DEAR ANN: Last year, I had been feeling down and sad, crying a lot and feeling lonely, helpless and worthless. I wasn't motivated, had little energy and didn't enjoy doing things that I once loved to do. I just didn't feel like myself. I was approaching menopause and thought my mood problems -were due to this change of life or, worse, due to some personal weakness or inability to handle my problems. Luckily, when I heard in your column about a free screening day for depression, I went to a local hospital that was participating. The clinicians explained that depression is a treatable illness, not a weakness, and that it wasn't my fault. They helped me find a therapist in my,area and reassured me that I would feel better with appropriate help and medication. Ann, I am so glad I took that first step. Things really turned around for me. I feel so much better and in control of my life. It is my hope that I can be an inspiration to others who suffer this devastating illness. ...Irene DEAR IRENE: Depression strikes about 17 million North Americans each year, but less than half receive the treatment they need. This is tn4c because more than 80 per cent of people with depression can be treated successfully with medication, psychotherapy or a combination of the two, Common symptoms include a persistent, sad, anxious, or "empty' mood, difficulty sleeping, changes in appetite and loss of pleasure in activities that were once enjoyable. Depressed people often have difficulty concentrating and may experience feelings of hopelessness, helplessness, worthlessness and guilt. Some people have, vague medical complaints such as aches and pains that won't go away, headaches, backaches and frequent stomach ailments. Many have thoughts of death or suicide. Depression is nothing to be ashamed of. I love my readers and don't want to lose any.
Queen Elizabeth, Audrey Hepburn, Tipper Gore, Anthony Hopkins, Thomas Wolfe, Barbara Bush, Jim Carrey, Monica Seles, Eleen DeGeneres, Winona Ryder, Harrison Ford, John Kenneth Galbraith, Sheryl Crow, Dolly Parton - these people have all spoken publicly about their experience with...DEPRESSION - Peter went to the University of Toronto law school and at a time when his career should have been flourishing, Armstrong struggled through a succession of low-level jobs, feeling worse with each failure. He raked leaves for a living. Sometimes he couldn't even get out of bed, no matter how many times his mother told him to. He tried to kill himself with an overdose of pills. Finally properly diagnosed in 1993 as a manic-depressive - someone who is excited and agitated at times, then fatigued and depressed at others - Peter is on medication and loving his life. At age 50, he is working in the communications office of the Mental Health Association, and living with a group of Catholics dedicated to community work. "I would get up and go to work, if I had a job, and try to cope. On the groundskeeping crew, I was in my 30s and all these kids were 19 and 20. I was slow. I was barely able to shovel. I wasn't even aware how disabled I was," he recalls. "I got a job as a law clerk. The agency that got me the job phoned me to say that I smelled. I wasn't taking care of myself. Can you imagine my reaction? I simply wasn't aware. Things don’t matter to you that everyone else is doing automatically." Lynda raised two sons, one who was ADHD. She had no energy, felt lethargic, gained weight, felt terribly unhappy and felt no pleasure in anything. She would drive to the dry cleaners but when she arrived, she couldn’t get out of the car to go in. She would miss turns and actually got lost one day - not too far from home. She had no idea where she was. Lynda cut herself off from all of her friends, stopped answering the phone, and couldn’t answer the door because she frequently didn’t get dressed but sat around in her nightgown all day. Then she stopped eating. By the time she got to the Doctor for help - she was a borderline anorexic. She had lost over 30 pounds in 3 months. Her marriage fell apart. Her children suffered. She had no self-confidence, no self-esteem. She felt ugly and hopeless. Thankfully, they both got help. Lynda saw a commercial on TV one day about the symptoms of menopause. Thinking it was time to go on hormones she went to her doctor. Much to her surprise she was diagnosed with severe chronic depression. For both Peter and Lynda, a combination of medication and therapy helped. The solution is for doctors to be better informed about diagnosing and treating depression and for families and friends to help by being watchful of the person' s behavior says Peter. "You fall out of the loop and need people to be paying attention. You need a lot of help. The key to my great life has been people having a little compassion and mercy.” Doctors specializing in treatment of depression point out the following: - 5% of the population is severely depressed at any one time. Throughout a person’s lifetime, depression will hit one in 10 men and one in 8 women. - Anti-depressant drugs (such as Prozac, zoloft, serzone) and psychotherapy are the two main treatments for severe depression, often together. In rare circumstances electric shock therapy is still being used. - Depression can happen for no outside reason, but it can also be brought on by sad events such as the death of a loved one or especially emotional events such as the birth of a child. - In the majority of cases, about 70 per cent, depression can be successfully treated. - Depression is recurring. If you've had one serious case, there is a 50 per cent chance you will experience another. - It is hereditary, with strong links between generations. A depressed person from a family with a history would be considered