Depression

Depression. What a depressing topic! But, they say you should write what you know about and I do know about depression.

A few years ago I was diagnosed with Dysthymia, a life-long, or—at least—decades-long disorder characterized by a general mild depressive state with periods of profound depression. In other words, I tend to see things as more grey than they really are, even at the best of times. Mostly this is self-directed, such as low self-esteem—a sense of unworthiness or that “they” are going to realize that I am a fraud. No matter how much positive feedback I get, those feelings still nag at the back of my mind. I tend to, as a result, swing between periods of feeling incapable and periods of supreme self-confidence. Bipolar disorder (manic-depression) is often associated with depression, but it is not as marked in my case.

I want to explain this, because depression is so wide-spread today that it is estimated that at least 20% of North Americans could be diagnosed as having a depression disorder. It’s no accident that sales of anti-depressants are so high. At the same time, it is also no accident that dismissive remarks about the “Prozac-generation”—aw, feeling sad? Take a pill! –are so popular. Many people just don’t get it. They tend to view depression as an excuse for laziness, and its sufferers as unjustified complainers. Can’t get out of bed in the morning? All you need is a good swift kick in the ass!

Try to imagine that a heavy weight is pressing down on you and, no matter how hard you try, you can’t shake it off or escape from under it. It is so easy for an outside observer to assume that you don’t want to. I have described my serious bouts of depression as a feeling that the black dogs are circling round me and closing in, or that there is a blackness just outside of my peripheral vision waiting to overwhelm me. Apparently that is a fairly common description of the state of being as reported by those depressed.

The point of those two metaphors—of the circling black dogs or of a black cloud closing in—is that they are beyond control of the suffer who may well be trying to stave off what he sees as inevitable: that he will be overwhelmed by and consumed by the negativity expressing itself in his head. The depressed are not crazy; they know that they are facing a battle or that they have given up. I knew it was not healthy when I slept 20 hours a day, but, there was nothing I could do about it. You have to sleep, you sleep. People who can’t face the prospect of eating know that their repulsion towards food is not a normal reaction. But, they can’t ignore a gagging sensation whenever they think of eating.

There are many causes. But, underlying it all is a physical basis. Whether the physical changes are a result of, or a cause of, depression is irrelevant: they are there. Moods, thinking, emotions, are related to chemicals in the brain. You might not like to think of the rush of “love at first sight” as a release of hormones from various bodily organs. Which one is the primal cause: the experience or the chemicals? Does it really matter? Low levels of two important hormones that affect the functioning of the brain are common in people suffering from depression: dopamine and serotonin.

Dopamine affects behavior and cognition, motivation, sexual desire, sleep, mood, attention, and learning. A shortage of it in the brain can cause difficulties in all those areas and more. Serotonin is the “feel good” hormone that affects one’s feeling of well-being and happiness. Both of these chemicals are created in the body and are broken down by normal functioning, but the rate of loss can be affected by various drugs, variously known as “anti-depressants.”

Of course, if that’s all that depression is—a deficiency of certain chemicals—depression would disappear overnight. If only it were that easy. Some of my friends would still be alive today if that were the case.