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Sept. 9-15, 2004

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September 9, 2004

Depression Millions suffer from a serious mental illness that can be treated but never really goes away.

BY KIMIKO L. MARTINEZ kimiko.martinez@indystar.com Editor's note: Due to the sensitivity of the story, some last names have been withheld.

All Maureen could think about was how to make it stop.

Ongoing battle: Maureen's depression had taken her to the point of attempting suicide. It's

Standing on the edge of her apartment complex's pool, she

been more than three years,

stared at the clear water and longed for its peaceful serenity.

and though she takes

She'd been through dark periods before, but things were spiraling out of control.

antidepressants, she still struggles with her condition.

Depression affects more than

Underwater, she could make it all disappear: She could

19 million Americans each year.

escape the loneliness of a new city without any friends to turn

-- Arnel Reynon / INtake

to. She could bury the hurt and loss of a recent breakup and forget the stress of losing her job. If she could just jump in,

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maybe it would all just go away.

CLINICAL DEPRESSION

Your time to remember

"My world was crashing around me, and I didn't know what to

Symptoms

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• Persistent sad, anxious or

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"empty" mood

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do," Maureen said. "Things were in such turmoil. I just wanted peace."

Suicidal thoughts were nothing new to Maureen. The 28-year-old had been battling depression since high school.

• Sleeping too much or too little,

She sought treatment while in college, but a particularly

middle of the night or early

severe severe episode forced her to take time off from

morning waking

medical school.

• Reduced appetite and weight For a while, though, it seemed things were getting better.

After trying several different medications, she'd finally found one that seemed to work for her. But within a few months of

loss, or increased appetite and weight gain

moving to Indianapolis for a new job, things started to

• Loss of pleasure and interest in

unravel again.

activities once enjoyed, including

"I needed to do something because I couldn't handle all this," said Maureen, now 34. "I started to think of ways that I could kill myself. I was so out of it, though, it was really more like fantasizing wanting to do it, but never really getting there."

But here she was, standing beside the pool ready to drown

sex • Restlessness, irritability • Persistent physical symptoms that do not respond to treatment

Depression

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herself.

(such as chronic pain or

She took a deep breath and walked in.

digestive disorders)

For some reason, though, she just couldn't do it.

• Difficulty concentrating,

Stepping out of the pool, she thought the worst was over. But when she got back to her apartment, she couldn't shake the thought to finish the task.

She began grabbing handfuls of pills, leftover medications that she'd never used, and downed them with alcohol.

"I felt like I wanted to die, but I think I knew subconsciously that the pills weren't going to kill me," Maureen said. "Even though I think I knew I wasn't going to overdose, I prayed it would kill me."

It didn't.

remembering or making decisions • Fatigue or loss of energy • Feeling guilty, hopeless or worthless • Thoughts of suicide or death Causes Many things can contribute to clinical depression. For some

In what could have been her last moments, she called her

people, a number of factors

boyfriend and told him what she'd done. Before she knew it,

seem to be involved, while for

paramedics were at her door.

others a single factor can cause the illness. Oftentimes, people

ROCK BOTTOM

become depressed for no

It has been six years since Maureen tried to kill herself. And

apparent reason.

for 3 1/2 years, she has lived in a pit of isolation, depression and darkness.

"This last year and a half has been a slow recovery," she said.

There are still days when Maureen can't do anything. She can't pay bills, can't run to the store, can't get out of bed. Up until six months ago, she was still dealing with suicidal thoughts on a daily basis.

Biological -- People with depression typically have too little or too much of certain brain chemicals, called neurotransmitters. Changes in these brain chemicals may cause or contribute to clinical depression.

It's all part of the daily struggle of fighting a disease that attacks the brain instead of the body. "(The suicidal thoughts) were familiar to me," Maureen said.

"But I knew not to act on them. I knew they were part of the disease."

It's a disease that most people don't understand, though.

Cognitive -- People with negative thinking patterns and low self-esteem are more likely to develop clinical depression.

Gender -- Women experience clinical depression at a rate that

"They think you have control over it," Maureen said. "When I

is nearly twice that of men.

told my family, they thought I could just snap out of it."

While the reasons for this are

Experts say that sentiment represents one of the most

still unclear, they may include

common misconceptions about the disease.

the hormonal changes women go

"It really is a medical condition; that's why people who are depressed respond to medications," said Gina Eckart, 36, a licensed mental health counselor at Wishard's Midtown Community Mental Health Center. She wishes more people could see it as a medical condition, "instead of a sign of weakness, that it's not something they can control," she said.