a high suicide risk. - People who threaten or talk about suicide should be taken seriously, particularly young people. Suicide is largest cause of death (after accidents) of young males. - A depressed person might not be crying or even look sad. A person can hide depression or may express it as anger or irritation. - A depressed person might not realize he or she is depressed. The more likely to think, or say, he or she no longer gets any enjoyment out of life and blame himself or herself for that. - Evaluation of depression is most commonly performed by family physicians. Depression usually creeps into people’s lives, gradually robbing them of happiness and initiative without their realizing what is happening. "They may have feelings of worthlessness and guilt. They won't be as aware of the changes as someone who hasn't seen them in six months." Depressed people don't see things clearly and can lose touch with reality, he says, even becoming a little paranoid. They may start to get suicidal thoughts and families should act quickly if they see this. "Happy, well-adjusted children/adults don't take an overdose of pins, don't make a noose in the garage. If drugs and therapy are used properly, 75% of patients respond well to treatment and come out of the depression. "The most important thing in therapy is that the patient feels understood and that the Doctor is warm and empathetic.” Anti-depressants aren't without their side effects, the most common being reduced sexual enjoyment and ability to have orgasm. However, someone with a tenacious and recurring depression may need drugs to hold attacks at bay. Depressed people don't see things clearly and can lose touch with reality Doctors used to classify depressions into two categories: reactive, meaning the depression was a reaction to something in a person's life, and endogenous, meaning it sprang up spontaneously. Currently, doctors are less concerned about finding a cause and more centered on diagnosis and treatment. This involves talking to patients about their symptoms and trying various drugs or therapies. "At the moment, there is no blood test, no brain scan, no diagnostic test to diagnose depression." Depression can be found even in young children. Depression is biochemical and triggered by the brain. When it is extreme, depression can cause the person to have delusions. 1/4 to 1/3 of all women who develop bipolar disorders started with a post-partum depression. (Bipolar refers to people who experience extreme highs and lows, while unipolar refers to those who are depressed) Prozac-is a popular antidepressant because it enhances serotonin transmissions in the brain. Serotonin helps us feel good. Therapy that helps people get out of the negative way of thinking, to examine their interactions throughout the day, their interpretation of events and to see things in a new, more positive light can he helpful. People suffering from depression have difficulty “perceiving” things the way others see them. Interpersonal therapy helps patients see how conflict with others contributes to a depressed state. Therapy and drugs both have important roles to play in treatment programs. New brain-imaging technologies are being used to see what is happening to depressed people and indications are that they have low levels of activity in the frontal lobes. When they are no longer depressed, the activity returns to normal. It is not an easy task to find out how chemicals and the circuitry of the brain work, because it is difficult to see how a person's brain operates while alive. (Autopsies of people who have committed suicide have shown brains low in serotonin). But the investigation is a matter of life and death to those suffering from depression. When people who attempt suicide are saved and treated for their depression, they feel they had a lucky escape. "Just like people who are in remission from cancer, they are delighted they got out alive."
By IAN SAMPLE SPECIAL TO THE STAR -Aug 18/2000 People likely to commit suicide have a distinctive tone of voice. A subtle change in. the sound of someone's voice is the first sign that he or she is serious about committing suicide. The change is so distinctive that psychiatrists plan to use it as an early warning system to separate those who are seriously suicidal from those merely depressed. The idea that the voice might contain clues about someone's mental health came when Stephen Silverman, a psychiatrist at Yale University, noticed he could often sense from a patient's voice whether he or she was a serious suicide risk. "In suicidal patients, the voice becomes slightly hollow and empty. You get this change in quality," he says. "They call it ihe voice from the grave.' " To find out if this observation had any practical use, Silverman teamed up Mitchell Wilkes, an electronics engineer based at Vanderbilt University in Nashville, Tenn. Wilkes recorded a series of interviews with 64 depressed patients and compared them with recordings of 33 others who weren't depressed. In total, 22 patients made a se.rious attempt on their lives. He then compared the recordings with the subsequent histwy of the patients. Wilkes noticed that truly suicidal people use a narrower range of frequencies when pronouncing their vowels than people who are just depressed. The voices of suicidal people also become higher pitched. The reason for the frequency shifts could be related to stress induced physiological changes, he says. "A variety of changes can take place under stress - like muscle tone quality - that can affect the vocal chords. Also you get changes in moisture and elasticity of the vocal tract." His findings could help the volunteers who staff helplines to assess a depressed caller's mental state.
