Everyone has ups and downs. But if you find that you are frequently down or that your feelings of being down seriously interfere with your usual activities, depression may be a likely diagnosis. Depression can be triggered by a major life event, such as the death of a loved one, separation, divorce, or a health problem (12 percent to 36 percent of patients with medical disorders develop depression). It also can be caused by an underlying medical disorder or interactions between various drugs. Chronic drinking of alcohol, even in moderate amounts, can cause or worsen depression.

Depression can be mild to severe. Many depressed people describe their condition as "living in a fog." They have limited interest in the activities of daily living. If you suspect that you or a loved one is clinically depressed, it's best to see your doctor for a professional evaluation. An estimated 80 percent of depressed individuals can be treated, with most feeling better within weeks.

More than 18 million people in the United States suffer from depression. About twice as many women as men suffer from this medical condition. Major depression is a whole-body illness that affects a person's body, feelings, thoughts, and behavior.

Everyone experiences bouts of the blues or periods of sadness now and then. However, if these feelings last more than a couple of weeks or interfere with daily life, a person may be suffering from clinical depression.

Depression involves a set of symptoms that can last for months and sometimes years. It is not a sign of personal weakness or a condition that can be willed or wished away. People with depression cannot merely "pull themselves together" and get better. Professional treatment is needed.
 

What's the difference between a bad case of the blues and depression? The difference between depression and feeling down is how severe the symptoms are and how long they last. To help you determine if you are depressed, answer these questions.

• Do you often or usually feel sad, anxious or "empty"?
• Do you sleep too little or too much?
• Has your appetite shrunk, and have you lost weight? Or do you have a bigger appetite, and have you gained weight?
• Have you lost interest in activities you once enjoyed?
• Are you restless or irritable?
• Do you have persistent physical symptoms, such as headaches, chronic pain or constipation, that don't respond to treatment?
• Do you have difficulty concentrating, remembering or making decisions?
• Do you often feel tired or have a lack energy?
• Do you feel guilty, hopeless or worthless?
• Do you have recurring thoughts of death or suicide?

If you or a loved one answered yes to three or more of these questions and have felt this way for longer than two weeks, or if the symptoms interfere with your daily routine, please contact us to help determine the best course of action.

The key to helping yourself or a loved one overcome depression is to understand the effects of depression on day-to-day living. These Quick Facts are the perfect way to start developing an understanding of depression and to prepare yourself to further explore the informative content below.

• Depression is a medical illness, not a character weakness.
   
• One in ten Americans each year experience a depression.
   
• Depression does not discriminate; it affects men and women, young and old, and people of all races, cultures, and incomes.
   
• Major Depression is 1.5 to 3 times more common among first-degree biological relatives of those with the disorder than among the general population.
   
• The economic cost of depression is estimated at $30.4 billion a year but the cost in human suffering cannot be estimated.
   
• By the year 2020, the World Health Organization (WHO) estimates that depression will be the number two cause of "lost years of healthy life" worldwide.
   
• According to the U.S. Centers for Disease Control and Prevention (CDC) suicide was the ninth leading cause of death in the United States in 1996.
   
• Two-thirds of people suffering from depression do not seek necessary treatment.
   
• 80% of people who have received treatment for their depression experience significant improvement in their lives.

Depression isn't a part-time problem. It can easily affect a person's performance in the office as much as it does in the home. The added stress of daily workloads, deadlines and professional communications may help to agitate the affects of depression.

At any one time, 1 employee in 20 is experiencing depression.

While more than 80% of depressed people can be treated quickly and effectively, nearly two out of three people with depression do not receive the treatment they need. Unfortunately, many depressed people suffer needlessly because they feel embarrassed, fear being perceived as weak, or do not recognize depression as a treatable illness.