SHARED MISERY

through during menstruation, pregnancy, childbirth and menopause. Other reasons may include the stress caused by the multiple responsibilities that women have.

Co-occurrence -- Clinical depression is more likely to

According to the National Mental Health Association, clinical

occur along with certain

depression is one of the most common forms of mental

illnesses, such as heart disease,

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illness, affecting more than 19 million Americans each year.

But fewer than half of those suffering from the illness seek treatment, thinking the depression isn't serious, that they can treat it themselves, or believing that it's a personal weakness rather than a medical illness.

cancer, Parkinson's disease, diabetes, Alzheimer's disease and hormonal disorders.

Medications -- Side effects of

Many times, people suffering from depression fault

some medications can bring

themselves, thinking they should be able to control it, Eckart

about depression.

said.

That's how Maureen said she felt.

"You feel stigmatized," she said. "You have depression. You're an outcast. It's really hard and you end up having a job that you feel like you should be able to do more, but you can't."

Genetic -- A family history of clinical depression increases the risk for developing the illness.

Situational -- Difficult life events, including divorce, financial

The bright 34-year-old California native had managed to

problems or the death of a loved

"fake it" through high school and college, but her world came

one can contribute to clinical

crashing down the first time during medical school when the

depression.

stress of school mixed with sleep deprivation from beginning medical rotations proved too much.

She dropped out of classes, sought counseling and, for more than a year, cycled through different medications.

"I lost most of my friends because I couldn't go out with them

TREATMENTS FOR CLINICAL DEPRESSION: • More than 80 percent of those who seek treatment for clinical depression show improvement.

socially," she said. "So I felt really alone. It was a year of total darkness."

According to Julie Szempruch, a clinical nurse specialist and director of acute care services for Midtown Community Mental Health Center, it's easy for things to quickly spiral out of control.

• Some of the most common treatments include antidepressant medication, psychotherapy or a combination of the two.

"They're not keeping up with daily life, so their finances are

• Choice of treatment depends

out of control and their relationships are out of control,"

on severity of the illness and the

Szempruch said.

pattern, and persistence.

That's when people start thinking about suicide as their only

• Early treatment is more

way out.

effective and helps prevent the

According to Anantha Shekhar, professor of psychiatry at Indiana University School of Medicine, suicides are a "fairly common occurrence and account for a fairly high number of deaths, especially for teenagers and the elderly."

The International Association for Suicide Prevention, which sponsors World Suicide Prevention Day on Sept. 10, estimates that approximately 1 million people around the

likelihood of serious recurrences.

• Depression must be treated by a physician or qualified mental health professional.

Source: National Mental Health Association

world die from suicide each year, equaling one death every 40 seconds.

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Elaine Lockwood, who volunteers for a local crisis and suicide hotline, deals with depression every time she works a shift.

• Medication and suicide

"Some people have already overdosed or hurt themselves in some way," she said. "They're on the brink, they have no hope left, and our purpose at that point is that we are their last best hope."

OUT OF THE DARKNESS "When you've lived most of your life with depression, you don't know any different, and you think

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it's normal," Maureen said. "It's when you're not functioning that you start to think something is wrong."

But she thinks she could have gotten treatment earlier if she'd known more about the disease, or if someone would have intervened.

"Education is number one, so that people can begin to accept this as a medical condition," Szempruch said. "It's really not an individual problem, it's a family, a society. Sometimes in our society, we just want to mind our own business. But whatever way you can get involved, do it.

Reach out and help them get the treatment."

Besides meds and counseling, Maureen has found her depression support group extremely helpful.

"It really became the mainstay of my life," she said.

Though she usually had trouble leaving the house, she managed to get to the meetings one day each week. "It was my lifeline."

Knowing other people have experienced the same type of emotional pain has helped her cope.

Though Maureen is on disability, she has been actively seeking a part-time job and has been working temporary part-time data entry and receptionist jobs throughout the last year.

But finding a job that offers the flexibility that allows her to stay healthy and keep her depression in check is difficult.

"I know I can never again have my high-functioning job that I used to have," Maureen said. "I'm going to have to stay at this lower level functioning. And that's a big loss."

But she continues to work at ways of taking care of herself and healing. Awareness of her triggers for depression helps maintain her recovery. Friends and family now know what signs to look for to prevent future episodes.

"The key is finding as many ways to help yourself as you can," Maureen said. "You need a psychiatrist, you need a counselor, a support program. If you're religious, try to find a religious program to help you. By going to an alternative therapist I've really opened myself up to spirituality, which has helped me realize that maybe the things that have happened were for a purpose. The things I've achieved and haven't achieved, maybe that's OK."

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