How Come They're Happy and I'm Not? (33 page)

Depression falls into the category of mood disorders, also known as affective disorders. It encompasses a continuum of disturbance in thoughts, feelings, behaviors, and physical health, with the prevailing characteristic of persistent sadness and despair. While some people experience depression to the point that they can no longer function in their lives, others may not even realize that they are depressed. An estimated twelve million people in the United States are not aware that they are suffering from depression,
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and 80 percent of primary care patients actually fit the criteria for a diagnosis of major depression.
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Melancholia, a former term for depression, has plagued humankind for at least as long as recorded history, and likely from the beginning of human existence. Written accounts of depression date back to 2500
B.C
., with an ancient Egyptian papyrus relating a man's despair and sense of emptiness as he contemplates suicide.
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One way of explaining the presence of mood in the human spirit is to regard it as an evolutionary adaptation.
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A depression in mood, for example, pulls us back from engagement with life, which we may need at that moment to keep us safe or to give us time to gain a perspective.

Viewed in this light, one might say that there is a tremendous need today for safety and perspective, given that depression is a worldwide epidemic. This point gains validity when one considers
the complexity, toxicity, and stress of modern life and the physical, psychological/emotional, and spiritual causes of depression, as discussed in
chapter 2
and throughout the book.

In the United States alone, thirty million people are taking Prozac, which is now in the top ten most prescribed drugs.
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That translates to nearly one in ten people. One in eight adolescents and one in thirty-three children overall suffer from depression. One in four women will have clinical depression in their lifetime—twice the rate for men. (These rates reflect reported cases. The rate for men may actually be equal to that of women as societal factors contribute to men not seeking help.) Depression cuts across all ages, with more than one in six people over the age of 65 afflicted.
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While the devastation of depression cannot be measured solely in dollar amounts, its economic cost illuminates its far-reaching reverberations. The annual cost of depressive disorders in the United States is $43 billion, a total of the costs of direct treatment, absenteeism, lost productivity, and mortality.
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Another tragic set of statistics reflects the profound human loss resulting from depression. A study by the World Health Organization (WHO) and the Harvard School of Public Health reveals that by the year 2020 depression will be the single leading cause of death around the globe.
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The risk of suicide is 30 times greater among people with depression than in the general population.
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In the United States alone, there are 30,000 suicides every year.
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Suicide among the teen population has increased 300 percent in the past 30 years.
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Among children between the ages of 10 and 14, the rate of suicide has more than doubled in the last 10 years. For youth between the ages of 15 and 24, suicide is now the third leading cause of death. For college students, it is the second leading cause.
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While the statistics on depression and its effects are grim, they reflect the fact that only one in three people with a major mood disorder seek help,
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and 50 percent of people with clinical depression turn to their primary care physician, who may or may not have the training needed to provide true assistance.
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The dismal nature of the statistics also reflects the fact that the vast majority of those who seek help for their depression are receiving conventional treatment, which does not have a good success rate (as the epidemic proportions of depression verify).

The overwhelming emphasis in the conventional approach to depression is on antidepressant drugs. Despite the fact that psychotherapy is cited as a primary component in WHO and APA (American Psychiatric Association) standards for depression treatment, its use accounts for just eight percent of the money expended in treating depression.
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Unfortunately, the effectiveness of antidepressants is greatly overrated. In disregard of disturbing side effects and of research showing that they do not work for a third of the people who take them, and do no better than placebos for another third,
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these drugs continue to be dispensed widely and to be regarded as the panacea for depression.

While in some cases of chronic severe depression, they may provide an important intervention to save a life, antidepressants are handed out far too freely. The prescription flurry is now extending to increasing numbers of children, despite the fact that Prozac and similar antidepressants are approved by the Food and Drug Administration (FDA) only for use in patients over the age of 18.
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Even for those people who get welcome relief from antidepressants, it is important to keep in mind that they are not getting a cure for their
depression, in that the drugs do not address the underlying factors that caused the depression in the first place.

Fortunately, there is a way out of this current state of affairs. The statistics of depression will change to a far more positive picture as more people learn about and gain access to natural medicine approaches to the disorder, which make profound and lasting recovery from depression a strong possibility. Meanwhile, the present statistics should put the medical profession on alert that changes need to happen in regard to the treatment of depression. The statistics also serve another important function: to highlight how important it is to determine if you are suffering from depression and to get help.

The common subcategories of depression are major depressive disorder, dysthymia, and seasonal affective disorder. Major depressive disorder is also known as clinical depression, major depression, major affective disorder, and unipolar disorder. Dysthymia, being chronic moderate depression, is the type that many people fail to recognize as a mood disorder. Seasonal affective disorder, or SAD, results from the reduced light of the winter season, which explains why it is known colloquially as “the winter blues.”

Bipolar disorder (formerly known as manic-depression) is another mood disorder involving depression. It is not covered in this book because
another book in
The Healthy Mind Guide
series is devoted to that subject. See the author's
The Natural Medicine Guide to Bipolar Disorder
(Hampton Roads, 2003).

A holistic approach does not use such diagnoses to determine the appropriate treatment course, focusing instead on the particular manifestations and underlying imbalances in the individual patient. Many people receive these labels, however, so it's helpful to know to what they refer.

For a diagnosis of major depressive disorder, according to the
Diagnostic and Statistical Manual of Mental Disorders
, Fourth Edition
(DSM-IV)
, the APA's diagnostic bible for psychiatric disorders, a person must have one or more major depressive episodes, which are defined as depressed mood or loss of interest lasting at least two weeks and accompanied by at least four other symptoms of depression (see lists that follow). For dysthymia, the person must have experienced a depressed mood for more days than not over at least a two-year period, accompanied by other symptoms of depression, but the whole does not fit the diagnostic picture of major depressive disorder. SAD is depression that occurs on a seasonal basis and does not fit the criteria for any of the other depressive disorders that involve a seasonal pattern.
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The statistics of depression will change to a far more positive picture as more people learn about and gain access to natural medicine approaches to the disorder, which make profound and lasting recovery from depression a strong possibility.

The following are symptoms of depression:
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• persistent sadness
  
• significantly reduced interest or pleasure
  
• significant change in weight or appetite
  
• insomnia or oversleeping
  
• restlessness, agitation, or lethargy
  
• fatigue or lack of energy
  
• feelings of worthlessness or excessive or inappropriate guilt
  
• problems thinking, concentrating, or making decisions
  
• recurrent thoughts of death or suicide
  

While these are the symptoms for diagnosis according to
DSM-IV
criteria, anxiety, even extreme anxiety, is another common symptom of depression.
²⁹

Since this fact is not well known, the anxiety can serve to mask the depressive disorder. Other symptoms of depression include:

• pessimism
  
• feelings of emptiness
  
• feelings of helplessness
  
• irritability or anger without apparent cause
  
• tearfulness or excessive crying
  
• withdrawal from social activities
  
• loss of interest in formerly pleasurable activities, including sex
  
• desire for solitude
  
• unexplained aches and pains
  

Depression can be a corollary of other medical conditions (see
chapter 2
) and there is a comorbidity factor with substance
abuse, eating disorders, and obsessive-compulsive disorder (OCD). Comorbidity means that two disorders exist together. In the case of substance abuse in relation to depression, for example, alcoholism is a factor in 30 percent of all suicides.
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