Depression. We hear this word being used in more than one con-text. It may be a “depressing” day because of the dreary weather. You may be “depressed” hearing about a friend’s misfortune. But the word is being misused. Those descriptions are actually customary feelings of sadness or empathy.
Being sad is not an illness, it is a normal emotional reaction. Just like a cough is a normal physical reaction. When most people cough once or twice, they don’t think anything of it, or are able to correlate it with some trigger. It is when that cough becomes longer lasting and severe that they determine there is a problem and begin seek-ing medical attention. The illness of depression, more accurately referred to in medical practice as a “depressive episode,” is usually characterized by sadness that may not be proportional to a trigger or the degree of stress, or there may be no trigger at all. It is also usually accompanied by significant changes in other areas like our thinking and behavior patterns.
But what signs should you look for? What does Depression look like? Here’s one example: You start to feel unwell. You may or may not feel sad, but you begin to lose interest in previously enjoyable activities (often including sex). No one may notice, because you can still talk yourself into going places although you no longer enjoy yourself.
Your outlook on life becomes more pessimistic and you may blame yourself unnecessarily or may feel you are a burden to your loved ones. Everyday problems begin to seem insurmountable. You are unable to concentrate and become more forgetful than usual. These changes may go on without anyone recognizing since, of course, they can not read your mind.
Physically, you tire more easily. There is a definite change in your sleep and appetite patterns. Even your mind feels “tired” and mak-ing simple decisions becomes a chore. You may start to withdraw socially which may raise brows, but you always give some plausible explanation. But sooner or later, it may impact your productivity on your job, in school, or your relationships..
You may go to your primary care doctor at some point, but you only tell him or her about the physical changes, because you don’t know that the changes in your emotions and thoughts are related. Unfortu-nately, it is not fully explored at your visit. The blood pressure, tem-perature and blood work can’t reveal what is on your mind, and your PCP may not have asked.
Eventually, thoughts like, “I wish I was dead” or “Why am I even liv-ing?” may pop in your mind. You resist them with statements like “I am not that type of person! I am not selfish”- .”I am very religious”… “I am the strong person everyone comes to.” However, the thoughts’ keep popping up. You tell no one because it is too scary, to even acknowledge to yourself. Over time, specific thoughts about how to kill yourself may pop in your mind. Again you struggle to resist, but it
becomes more and more difficult.
Unfortunately, everyday, someone in this state of mind attempts or completes suicide, because they did not recognize the signs or never knew to get medical help before it got to that point.
Where do you seek help if you experience the above changes? You may start with your primary care physician or check your insurance for a participating psychiatrist. Friends and family members may also give you referrals. The most important factor in ensuring the most accurate diagnosis is relaying all the changes whether or not the evaluating clinician asks about them. Unlike other medical illnesses, there is as yet no laboratory test to diagnose depression. The only way is to gather the information about changes in feelings, thoughts, and behavior.
Not all the changes in the different areas occur to the same degree of severity, and just like the flu, the episodes or bouts of depression may have different patterns at different times. The course of a de-pressive episode may go several ways: it may worsen, it may eventu-ally run its course and symptoms resolve, or it may partially resolve and residual symptoms continue to adversely influence your function-ing. It may also be recurrent. Each episode increases the likelihood of having another, and the recurrences may make the illness more resistant to treatment.
Additionally, it is vital that you describe other changes you may have had in the past or that may be interspersed with current depressive symptoms. Examples are irritability, impulsivity, excessive activity, racing thoughts, and the need for little sleep. This may make a dif-ference in the medical treatment of that depressive episode or even help refine diagnosis. Like many other medical illnesses, heredity also plays a part, so relate any history of diagnosed (or undiagnosed, but suspected) emotional illnesses in blood relatives.
We cannot determine the genes we inherit that may predispose us to various illnesses. However we can have a say in facilitating accurate diagnosis and treatment. Since thoughts & feelings are internal, you are logically the best person to notice early changes suggestive of depression. By the time the signs are more noticeable to others, the illness is already more advanced. Recognizing your symptoms in the early stages and getting medical help is under your control. Exercise that power and give yourself a chance for a better life.
Dr. Kankam is a Board-Certified Psychiatrist and Fellow of the American Psychiatric Association. She completed her residency at University of Mary-land in Baltimore and has been in private practice for over 20 years with of-fices in Laurel and Glen Burnie. In 2005, she was appointed to the Maryland State Advisory Council on Medical Privacy and Confidentiality.
