Sunday, January 21, 2001
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Sunday, January 21, 2001 |
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Get help sooner, not later By MARY JANE
HOLT Not everybody is thankful at Thanksgiving, happy at Christmas, or hopeful as the New Year unfolds. Recently I asked a friend about his favorite holiday memory. His response: I'll have to think about that one. There were not a lot of happy holidays when I was growing up. Daddy drank all the time but gave himself permission to drink even more during the holidays. Any holiday, but especially Christmas. I turned to his wife, who recounted several fond holiday experiences but closed with concern for a good friend whose husband died on Christmas morning just a couple of years ago. Then we talked about the death of my father-in-law on Christmas Day in 1976. It took nearly a decade for Daniel and me to let ourselves really enjoy the holiday season again. At first, we felt guilty that we were still alive. Then it became more than being painfully aware that something/someone was missing we really felt kinda lost. Whatever it is about holidays that make them so special and offers such potential for joy and happiness, that same thing makes it a time for sadness to be more keenly felt as well. Nobody can expect to be happy all the time. Life does not give us that option. Into all lives the rains must indeed fall. But when does the unhappiness or sadness turn into real depression for which we would be wise to seek help? When depression persists and interferes with our daily lives, it can be an indication of what psychologists call a depressive or mood disorder. Normal sadness is distinguished from a depressive disorder by severity, duration and the presence of other symptoms. There are many categories into which clinical depression may be divided: major depression, chronic depression, mild depression (dysthymia), and atypical depression. Other important forms of depression are premenstrual dysphoric disorder (PDD) and seasonal affective disorder (SAD). And of course there is bipolar disorder, or manic-depressive illness, which is characterized by periods of depression alternating with episodes of excessive energy and activity. In major, or acute, depression, depressed mood or loss of interest will almost always be present. At least five of the following symptoms are usually present and they will most often represent a change from previous behavior or mood: • Depressed mood on most days for most of each day. (Irritability may be prominent in children and adolescents.) • Total or very noticeable loss of pleasure most of the time. • Significant increase or decrease in appetite, weight or both. • Sleep disorders, either insomnia or excessive sleepiness, nearly every day. • Feelings of agitation or a sense of intense slowness. • Loss of energy and a daily sense of tiredness. • Sense of guilt and worthlessness nearly all the time. • Inability to concentrate occurring nearly every day. • Recurrent thoughts of death or suicide. During depression the symptoms listed here will frequently impair important normal functions at work or in one's personal life. Major depression can last 20 weeks or longer and is not usually brought on by drugs, alcohol or other substances. It is also not caused by normal grief, though these things can set the stage for depression. Symptoms vary in children and adults. In children, watch for persistent sadness, an inability to enjoy favorite activities, increased irritability, headaches and stomach aches, poor school performance, persistent boredom, low energy, poor concentration, or changes in eating and/or sleeping patterns. Depressed children may even tend to bully others. Chronic but mild depression, or dysthymia, is characterized by many of the same symptoms that occur in major depression, but they are less intense and can last for years. Those with atypical depression frequently overeat, oversleep, and are aware of a general sense of heaviness; they may also have strong feelings of rejection. Seasonal affective disorder (SAD) occurs in the fall and winter and appears to be related to light. Symptoms may include fatigue, a tendency to overeat and oversleep in winter. (Under-eating may also occur in this case.) The syndrome of severe depression, irritability and tension before menstruation is known as premenstrual dysphoric disorder (PDD) and it affects an estimated 3 - 8 percent of women in their reproductive years. A diagnosis of PDD depends on having five symptoms of depression (see above) that occur during most menstrual cycles, with symptoms worsening a week or so before the menstrual period and resolving afterward. And then there's grief. Grief, or bereavement, and depression have much in common. It may even be difficult to differentiate between the two. Grief is a healthy and important emotional response for dealing with loss. In people without any other emotional disorder, bereavement usually lasts between three and six months. Grief usually incorporates a series of emotions that include shock and denial, loneliness, despair, social alienation and anger. The recovery period following bereavement, during which the individual again becomes involved with life, takes about the same amount of time. If the grief is still severe after this period, however, it may affect a person's health or increase the risk for on-going depression. Some experts suggest that this severe persistent grieving state be categorized as a separate psychologic diagnosis termed complicated grief disorder, which would be related to post-traumatic stress syndrome and require special treatment. Depression can afflict anyone, regardless of age, race, class or gender. No one is exempt. During the holidays, and every day, tune in to those you love. Learn to listen to what they say and don't say. The unspoken word can tell us much. I much prefer to recommend good friends and/or a good therapist to those who are depressed. I have never been an advocate of drug therapy, but the truth is there are some remarkable medications on the market now that can make a miraculous difference in the life of a depressed individual. If you or someone you love is depressed, get help. Life is far too precious to waste.
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