likely to be experiencing a major depressive episode.
Depression is a serious, treatable, and very common medical illness.
The World Health Organization’s Global Burden of Disease study reported that, in 1990, depression was the disease responsible for the largest number of years lived with disability by people around the world. In fact, the study estimated that 10.7% of total years lived with disability were due to depression, and that another 3.0% were due to bipolar disorder, in which periods of depression alternate with periods of mania, or overly elevated mood. Depression is common among adults, adolescents, and even children. The incidence of depression is higher in people with family members with depression or with alcoholism.
Fortunately, depression and bipolar disorder are highly treatable illnesses. A combination of antidepressant medication, such as fluoxetine (Prozac), escitalopram (Lexapro), or bupropion (Wellbutrin), with psychotherapy benefits the vast majority of depressed people. In exceptional cases, when other treatments fail or when depression is life-threatening, electroconvulsive treatment (ECT) is a highly effective treatment; patients undergoing ECT receive anesthesia and muscle paralyzing medication before receiving a brief electric shock to the head, which causes seizure activity in the brain. For reasons that are not yet clear, the seizure activity seems to counteract depression in those patients.
For those individuals who have bipolar disorder, a mood stabilizer, such as lithium, lamotrigine (Lamictal), or valproic acid—divalproex sodium (Depakote) will often be prescribed to help smooth out the ups and downs in mood which people with bipolar disorder experience. Studies have shown that the effectiveness of treatment for depression and bipolar disorder compares favorably with the effectiveness of treatment for many other medical conditions, such as high blood pressure.
Untreated depression or bipolar disorder
can wreak havoc on the lives of individuals
with the illness and their families.
Many people lose time at work or school, have problems in their marriages or relationships
with friends and parents, and miss out on the fun of life due to depression. The most serious
medical complication of depression is suicide. The yearly suicide rate in the United States in
1994 was 12.0 suicides per 100,000 population. Many are the result of untreated depression.
Fortunately, there is help available for people who feel hopeless and are considering suicide.
In Milwaukee County, the Crisis Line for Mental Health Emergencies is (414) 257-7222; in Ozaukee County, it is (262) 377-COPE, or (262) 377-2673; in Waukesha County, the Mental Health Association has a crisis line at (262) 547-3388. Milwaukee and Waukesha Counties have also pioneered the use of 211 as a general crisis number; the rest of Wisconsin is expected to adopt that number soon. In addition, there is a National Hopeline Network crisis service at 1-800-SUICIDE, or 1-800-784-2433. Counselors on each of these crisis lines can help someone who is considering suicide find help to avoid seeking an irreversible “solution” to a treatable medical problem.
Current research in the activity of the brain is likely to explain the biochemical nature of depression and bipolar disorder and to lead to even more effective treatments for the illnesses. Meanwhile, people with these common medical diseases can turn their lives around with treatment—psychiatrists, family physicians, psychologists, and social workers can all help depressed persons get back hope and get fun out of life again.
Joseph B. Layde, M.D., J.D.
Associate Professor
Department of Psychiatry and Behavioral Medicine
Medical College of Wisconsin