Depression

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Depression

Treat an Illness, Not a Weakness

If you're depressed to the point that you can't sleep, can't concentrate and don't want to get out of bed, you're not alone. More than twice as many women as men have severe depression that can linger for several months, even years, if not treated. Sometimes depression can lift only for symptoms to recur, says Ellen McGrath, Ph.D., a clinical psychologist in Laguna Beach, California, and New York City, chairperson of the American Psychological Association's National Task Force on Women and Depression and author of When Feeling Bad is Good.

Women are also more likely than men to experience mild depression--to feel overwhelmed, powerless, discouraged, ineffective or sorrowful and possibly angry or guilty. These feelings last longer than the blues but typically lift after several hours or days, says Dr. McGrath.

WHY SO SAD?

Research suggests that our genes and biochemistry, our circumstances and our personal history can all--independently or in combination--contribute to depression. It's an illness, not a character flaw, and experts say that it runs in families. People with severe depression seem to have a brain chemistry that predisposes them to bouts. Hormonal changes that precede menstruation and follow pregnancy also appear to play some role. Losses, disappointments, difficult relationships, stress and past trauma can all contribute. So can other illnesses or certain prescription drugs, including oral contraceptives.

"We don't know why depression is more common in women, but a number of theories exist," says Leah J. Dickstein, M.D., professor and associate chair for academic affairs in the Department of Psychiatry and Behavioral Sciences and associate dean for faculty and student advocacy at the University of Louisville School of Medicine and past president of the American Medical Women's Association. "In addition to hormonal and biochemical differences, it may be caused by the added stress in a society where women don't get the same opportunities and respect that men do. Differences in the ways that boys and girls are socialized may also leave women more vulnerable."

Then there are relationships: Unhappily married women run 25 times the risk of depression that happily married ones do, says Carol Landau, Ph.D., clinical professor of psychiatry and human behavior at Brown University School of Medicine in Providence, Rhode Island. No big surprise. But it doesn't end there: Dissatisfaction with other roles--as mother or as employee--can have a similar effect. A study comparing stay-at-home moms and working mothers found that the mothers who were most depressed were those who were unhappy with their roles--whatever they were.

WHAT YOU CAN DO FOR MILD DEPRESSION

Studies suggest that depression takes a toll on the immune system, leaving us more susceptible to illness, and may increase our risk of heart disease. If severe, it can lead to thoughts of suicide, so severe depression warrants professional treatment. Mild depression can respond to some tender self-care, says Dr. McGrath. Here's what she and other experts suggest.

Get some exercise. Studies show that exercise alleviates depression by reducing stress and raising levels of feel-good substances in the brain, notes June Pimm, Ph.D., a clinical psychologist and associate professor of pediatrics and psychology at the University of Miami School of Medicine.

So get up and walk, even if it's the last thing that you feel like doing, says Dr. McGrath. "Remind yourself, 'I can do this. It'll be worth it; I only have to take a few steps,'" she says. Set a goal of exercising 20 minutes a day, three times a week.

When To See A Doctor If you have five or more of the following symptoms for more than two weeks, experts recommend that you consult a physician or counselor. * Persistent sad, anxious or empty feelings * Loss of interest or pleasure in activities * Feelings of hopelessness and pessimism, guilt, worthlessness or helplessness * Insomnia or oversleeping * Appetite loss or overeating * Fatigue * Restlessness * Irritability * Difficulty concentrating or remembering * Persistent headaches, digestive trouble or chronic pain that won't respond to treatment Even if you have none of the above symptoms but have thoughts of death or suicide, you should seek help, stresses Leah J. Dickstein, M.D., professor and associate chair for academic affairs in the Department of Psychiatry and Behavioral Sciences and associate dean for faculty and student advocacy at the University of Louisville School of Medicine and past president of the American Medical Women's Association. You should also seek help if: * Depression interferes with your work or relationships. * You experience periods of depression alternating with periods of extreme euphoria, or mania. Your doctor should first attempt to identify or rule out physical illnesses--like thyroid disorder--that can cause symptoms similar to those of depression, says Dr. Dickstein. If your physician diagnoses depression, she may prescribe antidepressant medication to correct brain chemical imbalances that can perpetuate it, along with talk therapy or cognitive or behavioral therapy.

Explore your feelings on paper. "If you don't feel like yourself, it may not be enough to sit down and ask yourself, 'Why am I feeling different? Am I depressed?'" (Although it's a start, suggests Dr. Pimm.)

It can help to write about or illustrate your feelings in a journal, says Dr. McGrath. Note the time, place and situations in which you feel out of sorts. Eventually, patterns may emerge. You may find that you're likely to get depressed in certain circumstances. "The writing stops you from obsessing and ruminating so much, so the issues become clearer," Dr. McGrath says.

If you can determine what is contributing to your depression, the next step is to figure out how to address it, says Dr. McGrath.

Confide in friends. When you're depressed, bed may seem the safest place. It isn't. Social isolation contributes to depression, says Dr. Landau. If you're down, make a particular point of seeking out and confiding in supportive friends, even if only by phone.

While it's important to get out there and be with people, avoid taking on too many responsibilities, since stress feeds depression, warns Dr. Pimm. "The conventional wisdom is that a large social network is a buffer against depression, but that isn't necessarily true for women," she says. "For many women a large social network means a lot of responsibility--for children who can create anxiety, for parents who need to be taken care of, and so on."

Steer clear of whiners and complainers. Try to avoid relationships that are all work and no gain. By all means, don't let guilt or a sense of obligation keep you in a relationship that you don't enjoy, says Dr. Landau. They'll make you feel worse, not better.