Question: I'm worried about my sister. She went through a divorce about six months ago. She doesn't want to get out of bed in the morning or take care of herself or her kids. She's been blue before, but never anything like this. I've asked her to snap out of it and get back to normal, but to no avail. What can I do to help her?
Answer: It sounds as if your sister is severely depressed. Depression is a common malady that affects about 20 percent of women and 10 percent of men during their lifetime. Anywhere from 5-9 percent of women and 2-3 percent of men have depression at any given point in time.
It's important to clarify terms for a moment. Many people use the word "depression" to suggest momentary sadness or discouragement due to present circumstances. This is not clinical depression.
Clinical depression is a mood disorder of such intensity and duration that it disrupts family, job or social functioning, as it has for your sister. It is usually associated with at least a few of the following features: a loss of pleasure or sense of control, intense anguish, insomnia, weight gain or weight loss, feelings of worthlessness, fatigue, the inability to concentrate and pervasive thoughts of death.
Several kinds of clinical depression exist, and each is treated somewhat differently. Therefore, it's important for your sister to be properly evaluated by a doctor.
The most common kind of depression, also known as unipolar depression, is manifest as a lifelong tendency toward unexplained depressive episodes lasting longer than two weeks. Unipolar depression needs to be distinguished from the following:
— Grief reaction: Depression that occurs following a major negative life event, such as the death of a loved one or divorce, is a common and normal reaction. It is notable for the fact that it lasts for a limited period of time (no more than a few weeks) and self-esteem is preserved.
— Bipolar disease: Depression can occur in persons with bipolar, or manic-depressive, disease. These individuals cycle between low mood (depression) and inappropriately elevated mood (mania).
— Other psychiatric problems: Depression can be associated with other kinds of mental illness, such as schizophrenia and borderline personality disorders.
— PMDD and SAD: Depression that occurs in women only in the premenstrual phase of their cycles is called premenstrual dysphoric disorder (PMDD) and is partially due to hormone changes. Depression noticed only in winter is called seasonal affective disorder (SAD) and is felt to be due, at least in part, to limited sunlight exposure to the brain.
The past few years have seen amazing breakthroughs in the understanding and treatment of clinical depression. Researchers have discovered that depression is primarily due to the improper brain regulation of a neurotransmitter called serotonin.
They have also shown that there is a strong genetic link to depression, although traumatic life events, conflict and stress play significant roles. This means that depression, particularly severe depression, is to some extent not controllable — people cannot simply talk themselves out of being depressed. Telling your sister to just "snap out of it" will clearly not work.
The enhanced medical understanding of depression has destigmatized the disease and allowed both doctors and patients to approach it without the social and emotional connotations it once possessed. Thought in times past to be evidence of God's displeasure, past mistakes or an evil disposition, we now know that clinical depression is primarily due to an inherited inability to regulate serotonin properly. This is not unlike a diabetic who cannot regulate insulin properly.
Classically, the treatment of depression has consisted of medical therapy, psychotherapy and electroconvulsive therapy (ECT). Today, medications form the backbone of most treatment programs, particularly since drugs that alter serotonin metabolism have been developed over the past decade.
Psychotherapy, counseling and behavior modification are also successful in treating mild depression, but ECT is reserved for severe situations unresponsive to other interventions.
Stephen Lamb practices OB/GYN at the Millcreek Women's Center in Salt Lake City. He is also the co-author of "Between Husband and Wife." E-mail: slamb@desnews.com