Signs of depression in the workplace may include:

• Decreased job performance or productivity
• Difficulty attending to or concentrating on assignments
• Difficulty in decision making
• Withdrawal or irritability with coworkers or supervisors
• Safety risks and accidents
• Absenteeism
• Unexplained aches and pains
• Alcohol and drug abuse

While the issues one may be facing are of a personal nature, when they manifest in the work setting, they may quickly escalate into a professional problem. The key is to recognize the symptoms of depression early and to receive appropriate treatment. CONCERN:EAP can assist you in locating the appropriate treatment resources and helping you manage any work performance issues that you are facing.

One of the most common places to find and fight depression is in the home. Depression in the home can come from almost any direction. Perhaps the depressed person is involved in a tense relationship or is going through a divorce. Perhaps a child is having trouble performing at school or adjusting to a new area after a move. Caring for an aging or disabled relative in the home may also magnify the effects of depression.

What is known is that depression can run in families. Depressed parents may have depressed children. Knowing how to overcome depression in the home will help you create a place focused at supporting those affected, instead of a place that enables the illness to grow.

The most important thing anyone can do for the depressed person is to help him or her get an appropriate diagnosis and treatment for depression. This may involve encouraging the individual to stay with treatment until symptoms begin to abate (several weeks), or to seek different treatment if no improvement occurs. On occasion, it may require making an appointment and accompanying the depressed person to the doctor. It may also mean monitoring whether the depressed person is taking any prescribed antidepressant medication. The depressed person should be encouraged to obey the doctor's orders about the use of alcoholic products while on medication.

The second most important thing is to offer emotional support. This involves understanding, patience, affection, and encouragement. Engage the depressed person in conversation and listen carefully. Do not disparage feelings expressed, but point out realities and offer hope. Do not ignore remarks about suicide. Report them to the depressed person's therapist.

Invite the depressed person for walks, outings, to the movies, and other activities. Be gently insistent if your invitation is refused. Encourage participation in some activities that once gave pleasure, such as hobbies, sports, religious or cultural activities, but do not push the depressed person to undertake too much too soon. The depressed person needs diversion and company, but too many demands can increase feelings of failure.

Do not accuse the depressed person of faking illness or of laziness, or expect him or her "to snap out of it." Eventually, with treatment, most people do get better. Keep that in mind, and keep reassuring the depressed person that, with time and help, he or she will feel better.

Depression has many causes. Often it's triggered not by a single factor but by a combination of factors, such as genetic vulnerability, stress, or changes in brain chemistry:

Biochemistry

Disturbances in chemicals in the brain, like serotonin and norepinephrine, are thought to be connected to certain symptoms of depression, including anxiety, irritability and fatigue. Brain cells are designed to produce optimal levels of neurotransmitters to keep senses, learning, movements, and moods perking along. But in some people who are severely depressed or manic, the complex systems that accomplish this go awry. For example, receptors may be oversensitive or insensitive to a specific neurotransmitter, causing their response to its release to be excessive or inadequate.

Genetics

Depression runs in families. For example, if one identical twin has depression, the other twin has 70% chance of also having the illness sometime in life. Thus far, experts say genes alone are not known to trigger bipolar disorder or any form of depression. Rather, these illnesses probably result when genetic variations that create vulnerability are amplified by environmental factors, including early losses or chronic stress.

Thinking Patterns

How resilient you are in the face of difficult life events, such as a job loss or divorce, may depend partly on your temperament and view of the world. Temperament-for example, how excitable you are or whether you tend to withdraw from or engage in social situations-certainly helps dictate behavior. People with low self-esteem, who are easily overwhelmed by stress, or who are generally pessimistic appear to be more vulnerable to depression.

Environmental Factors

Repeated exposure to violence, neglect, poverty or physical, sexual or mental abuse may make people who are already susceptible to depression all the more vulnerable to the illness. When an individual is unaware of the wellspring of his or her illness, he or she can't easily move past the depression. Moreover, unless the person gains a conscious understanding of the source of the condition, later losses or disappointments may trigger its return.

