Depression (in progress)

Depression is one of those topics.

Everybody knows about it, and everybody has their own opinion- bolstered by personal experience and more objective 'clinical' data. And everybody is pretty sure that they're right.

They can't all be right, of course...or even if they are, there are several varieties of the thing we call depression.

At the minor extreme, there's just your basic funk. The sadness that most everyone feels from time to time, a melancholy mood that can settle in with a few days of rain and pass just as quickly. On the other end, there's the soul-destroying monster depression, which ruins and ends lives. And a whole spectrum of mental states in between; it's a bit of a shame that they're all called depression, because a lot of them are only superficially similar.

There's the depressions which have an immediately identifiable cause- a death in the family, loss of a job, et cetera- and those that are characterized by less obvious causes, or no significant cause at all.

In the former types of depression, treatment is relatively straightforward; the mind itself is most likely trying to regain the previous less depressed state. A little extra attention- by the self, loved ones, or professional therapy- is usually all that is necessary.

In the latter types of depression, the feeling comes first. Very often the symptoms of depression contribute causes themselves; one gets depressed and their behavior pushes loved ones away, which creates more "reasons" for depression. A cycle such as this is very common to depression, and presents deep complications.

The only significant common factor to all depressions is a lack of "normal" emotional response...one simply does not find happiness where it should be found.

Here again, however, there appears a wide range of responses. Typically, the severity of depression is usually characterized by how much it has affected the sufferer's life. Unfortunately, this is a completely external judgment- one person may live a long and productive life with untreated depression, while another may suffer a sudden bout that they desperately and unsuccessfully attempt to cure, with disastrous results.

A significant part of this depends on the individual themselves; someone accustomed to restraint and self-discipline may be better able to manage unwelcome impulses. Unfortunately, this provides much basis for the belief that depression is simply self-indulgence and emotional negativity.

For the many people that profess such beliefs, it is obvious that depressed people just need to stop being pussies. Everything else is just psycho-babble.

Which is, unfortunately, well supported by the vast amount of pseudo-science and pop psychology that deals with the topic. While the Internet hold the current crown for muddled thinking, it is only the latest and most convenient contender. Online resources draw from an already mature pool of dubious authority, from pearls of "common wisdom" all the way to respected psychiatric sources...all of which contain just enough evidence and helpful advice to disguise the fact that they amount to little more than shooting in the dark.

At the other extreme, there is clear and specific evidence that depression can be caused by identifiable physiological factors such as damage to the brain, or an excess or lack of specific neural activity. The most recent work has combined neurological studies with pharmacological research, all backed up with the highest scientific standards. The preferred method of treatment at this time is prescription drugs, often assisted by psychiatric therapy.

Unfortunately, there are several downsides to this; most glaringly, that it is often little more than trial and error for most people. Your doctor prescribes something that takes several weeks to show its effects, it doesn't quite do the trick, so you get a different or additional prescription, which takes several more weeks to show its effects, and before you know it many months have gone by and you no longer know whether what you're feeling is better, worse, or just complicated by the treatment. As with any pharmaceutical solution, there is the danger of unexpected side-effects and interactions...and even if it works, it's not a cure per se; you will be tied to these drugs for the rest of your life.

And that's the best case. Most people with depression don't even get that far.

Nope, many people with depression do not get help. In fact, it's a funny thing about depression (and several of the psychological ailments); if you've got it, you're less likely to get treatment.

For one thing, depression can be very insidious and subtle. Just feeling "a little off" for a few weeks is usually not enough for anybody but the most self-aware and perceptive folks (or those who have easy access to the necessary treatment). So you get used to it as it's getting worse a little at a time. By the time it's really a serious and obvious problem, you've grown accustomed to it. While people who you haven't seen in years may recognize a big difference, but you and the people around you have been slowly getting used to your decaying mood. And, after all, getting older tends to go hand in hand with getting a little sadder, doesn't it?

For another thing, depression's effects tend to reduce your likelihood to seek treatment. The more you withdraw from people, the fewer people there are to encourage you to seek help. The more you reject optimism, the less likely you'll be to believe that help is out there. The more work you miss, the less money you have to pay for treatment.

It's a sad truth that the people who are suffering the least will get help far more often (and certainly will be more visible and communicative) than the people who are closer to the bottom. Not only is this unfortunate for the sufferers, it contributes to the belief that depression is often a superficial indulgence of the bored and affluent.