The Hidden World of Depression

The teenaged daughter of a good friend was just hospitalized for depression. Yes, depression.  Not cancer. Not some runaway infection. Although in my mind, depression is both. A cancer that destroys your life from the inside out and an infection that, if not treated early and well, becomes resistant to the best therapies and turns septic.

I talked about my own depression a bit in an earlier blog. But the situation with my friend’s daughter  reminded me again of how differently we respond to a mental illness than a physical illness.

For instance, as this girl was being driven to the hospital, her brother left her a voice mail telling her, basically, to “buck up.” To get her act together and “beat this.” Once the girl was out of immediate danger, her grandmother emailed and said she hoped she could “get her life on track” since she had so much promise.

Um, people. This girl was not out stealing cars, shooting up drugs and failing school. She was caught in what I can tell you from personal experience is a quicksand of apathy and pain into which, unless you are by the miraculous combination of medication and therapy pulled out in time, you keep sinking.

My friend’s daughter is not alone. The inpatient adolescent unit where she stayed for four days had 16 beds–all full. Several of the kids had been there more than once. “Do you know  the first thing they say  when they meet you?” she asked when I visited. “Hi, my name is ‘Susan.’ How did you try to kill yourself?”

For depression is far more than a bad mood. It’s the second leading cause of death in adolescents (behind accidents), and the eighth leading cause of death overall in this country.

People who are as depressed as my friend’s daughter–as I’ve been in the past–cannot simply “pull it together.” The first step is getting the medication right. Then you’re able to tackle the rest of the work needed to slowly, one step at a time, pull yourself out of the pit.

We also know that major depressive disorder (MDD) is not a personality disorder or malingering. It is a true biochemical disorder in which the neurotransmitters that keep our brains on an even keel get out of whack. That’s the same thing, by the way, that happens with diabetes or hyperthyroidism. Get the medication right for those diseases and wow! The symptoms disappear and you feel great.

The same is true of depression. As soon as my friend’s daughter’s meds were adjusted, she was transformed from a sullen, angry, uncommunicative child who cut herself and heard  voices telling her to kill herself into the energetic, smiling, focused teenager of old. For when the  meds start working, it really is like flipping a switch.

During my first major depressive episode, I broke up with my fiance (kicked him out, actually), convinced that it would make me feel better (for the record, he’d been nothing less than perfect. There was no reason to break up with him other than my own disordered thinking). As I continued to spiral down, my therapist recommended a new drug — Prozac. I started on Prozac in early December. And our anniversary is January 11. That’s how much better I felt (and I’m happy to report we just celebrated our 22nd anniversary).

Medication can’t cure depression and, on its own, it can’t prevent a recurrence, just as medication alone won’t “cure” diabetes or even prevent complications. You have to treat the disease holistically, with therapy, exercise, rest, and recognizing, managing and avoiding situations that can trigger a relapse, just as people with diabetes need to manage their diet and weight to avoid a hypo- or hyperglycemic episode.

So please, the next time someone you know is dealing with depression don’t tell them to get their act together or highlight the fact that they have a wonderful life and thus nothing to be depressed about. We know that there is no specific “reason” for the depression. That makes us feel guilty and increases the self-loathing that is the hallmark of MDD.

Instead, talk to them, let them share how they feel, and recognize you can’t “fix” it. But you can listen without judging. If more of us did that, maybe someday we’d be able to eliminate the stigma that keeps most of us from sharing our stories, and which contributes to the misinformation and misunderstanding that remains a part of this and other mental illnesses.





6 Responses to “The Hidden World of Depression”

  1. ST

    When I got out of the hospital, my first hospitalization at age 38 after 20 years of off-and-on depression, my psychiatrist lectured me. He said I was selfish, and ungrateful for things I had in life. I never went back to him. Can’t even see how he’s a psychiatrist with attitudes like that. I found a new doctor.

  2. Craig

    I too have been there (and sometimes think I’m going back). Drugs didn’t help at all. I finally got my thyroid in order and have had a numbet of good years since…

  3. Joan Flynn

    I understand a lot more now than I ever did about mental illness. Thank you

  4. Karen M

    I can’t tell you how much I agree with and appreciate your post. My two daughters (18 and 21) struggle with anxiety and depression. It impacts both sides of their families, including just about every adult. All manage to live successful lives, thanks primarily to drugs like Prozac. I’ve probably been the least impacted by depression and yet now I’m on Prozac likely for life, due to having come down with a condition that causes chronic pain and because the low amount of sun in the winter months was really tough to handle.
    Anyway, my youngest has been briefly hospitalized, and several of her friends have faced weeks and months of hospitalization. All of them hated it and it had mixed results. The best things that worked were practically living at our home where I make sure they are listened to and loved dearly and valued highly.
    While I am a strong advocate for medication, I agree that a great counselor can make a huge difference — but try finding one! We have a great psychiatrist to handle my youngest but she’s now over 18 and gets a shrink who handles adults. Ugh. She’s SO sensitive that it’s been hard to find the right person. Impossible really. Even the shrink really only wrote prescriptions, although she had to know her well enough to know what the problems were and how to handle them and track the progress of the medication.
    One issue that also gets ignored is the impact of mental health issues on school, and dropping out. I co-authored a major paper on dropouts but we didn’t touch on that much. And schools have little idea how to handle kids with these problems/challenges. We did finally get my youngest (now a HS senior) into a public alternative school, a wonderful place that offers a caring environment that feels like a warm, elementary school but that educates high school students. It’s the best mix possible. Truly, all HS should be like this, or at least offer this level of adult-student interaction. We’d drop the dropout rate dramatically. (I have a pretty strong set of credentials to make that statement.)
    Anyway, thanks SO MUCH for writing about this and your own challenges. I look forward to reading your other posts. I have several decades of policy work on some of these issues.

  5. Lori Malvey

    FYI…for every success story there is a nightmare when it comes to anti-depressant medications. These are very powerful drugs that are still in their infancy, make no mistake about it. A personal friend just got off of 20 years on anti-depressants. She is having severe SSRI (selective seratonin reuptake inhibitor) withdrawal syndrome. The lack of information/recognition by the medical community about SSRI Withdrawal is astounding to me. Please refer to: to read more about it, as well as to find out more.

    I’m glad they worked out for you.

  6. Toni

    You’re right that most people don’t realize that depression and other mental illnesses are biochemical disorders. Debra, you and this young girl are fortunate that drug treatment brought you back to normal function. Many people with depression fail to respond to available medications and also to combination therapy with two more more medications. Some people who do respond later relapse and require a change in medication. Whenever I write about depression, I avoid any message suggesting that if patients would only take medication, they’d be just fine. It’s not that simple!


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