Other Medical Conditions

People with chronic illnesses such as asthma, diabetes, cancer, stroke, chronic pain, alcoholism or other drug disorders, heart disease or HIV are at higher risk for depression. There is no doubt that the stress of having certain illnesses-diabetes or cancer, for example-can trigger depression. In other cases, depression precedes the medical illness and may even contribute to it. To find out whether the mood changes occurred on their own or as a result of the medical illness, a doctor carefully considers a person's medical history and the results of a physical exam.

The Birth of a Baby

Although getting the "blues" is common among new mothers, symptoms that are prolonged or severe may indicate postpartum depression. Please see the section on Postpartum Depression for further information.

Depression in Women

Women experience depression about twice as often as men. Many hormonal factors may contribute to the increased rate of depression in women-particularly such factors as menstrual cycle changes, pregnancy, miscarriage, postpartum period, pre-menopause, and menopause. Many women also face additional stresses such as responsibilities both at work and home, single parenthood, and caring for children and for aging parents.

A recent NIMH study showed that in the case of severe premenstrual syndrome (PMS), women with a preexisting vulnerability to PMS experienced relief from mood and physical symptoms when their sex hormones were suppressed. Shortly after the hormones were re-introduced, they again developed symptoms of PMS. Women without a history of PMS reported no effects of the hormonal manipulation.

Many women are also particularly vulnerable after the birth of a baby. The hormonal and physical changes, as well as the added responsibility of a new life, can be factors that lead to postpartum depression in some women. While transient "blues" are common in new mothers, a full-blown depressive episode is not a normal occurrence and requires active intervention. Treatment by a sympathetic physician and the family's emotional support for the new mother are prime considerations in aiding her to recover her physical and mental well-being and her ability to care for and enjoy the infant.

Depression in Men

Although men are less likely to suffer from depression than women, 3 to 4 million men in the United States are affected by the illness. Men are less likely to admit to depression, and doctors are less likely to suspect it. The rate of suicide in men is four times that of women, though more women attempt it. In fact, after age 70, the rate of men's suicide rises, reaching a peak after age 85.

Depression can also affect the physical health in men differently from women. A new study shows that, although depression is associated with an increased risk of coronary heart disease in both men and women, only men suffer a higher death rate.

Men's depression is often masked by alcohol or drugs, or by the socially acceptable habit of working excessively long hours. Depression typically shows up in men not as feeling hopeless and helpless, but as being irritable, angry, and discouraged; hence, depression may be difficult to recognize as such in men. Even if a man realizes that he is depressed, he may be less willing than a woman to seek help. Encouragement and support from concerned family members can make a difference. In the workplace, employee assistance professionals can be of assistance in helping men understand and accept depression as a real illness that needs treatment.

Depression in Children

Only in the past two decades has depression in children been taken very seriously. The depressed child may pretend to be sick, refuse to go to school, cling to a parent, or worry that the parent may die. Older children may sulk, get into trouble at school, be negative, grouchy, and feel misunderstood. Because normal behaviors vary from one childhood stage to another, it can be difficult to tell whether a child is just going through a temporary "phase" or is suffering from depression. Sometimes the parents become worried about how the child's behavior has changed, or a teacher mentions "your child doesn't seem to be himself." In such a case, if a visit to the child's pediatrician rules out physical symptoms, the doctor will probably suggest that the child be evaluated, preferably by a psychiatrist who specializes in the treatment of children. If treatment is needed, the doctor may suggest that another therapist, usually a social worker or a psychologist, provide therapy while the psychiatrist will oversee medication if it is needed. Parents should not be afraid to ask questions: What are the therapist's qualifications? What kind of therapy will the child have? Will the family as a whole participate in therapy? Will my child's therapy include an antidepressant? If so, what might the side effects be?

The National Institute of Mental Health (NIMH) has identified the use of medications for depression in children as an important area for research. The NIMH-supported Research Units on Pediatric Psychopharmacology (RUPPs) form a network of seven research sites where clinical studies on the effects of medications for mental disorders can be conducted in children and adolescents. Among the medications being studied are antidepressants, some of which have been found to be effective in treating children with depression, if properly monitored by the child's physician.

