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Depression widespread and treatable, but the stigma and the costs deter many from a more normal life By
Dusty Decker
For more than two weeks do you feel sad, blue, unhappy, or "down in the dumps?" Do you feel tired having little energy, unable to concentrate? Do you have trouble sleeping or eating (too little or too much)? ----- A. Never B. Rarely C. Sometimes D. Very Often E. Most of the time. These are three of seven questions taken from an online depression-screening test done by the department of psychiatry at the New York University School of Medicine. A young man we'll call Jared, 19, got used to answering questions like these before he was 15. That is the age that he started taking medication to treat major depression. "I was raised differently, my parents weren't idiots," he said. He considers himself lucky because he understands his illness. He's read up on a lot of information thanks to his dad, who knows a lot about it because of all the books he has read and the seminars he has gone to. "He knows his stuff and I know my stuff more so than most people that have it who take medication, because he's given me reading material and stuff to learn and read about my problem and so I'm way better off than most," Jared said. He stands over 6 feet tall and has short, blond hair and blue eyes. He stays active by going to the gym and climbing, mountain biking and skiing. He likes to joke around and laugh with people. Anyone who meets him would think he was high on life. He is appreciative of his parents, who have had some practice combating major depression. They have six sons, and Jared, second to the youngest, is the third to suffer from it. The oldest son has had the hardest time because he denies having a problem, but he is doing better. He just graduated from college and is trying to get a job. The third to oldest son also has depression. He was doing OK until he went on a mission for the LDS Church. He wasn't on medication then and he had a hard time. When he returned home the medication no longer worked for him, "so that's just a sad story," Jared said. About medication he explained, "Even with your medication it raises your tolerance level for what you can handle and what you can't up to a fairly normal level and then you'll get in a situation where a lot of people can't hack it either and you'll crash." Symptoms Major depression involves at least two weeks of deep despair and at least four of the following: sleep problems, appetite problems, lack of energy, feelings of worthlessness, hopelessness, and or terrible guilt, difficulty concentrating, or unusual indecisiveness and suicidal thoughts or suicide attempts. Jared explained his symptoms, "Your mood doesn't change based upon environmental cues; the world seems like gray and bleak there's no color or variance everything is bad. You can't eat you can't sleep. You can't let go of things . . . you can't dismiss ideas." He also said, "You can't sleep because you're brain keeps thinking things through, that happened that day, that's why you'll get these twisted ideas about the world. You can't eat; you have no appetite. If you can't eat and you can't sleep you're going to want to die, you don't want to take responsibility for anything, you can't make decisions, you see that you're incapable of all this stuff and so then you become afraid of it, because you can't do normal things. "You want more than anything to be able to do it but you can't and so you feel like you're just a waste." According to Jared, his depression did not allow for emotions and feelings. "It's not the same for you as it is for everybody else because your incapable of understanding or feeling what they are or what they're doing or why they're doing it and so you develop things that go against that and you can't function in the world." Jared said. Different statisitics have been given on the suicide rate of depression. According to a report of the U.S. surgeon general, major depression disorders account for 20 percent to 35 percent of suicides. However the National Depressive and Manic Depressive Association states that "more than 15 percent of people untreated or undertreated for depressive disorders kill themselves." WebMD Health, an online internet source, published an article recently that denounced the 15 percent statistic. It said that the statistic was only of people, hospitalized for depression and the risk is higher for those people than for ones treated in an outpatient setting. John Michael Bostwick, MD, a psychiatrist at the Mayo Clinic in Rochester, Minn., concluded that the statistic was incorrect. He said that there was actually an 8.6 percent chance of suicide among those hospitalized after suicide attempt or for suicidal thoughts; a 4 percent chance that those hospitalized for depression, but not for suicide and only a 2 percent chance for someone treated for depression as an outpatient. The biggest concern is that medication is sold based on those previous statistics and Bostwick said, "There is a lot to suggest that we need to put our efforts toward the two-thirds of people who kill themselves who have never had any contact with mental health professionals." Psychiatrists are still just as concerned about suicide and know that losing one patient to suicide is losing too many. To Jared it goes beyond statistics, it is a simple fact: "People aren't willing to