``The depression came out of the blue. Nothing had happened to cause it that I could ever figure out. The sickeningly familiar, terrible feelings came flooding back-self-doubt, anxiety, sadness, hopelessness, thoughts of dying.`` - Lissa Falk, 39, high school counselor, at a National Institute of Mental Health press conference.
Maybe it would help if the disease had another name.
``Depression`` sounds too much like a transitory emotion, something a person could snap out of if he really tried. ``Mood disorder,`` which is also used, somehow implies nothing more serious than some mixed-up feelings, especially when self-help books talk about ``mood therapy`` and stress variations on old-fashioned positive mental attitudes. ``Affective disorder`` makes no sense to most laypersons.
No wonder the National Institute of Mental Health finds it necessary to mount a new national campaign to push ``depression`` into public awareness, along with the crucial message that when it is correctly diagnosed, most cases of depression can be effectively treated and its agonizing symptoms relieved. What the NIMH is fighting is actually a physiologic disorder caused by abnormalities in chemicals in the brain that affect feelings and actions. At least one form of depression is linked to a genetic error that is passed along through families in traceable patterns. One such abnormal gene has been located near the end of the short arm of chromosome 11.
``I was irritable, overreacting and crying at the drop of a hat. I lost my appetite, began sleeping a lot more and noticed that although I was going through the motions, nothing seemed to have any meaning or be much fun.``
``Depression`` isn`t the ``blues.`` It isn`t sadness or discouragement or disappointment or frustration or irritability or hopelessness that are normal reactions to distressing life events-although it may feel like all of these emotions. It may even coincide with real situations that normally do generate such feelings.
But what the NIMH is battling is darker, more persistent, inexplicably severe in the context of a victim`s life. It can`t be relieved by well-meant advice to buck up or shape up or snap out of it or by will power,
determination or the traditional talking treatment of psychotherapy. In fact, efforts to treat ``depression`` as a classic ``mental health`` problem have long delayed its diagnosis as a disorder in brain chemistry and the search for effective medication.
``I began snapping awake very early in the morning and feeling sick to my stomach as if something awful was about to happen. Every morning became a struggle to make myself get up and go to work. But the weekends were worse because then there was nothing to take my mind off my thoughts.``
Every year, about 10 million Americans experience a serious depressive disorder. It costs the nation about $16 billion annually, including $10 billion in lost productivity. It is a major cause of suicide. An estimated 40 to 80 percent of people who kill themselves have a record of depression, a disease that prevents them from coping with problems and with their life as other people manage to do.
``When I got home from work I was exhausted, so I went to bed. I tried to watch TV as a diversion, but it got harder and harder to pay attention. I stopped going out with friends and even answering the phone, the mail piled up, household chores seemed pointless and went undone. My thoughts were confused and increasingly irrational. I believed I was in a hopeless situation with no options and that life would never get any better. Suicide seemed like the only way to escape the constant pain I was in.``
The NIMH`s current campaign doesn`t stop with pushing for public recognition of depression as a clinical disorder. It notes that only about one-fourth of the people suffering from serious depression get effective treatment-but 80 percent could recover with correct diagnosis and help, usually in weeks.
What is most likely to work are three groups of anti-depressive medications: tricyclics, monoamine oxidase inhibitors (MAOS) and lithium. It may take some experimenting to find the best drug and dosage for an individual. Often it helps to combine the medications with psychotherapy.
``Here I am today-healthy, happy and productive. . . . Therapy and medication have controlled my depression. I try not to look back but my biggest regret is just that I wish someone had been able to figure out sooner what was happening to me. If you know what to look for, this illness is easy to spot. Once diagnosed, depression can be treated. Years of suffering are not necessary.``
Maybe if NIMH renamed depression after a leading researcher (as Down syndrome is identified) or for a prominent victim (Lou Gehrig`s disease, for example) or by an acronym describing its clinical basis (such as AIDS), it would be easier to get across the life-saving message that this is a real illness, not just a bad mood, and that it can be treated effectively. It`s a long-overdue understanding.