Depression in the Elderly

Some people have the mistaken idea that it is normal for the elderly to feel depressed. On the contrary, most older people feel satisfied with their lives. Sometimes, though, when depression develops, it may be dismissed as a normal part of aging. Depression in the elderly, undiagnosed and untreated, causes needless suffering for the family and for the individual who could otherwise live a fruitful life. When he or she does go to the doctor, the symptoms described are usually physical, for the older person is often reluctant to discuss feelings of hopelessness, sadness, loss of interest in normally pleasurable activities, or extremely prolonged grief after a loss.

Recognizing how depressive symptoms in older people are often missed, many health care professionals are learning to identify and treat the underlying depression. They recognize that some symptoms may be side effects of medication the older person is taking for a physical problem, or they may be caused by a co-occurring illness. If a diagnosis of depression is made, treatment with medication and/or psychotherapy will help the depressed person return to a happier, more fulfilling life. Recent research suggests that brief psychotherapy (talk therapies that help a person in day-to-day relationships or in learning to counter the distorted negative thinking that commonly accompanies depression) is effective in reducing symptoms in short-term depression in older persons who are medically ill. Psychotherapy is also useful in older patients who cannot or will not take medication. Efficacy studies show that late-life depression can be treated with psychotherapy.

Improved recognition and treatment of depression in late life will make those years more enjoyable and fulfilling for the depressed elderly person, the family, and caretakers.

The first months of a baby's life should be a time of joy for new parents. But for many new mothers, these months are marked by sadness, fear, anger or anxiety.

It's common to have short spells of sadness or grouchiness after giving birth, because of the pain, change in hormone levels, and lack of sleep. But sometimes the feelings are extreme and won't go away. These feelings may be signs of postpartum depression.

The baby blues can make a new mother feel alone, afraid and exhausted. These feelings are common and normal. But women who suffer from postpartum depression are so overwhelmed by these feelings that they can't function normally. They feel hopeless and anxious. They may feel angry at their partner or at their baby. They may begin to wonder whether they are cut out for motherhood.

Talk with your doctor if you experience any of the following warning signs:

• Sadness or anxiety that lasts for more than two weeks after giving birth
• Strong feelings of depression and anger that appear a month or two after your baby is born
• Increased or decreased hunger
• Anxiety or panic attacks
• Trouble sleeping
• Sleeping too much
• Fear that you might hurt your baby or yourself
• Sadness, guilt or hopelessness
• Little interest in your baby or other members of your family

It's important to know that although postpartum depression can be serious, it doesn't mean that you're unfit to be a parent. Pain from giving birth and changes in your body may contribute to the depression. The sudden drop in hormones and lack of sleep may also be factors.

Postpartum depression can be treated. The sooner it is diagnosed, the sooner you can begin to enjoy the new member of your family. But you must get professional help to be diagnosed and treated.

If you have the symptoms of postpartum depression, you can do a lot to improve your situation. In addition to talking with a doctor, it's important to take the following steps:

• Rely on your family and friends. By talking with friends and relatives who have children, you may also find others who have dealt with similar emotions.
• Share your feelings, no matter how frightening they may seem, with your partner.
• Try to create some private time for yourself.
• Get the support of your partner, and ask for help with cooking, cleaning and taking care of the baby. And don't be afraid to speak up when you feel overwhelmed.
• Getting help for postpartum depression starts with recognizing the symptoms, and then realizing that you are not alone. If you or a loved one is living with postpartum depression, seek advice from your doctor right away.

Treatment Strategies

The first step to getting appropriate treatment for depression is a physical exam by a physician.

Certain medications as well as some medical conditions can cause the same symptoms as depression, and a physician should rule out these possibilities. If a physical cause is ruled out, a diagnostic evaluation should be done. This is frequently done by referral to a psychiatrist or other mental health professional such as a psychologist or clinical social worker.