believe that if they don't get help they die but that's what happens." Fear Jared explained how irrelevant the idea of death becomes for someone who is severely depressed. "You just get to a point where you don't care if you're dead or not, you don't care if the next day you got hit by a bus like it would be no loss to you and so you just start acting different and doing things in a way that are different, it's like self-destruction." He added, "You honestly, completely and thoroughly don't care if you're living or dead. That's a scary position to be in yourself and it's scary for the people around you too, because [if] you get into a dispute with someone like that, they're going to be willing to take it further than you are no matter what." Depressed people can get to a point where "they just plain and simple don't care about normal things they don't value life, they don't value people's feelings, they don't value anything," Jared said. He has seen people get to this state and he said that to see the disease in its full entirety would scare anyone. "You're looking in the other person's eyes and like they want to kill ya and in their mind, when you're looking at their mind, it's this other level of crazy. They want to kill you and it's not because of anything you've done necessarily, it's because they've convinced themselves that you deserve to die in some weird sick way. It will scare anybody. It's like a serious thing when it gets to that point and they don't get help." Jared knows what it feels like to get angry. "You feel like throwing stuff, you feel like yelling, you feel like breaking things, hurting things. It's not like a huge thing, but when you're depressed you feel like that all the time, it's a miracle that you don't do it more often. Like I'd go outside and I'd beat up the fence and just break it to break it, it was like, why not?" Causes The causes for depression can be genetic, biological, personality and environmental factors. Jared's depression is inherited since his brothers have it also. According to the surgeon general, 20 million adults are affected by major bouts of depression. A bout that goes untreated can last up to nine months and 80 percent to 90 percent of untreated individuals will experience another episode within two years. Jared and his parents do not know where depression came from in their family. It's not an easy illness to trace because a couple of generations ago, it was not diagnosed and treated as it is now. It is crucial to understand that the kind of depression Jared has, does not have anything to do with his environment. Instead, it has to do with chemicals in his brain that he is lacking. That is why medication was not an option but a must for Jared, who was feeling the full symptoms of depression at age 15. Minor symptoms existed since he was a child but they did not get bad until later. Depression usually does not fully hit until the child reaches adolescence and sometimes a person does not experience it until their late 20s. He said, " I wasn't really happy all through middle school or elementary." He didn't have a desire to play with friends. The biggest problem with depression is that it often goes untreated and when that happens people begin to develop thoughts and feelings about the world that are wrong. Medication The first drug Jared started taking was Zoloft, an anti-depressant that helped him, but he said it gave him heartburn so he started taking a new drug called Celexa. It was first allowed into the United States a few years ago, but it has been actively used in Europe for 10 years. Both drugs are in the SSRI family of medication, which centers on serotonin, a chemical in the brain. The medications helps to make more of that chemical so that the brain will have the right level. Each medication has their own way of doing that and each have different effects on the brain. With Celexa, Jared hasn't noticed any side effects. For him he understands that being on medication is crucial. Once he found medication that worked, life got a lot better. "I got a hit on it, you can experience emotion, you'll experience emotion besides pain, like you can experience laughter you can experience happiness and you can experience like feelings toward people. You can sleep, you can eat. Like you get motivation and you want to go do stuff because you can experience things," Jared said. He wasn't just lucky with his medication by accident. His parents also had the money to take him to the doctors who understood his problem and how to treat it. Jared says that the best way to deal with depression like his is to have two doctors, a neurologist and a psychiatrist. The neuro doctor works on the chemical combination of medication and dosage so that he can find a hit that will allow the patient to experience normal things. The psychiatrist or cognitive doctor, Jared said, "works through all of the ideas and things you've come up with that are not correct and he separates them and he helps you work through that so you can understand other people [and] you can understand the world that you're in." As for the individuals who cannot afford treatment, Jared said, "They're screwed, if you can't afford help, you won't get it." Depressed people might see doctors but they will not get prescribed the right medication, the doctors will just pick one at random and keep trying different ones. Even if the right medication is prescribed, it