Forms of depression
This very common disease — the World Health Organization says it affects 350 million worldwide — comes in many forms, from mild to so severe (in the case of suicide) that it’s fatal. In unipolar depression, there are dark moods and a lack of energy; appetite and sleep may be affected, becoming either excessive or insufficient. Other symptoms can be poor concentration, indecisiveness, a loss of interest in previous pleasures, anxiety, numbness, emptiness, hopelessness, crying spells, unexplained physical pains, a generally negative outlook, low self-esteem, guilt, feeling alone in the world and even a feeling that everyone you know would be better off without you around. When severe, these symptoms can prevent the sufferer from functioning at work or socially or with any of life’s responsibilities.
In another form of depression called bipolar disorder, periods of depression alternate with periods of feeling normal and “manic” episodes of hyperactivity, little sleep, racing thoughts and increased self-esteem.
Whatever the cause, depression is not something people experience on purpose or willfully bring on themselves. It’s not a character flaw or a weakness. It is rather a chemical imbalance in the brain’s neurotransmitters (like serotonin, norepinephrine and dopamine) that is not yet thoroughly understood by medical science. A combination of factors, such as genetics, substance abuse, traumatic events like a breakup or death of a loved one, or abuse or other violence, whether recent or long ago, can make it more likely to occur.
Other serious health conditions, such as heart disease or cancer, can exacerbate the condition. So can a minimal social network, with little contact with family or friends. In a vicious circle, it can lead to other serious health problems as well, to alcohol and drug dependence, conflicts in relationships, work and school, and worse, to self-mutilation or suicide.
Treatment options
While not quite curable, depression is highly treatable. The first line of attack is either talk therapy or medication, for milder cases, and for the more severe, a line of attack using both is often effective.
Prozac appeared on the shelves in the late 1980s. When I worked in a medical office and asked patients what meds they took, it seemed very, very common indeed. Patients who were on it seemed giggly and silly to me, not depressed at all. At the time it may have been overprescribed. All you had to do is tell your family physician you’d been feeling unhappy lately and you’d get some.
Prozac is part of a commonly prescribed family of SSRIs (or selective serotonin reuptake inhibitors) that includes Zoloft, Paxil and Celexa. Also used can be SNRIs (serotonin and norepinephrine reuptake inhibitors) like Cymbalta. Others around for a while include Elavil (a tricycline antidepressant, or TCA), Wellbutrin (bupropion) and lithium.