Treatment choice will depend on the outcome of the evaluation. There are a variety of antidepressant medications and psychotherapies that can be used to treat depression. Some people with milder forms do well with psychotherapy alone. People with moderate to severe depression most often benefit from antidepressants. Most do best with combined treatment: medication to gain relatively quick symptom relief and psychotherapy to learn more effective ways to deal with life’s problems.

Recovery and Treatment

As you continue in treatment, you will see that your mood and energy level will improve.

The symptoms of your depression will start to disappear. As you begin to feel better, it will become easier to live a normal life again.

At this point many people make the mistake of thinking their depression is cured.

They may stop taking their medicine. They may stop going to therapy. However, it is important that you continue treatment. If you don't, the chances that your symptoms of depression will return are high. This is called a relapse. Relapses are discouraging because the symptoms you have worked hard to overcome reappear. Usually, treatment must start all over again.

Stages of Recovery

Feeling better.

Recovery occurs in stages. There may be a time when some or all of your symptoms of depression have disappeared. You may seem to be your previous self. It may seem as though your depression has been successfully treated. However, it is important to continue your medication or therapy to avoid a relapse. Talk with your doctor or therapist about the improvements you notice. Discuss if and how your treatment will change as a result of your improvement.
 

How long should antidepressant treatment continue?

Depression can be treated, but it takes time. How long it will take should be discussed with your doctor. Recent treatment guidelines suggest that for a first episode of depression, medication should be taken for at least 9 months. One reason for this recommendation is that people who have been treated for depression are at risk for a relapse. You can lower this risk by taking medications exactly as your doctor prescribes.
 

If this is your first episode, at about 7-9 months you and your doctor should discuss the process for stopping medication.

Stopping medications should be done slowly over a period of weeks. Stopping medications all at once can result in side effects. When stopping medications, you should watch for the return of any symptoms of depression. If any symptoms begin to reappear, talk to your doctor. Close monitoring by your doctor will make sure that medication can be started again before you develop a full relapse.

Medication for depression is taken to help symptoms and to prevent the depression from recurring.

If you have been treated for past episodes of depression, medications may be prescribed for a longer time. Your doctor may even recommend that you continue using antidepressant medication indefinitely.

How long should therapy continue?

You and your therapist should discuss ending treatment together. Both of you can determine which areas have improved. You can also see which areas need further work. You and your therapist can decide if you both agree that treatment is no longer necessary.

Some therapists may recommend having fewer therapy sessions.

This is done as part of the process of stopping treatment. You need to maintain newly developed ways of thinking, feeling, behaving, and relating throughout this less frequent treatment. Therapists are also willing to restart treatment at a later date, if necessary.

Risk of relapse and maintaining improvements.

About half of the people who are diagnosed with depression have only one episode. For the other half, depression is a recurring illness. For most people with recurrent depression, the symptoms disappear completely between episodes. However, some people have lingering symptoms between episodes. Maintenance treatment is the long-term use of medications or therapy for people who have had more than one episode of depression. The more episodes of depression you have had, the more likely you are to have a recurrence. In such cases, your doctor may recommend treatment for several years or indefinitely.

In addition to continuing treatments, there are many things that you can do to slowly ease yourself back to normal.

Keep in mind that these things are important as you begin to feel better. They are even more important in maintaining your improved feelings.

If you don't feel better.

Treatment of depression takes time and patience. If you do not notice any improvement or changes after several months in treatment, do not get discouraged. Talking with your doctor or therapist about your lack of improvement will be important in finding a treatment that works for you. Speak with your doctor or therapist about any symptoms which you continue to have. Discuss your expectations for change.

If you are not already taking medications, you and your doctor or therapist should discuss whether medications may be appropriate.

If you are currently in psychotherapy and unhappy with the treatment, speak with your therapist before deciding to stop or go elsewhere for treatment. There are different approaches to treating depression and most therapists know how to work with several of these. If one doesn't work, together you can find one that will.

Managing Your Medication

How you manage your medications is important to a fast and successful recovery from depression.

Take your medication regularly and exactly as prescribed.