might be the wrong dosage. Once a hit on medication is found for a person with depression it is important that they keep taking the medication, Jared explained. If they don't take it or go off it for a while than it might not work a second time. He said, "In a way they're playing with their life." "To me it's not worth the risk to try to go off it, I'm just planning on taking it for the rest of my life everyday. I consider myself very luck," He said. Not everyone shares in this appreciation for medication to combat depression, but Jared doesn't think they should. If they are depressed because of environmental issues than drugs probably aren't going to help them. That's the problem though, some doctors don't take the time to figure out where the depression is coming from, they just prescribe a drug and overlook the fact that some individuals only need a couple months of counseling. Stigma Some people do not like to take medication because they don't want to admit they have a problem. "The high majority of people wont accept the medication and it's because the world around them doesn't really accept it as anything like what it really is," Jared said. He also said, "a person has to be able to just forget about all that stuff and just do it for themselves and not be doing it for other people. A lot of people can't do that." Many feel that if they take medication they aren't normal. Jared never forgets to take his medication and says that he never will. He also says that it depends on how you have been raised. If parents do not accept that their child has a problem than they are not going to fully accept the fact that their son or daughter needs to take the medication and neither will the child. Some parents will even say things to their child like, "did you take your happy pill today?" There is a high success rate for treating major depression but according to an article in the San Diego Union-Tribune, access to services to diagnose and treat mental illnesses is worse because businesses, insurance plans and managed care companies have cut benefits in order to cut costs. According to the article, 50 million people will experience mental illness each year and if left untreated those different mental disorders are among the most disabling conditions people experience. These disorders are as effectively treated as any other medical problem as long as people are allowed treatment. Currently it is difficult for patients to get mental health coverage because of limits set by the majority of health plans, and once a patient is in treatment, definite efforts are made to terminate or shorten the treatment or significantly higher co-payments are demanded. This in turn cheats society because of worker absenteeism and turnover along with suicides, homelessness and involvement with the criminal justice system. Not to mention how it affects children and older citizens. About 14 million children in the nation have a mental disorder and only one-third receive help. Also, Americans between 80 and 84 years old have the highest suicide of any population group -- twice as high as the general population. Normal Life Even with medication and understanding of his problem, Jared has to be careful. About once a month he gets depressed for a couple of days, but he never has a problem with bouncing back. "You get problems you get hard times more so than average, but generally speaking I'm doing really good, like I can hold a job, I can fall asleep at night and I can have an appetite and if you can do those three things than you're doing pretty good," he said. The difference, Jared explained, is when you're depressed you get to a point where you almost want to kill people, but when you're normal you get sad and angry. However, it doesn't last for over 24 hours, but you might be the other way for over a week. Jared has been going to Bridgerland Applied Technology Center. He recently passed his test that certifies him with Cisco Systems. Right now, he is thinking about being a network engineer. He also likes to work on cars. For Jared life is normal. He said, "I think that I've got myself to the point where I could be married because if I did have a crash or a go down I would know what to do, I have the skills to at least be able to try to do everything in my power to get so I could be normal again. There's people out there with the qualities that we could make it through that, certain people have those kind of qualities." He added, "There was a point where you as a person are incapable of being married like there's no way in that state that you could be married to someone you're also in that state you're incapable of holding a job." Jared recognizes that he has devoted parents. They helped him a lot and still do and because of them, his life is normal. He said, "I live to recreate. I don't get satisfaction out of work I don't get satisfaction out of other people's opinion and a lot of the reason for that is because of what I've been through. I just get satisfaction out of things that are fun, like I live to go out and climb and to mountain bike or just hang out with people and laugh and stuff. "I'll never take that stuff for granted. That's what gets taken away from you when you have depression." In some ways, Jared has an even higher appreciation for life. "It doesn't matter how long I'm not ill, I'll still never take it for granted."
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