Take your medications even if you begin to notice that your depression is going away. Develop a reminder system so you don't forget to take your medications. For example, place all your medications in a pillbox. This will remind you which medications to take each day.

Communicate with your doctor.

Ask questions. Mention any reactions to the medication. Keep a record of any side effects. Tell your doctor how your treatment is working. Do not take any new medication until you talk with a pharmacist or the doctor who prescribed your antidepressant medication. This includes over-the-counter medications.

Keep all appointments with your doctor.

Meet with your doctor whenever you are scheduled to. Even if you feel well, it is important to keep all appointments with your doctor.

Make sure that you do not run out of medications.

Plan your prescription refills.

Do not drink alcohol while taking antidepressants.

Avoid drinking alcohol. Avoid the use of all drugs. If you do choose to use any of these substances, make sure to speak to your doctor about it.

Taking Care of Yourself

During the first few months when you feel better, you should think about areas of your life which may have led to, or worsened, your depression.

Think about the changes that need to be made. You may already know what kinds of changes are necessary.

While you are recovering you will continue to have daily demands on your time and effort.

This may be overwhelming at times. Be sure to care for yourself in the following ways:

Increase the amount of structure in your daily life. Maintain a consistent daily schedule.

Set small, realistic goals. Do one thing at a time. This way, tasks won't feel so overwhelming. Reward yourself for each goal you reach.

Practice thinking positively.

People who are depressed often have gloomy or negative thoughts about themselves. Blaming yourself, feeling hopeless, and expecting failure in the smallest tasks are examples of such negative thoughts. Begin to overcome these negative thoughts.

Challenge your negative beliefs.

Don't just accept them. If you find yourself thinking a negative thought about yourself, try to look at it another way. Often depression makes people think the worst. Stepping away from the problem and looking at it realistically can help you understand how your depression affects your outlook. Write the problem down. Think about it. You will see that your negative beliefs do not make sense.

Notice good things about yourself.

Noticing good things will help you put your negative thoughts in perspective. The negative thoughts you have may not be as accurate as you think.

Write down good things.

Write down even the small things that you feel good about. Write down the nice things other people say to you. Carry this list with you as a reminder that there are many things that you can do well.

Avoid making major life decisions when you feel depressed.

Depression changes how you think about yourself. Depression changes how you feel about situations. The decisions you make when you feel depressed may be clouded. Such decisions may not be in your best interest. If you must make a major decision about your life, ask your doctor, your therapist, or someone you trust to help you think about things. Once you start feeling better, begin making decisions again. But be sure to return to your responsibilities slowly and gradually.

Ask for help when you need it.

Depression changes the way you think about yourself. It is easy to think that no one wants to hear about your problems. It is easy to believe that you may be a burden to the people you talk to. However, there are people who want to help you. They want to understand what you are feeling. Your doctor, therapist, family members, and friends all want you to be well. Don't be afraid to ask people for help.

Don't criticize yourself when things go wrong.

Accept the fact that there will be setbacks. Feeling better takes time. Making positive changes in your life takes time. Sometimes changes can only be accomplished with trial and error. Allow yourself to be patient. Be sure to notice improvements.

Consider taking stress management or assertiveness courses.

These courses offer skills that may help you overcome your depression. These courses can help you deal with stress and relationship problems. These kinds of courses help with the issues that cause depression.

Consider joining a self-help group.

Join a group that is for people who have had trouble with depression. It will be helpful to talk to people who have had the same problems as you.

Get help for problems that make depression treatment more difficult.

If you or a family member have concerns about your alcohol or drug use, talk to your doctor or therapist. Therapy, a self-help group, or drug-rehabilitation is important for long-term success in treating any depression.

Jimmy

There were many days...I just didn't want to get out of bed. Honestly the only reason I got out of bed on more than a few of those days was because the dog had to get walked and my wife had to go to work. So, I'd walk the dog, take her to work, come back. Some days I'd get back in bed, some days I'd just sit on the couch and wonder what I was going to do next. And not knowing, not knowing at all.

No, when you're in the middle of it, you just, you don't know when it's going to end. You sit there and look at it. You know you want to get better. You know you want to be who you were before. You just don't know if it's going to end where it's going to end, how it's going to end. You don't know if you're ever going to be the person that you were before. There were days when I thought I'd never be myself again...I just thought...this is just the way it's going to be and I thought everything was going to have to change.

I pretty much lost interest in just about everything. In every aspect of your life the interest level just goes. You're just kind of there. You know your head is screwed up, that somebody is going to look at you like you’re crazy, that you’re weak for admitting that you’re having a problem. Especially in the fire service. Fire service, police service; it’s an entirely macho atmosphere. So it’s just natural that you’ll be looked upon as weak if you admit that you’re having some kind of problem dealing with something.

They think I'm a big, tough fireman. I'm supposed to be able to deal with anything, I'm supposed to be able to just pick up, carry on, like the old commissioner said, 'Just be able to suck it up. And just keep going.' It's not that easy. You can't just do that. If you tried to, it's just going to come back up again and again and again. It may take a while but it's going to keep coming back up. I don't know if I'd be a firefighter today if I didn't get help.

Everything's back to normal, now. What I experienced was something nobody should experience. But somehow I've been able to find a context for it in my life and it's there. It'll always be there; it's never going to go away. But I found a way to fit it into my life that I can live with it.

Rodolfo

I just felt terrible and I didn't know why it was, I didn't want to face anyone, I didn't want to talk to anyone. I didn't really want to do anything for myself because I felt so, I felt like I was such an awful person that there was no real reason for me to do anything for myself.

I just didn't feel any emotions, I just couldn't feel. My real feeling was just pure numbness, I just couldn't feel sad, I couldn't really feel happy; it was almost like I was under water with like my eyes and my ears all shut off and I was just there.

I barely went to class. I just couldn't wake up in time for class. Sometimes I'd sleep like only three hours a night cause I couldn't sleep for weeks, but most of the time the opposite happened where I would sleep ten, twelve, fifteen hours a day.

I totally think being Latino made it harder. Cause there is a silence over things. There's just things you don't talk about. And um, when I told my parents I had depression, I was like look Mom, I'm depressed, you know I can't deal with things anymore, I don't think I can finish school. My mom was like you're not depressed! Your brother went through, through a period, you know what? You're going to get over it.

Patrick

Everybody gets the blues. I call depression the super blues. The ultimate blues because when you get the blues, you sometimes can figure your way out of the them. Say I have the blues, that happens to people. But when you have the super blues, you can't find you're way back cause you've gotten so far in. It's like a hole that closes up behind you and you just get lost in your own mind. You literally get lost.

Here I am in the Air Force and I'm one of the senior leaders in the enlisted ranks. And that would be a sign that well maybe I'm not a leader. And then my career's derailed or maybe I'll lose my security clearance. I can't let anybody know, I've got to gut it out, I've got to fake my way through it...You don't where to turn for help. You don't want to be perceived as weak, you finally get to a point where you say, let all that be damned, you don't care how you're perceived, because you are barely breathing, you're barely getting up.

Think of, if you cut your arm off or got shot or you broke something or tore up a knee and think about how excruciating that pain is, that's mild and can be taken care of with an aspirin compared to mental anguish. I'd drink and I'd just get numb. I'd get numb to try to numb my head, and that would take a lot of beer, I'm telling you. I mean, we're talking many, many beers to get to that state where you could shut your head off, but then you wake up the next day and it's still there. Because you have to deal with it, it doesn't just go away.

It's just gradual. You don't even really notice it. You just kind of come back and then you're back to normal and then you go, where the hell have I been?

Paul

A feeling of isolation, a feeling of being cut off from the people around you, of not being able to, almost of being underwater, sort of emotionally underwater, you know, not being able to make direct physical contact. You lose interest in physical contact, in sexual relationships, you become very worried.

I remember the first time I knew something really was wrong, I was talking with one of my colleagues in the company in which I worked, a publishing house, and I just burst into tears. And I had no idea why that had happened. It is as if your inner core is being squeezed in such a way that it hurts, it just hurts, it feels as if somebody's been beating you. You feel as if your tissue has been wounded. You just feel internally, in pain.

You are, you are pushed to the point of considering suicide because living becomes very painful. You are looking for a way out, you're looking for a way to eliminate this terrible psychic pain.

Your tendency is just sort of wait it out, you know, let it get better. You don't want to go to the doctor. You don't want to admit to how bad you're really feeling. If I had not been lucky enough to have relief, I might well have killed myself.

Brenda

It was really hard to get out of bed in the morning. I just wanted to hide under the covers and not talk to anyone. I didn’t feel much like eating and I lost a lot of weight. Nothing seemed fun anymore. I was tired all the time, yet I wasn’t sleeping well at night. But I knew that I had to keep going because I’ve got kids and a job. It just felt so impossible, like nothing was going to change or get better. I started missing days from work, and a friend noticed that something wasn’t right. She talked to me about the time that she had been really depressed and had gotten help from her doctor.

I called my doctor and talked about how I was feeling. She had me come in for a checkup and gave me the name of a psychiatrist, who is an expert in treating depression. Now I’m seeing a psychiatrist once a month and taking medication for depression. I’m also seeing someone else for “talk” therapy, which helps me learn ways to deal with this illness in my everyday life. Everything didn’t get better overnight, but I find myself more able to enjoy life and my children.

American Foundation for Suicide Prevention

http://www.afsp.org
This nonprofit organization supports research on suicide. It also offers information on suicide and its prevention as well as support for survivors.

American Psychiatric Association

http://www.psych.org
This medical society's Web site offers fact sheets, booklets, and news articles on a wide range of mental health issues. It also includes a listing of psychiatric societies throughout the United States that can provide referrals to psychiatrists.

American Psychological Association

http://www.apa.org
The organization's Web site has information and helpful publications on mental illness and many other topics for psychologists, parents, teens, and others. It also carries news on psychology and offers referrals to psychologists in the United States and Canada.

Depression and Bipolar Support Alliance

(formerly the National Depressive and Manic Depressive Association)

http://www.dbsalliance.org
This nonprofit organization provides information, advocacy, and support for people with depression and bipolar disorder, as well as their family members. The Web site has detailed information on suicide prevention strategies for anyone struggling with thoughts of suicide or for concerned family and friends.

Families for Depression Awareness

http://www.familyaware.org
Families for Depression Awareness helps families recognize and cope with depressive disorders to get people well and prevent suicides. The site provides detailed handbooks for families dealing with depression in children and teens as well as adults.

National Alliance for the Mentally Ill (NAMI)

http://www.nami.org
This advocacy group offers information and support groups for people coping with a variety of mental illnesses and for families of people with such illnesses.

National Center for Complementary and Alternative Medicine

http://nccam.nih.gov
This government agency, part of the National Institutes of Health, offers a wealth of publications and fact sheets on a variety of health problems, including mental illness. It also sponsors valuable research on complementary and alternative medicine.

National Institute of Mental Health

http://www.nimh.nih.gov
This government agency, part of the National Institutes of Health, sponsors research on causes of and cures for mental illness. It offers a wide array of free publications. The Web site has educational segments on anxiety and depression, news on studies, and information about clinical trials.

National Mental Health Association

http://www.nmha.org
This nonprofit organization supports mental health research, provides advocacy, and offers information on a variety of mental health topics, including depression. The Web site has discussion boards and a free, confidential screening test for depression.

PSI: Postpartum Support International

http://www.postpartum.net/
This organization offers a helpline for support, linkages to local support networks and care providers, as well as educational information related to postpartum depression.

University of Michigan Depression Center

http://www.med.umich.edu/depression
This University based center is dedicated to the study of depression and its treatment. The web site provides the most recent information about research, education and treatment of depression.