Over the past 15 years, there has been an average of more than 3,500 recorded suicide deaths in Canada each year. That is about 10 people a day, every day. The actual number of suicides is likely two or three times higher, since many so-called "accidental" deaths are actually suicides. People who commit suicide often give a clue or warning of their intentions. People may say: "I wish I wasn’t around" or "life hardly seems worth it." Always treat even subtle threats seriously. The majority of people who commit suicide have seen their family physician in the preceding two or three months. This points to an important opportunity for family, friends and physicians to uncover and potentially stop the suicidal process. Yet many people won't admit to suicidal thoughts or plans and hide their utter-hopelessness and self-destructive intentions behind an apparently placid facade. Suicidal persons usually feel ambivalent about dying. People usually don't want to die. They want instead to end their horrible emotional suffering You can help by talking to them about it. -Be direct. Talk openly and matter-of-factly about suicide. -Be willing to listen. Allow expressions of feelings. Accept the feelings. -Be non-judginental. Don't debate whether suicide is right or wrong or whether their feelings are good or bad. - Don't lecture on the value of life. They will not believe you anyway - they "know"life is worthless. On the other hand, reassure them that treatment is available and that when they are no longer so depressed, they will enjoy life again. -Get involved. Become available. Show interest and support. -Don't be sworn to secrecy. You may need to involve others. You may have to urvoluntarily commit a patient to a psychiatric facility for assessment of his or her emotional condition. -Offer hope that alternatives are available, but not glib reassurances. -Take action. If possible, get other family friends involved. Have them remove the means to suicide, such as guns or stockpiled pills. -Get help from those specializing in crisis intervention and suicide prevention. Depression is a genuine - and seriously disabling - medical condition and is not due to laziness, a bad attitude or moral weakness. People who are depressed need professional treatment. A trained psychotherapist or counsellor can help them learn more positive ways to think about themselves, change their behaviour, cope with problems and handle interpersonal relationships. A physician can prescribe medications to help relieve the symptoms of depression. For most people, a combination of psychotherapy and medication is the best available treatment. Suicide affects the poor, the middle class and the rich equally. Nevertheless, having a family history of suicide, being male or native Canadian, making previous attempts and being separated, widowed or divorced have been statistically correlated with suicide. There is no proven scientific basis for prediction, but there are certain risk factors to consider. The most important of these are: - Psychiatric disorders, such as major depressive, disorders, schizophrenia or alcoholism. Unfortunately, many people who are depressed go unrecognized as suffering a medical disorder. - Age. Suicide is highest in older adults. - living circumstances. People who live alone, are unemployed and have suffered a recent loss are at highest risk. When a suicidal person begins to feel better, he or she will still be confronted with problems and responsibilities. This can be difficult and can lead to a return of suicidal thoughts. Also, some people who are very depressed are so fatigued and unfocused as to be unable to organize and execute a suicide plan. When these people get somewhat better, their risk of killing themselves may increase because they then have sufficient energy to carry out their plans. Full recovery from depression and suicidal is a gradual thing. It may take for the person to feel consistently better and in control. Most people have reasons for their suicidal feelings and are not psychotic or insane. Yet their thinking is undeniable distorted. Most suicides and suicide attempts are made by intelligent, temporarily despairing individuals who are expecting too much of themselves (and/or others), especially in a crisis. The following five mental disorders are correlated with suicide and suicidal behaviour. More than 90 per cent of completed suicides carry a diagnosis of alcoholism, depression, schizophrenia or some combination of thesethree. - Mood disorders (15 per cent lifetime risk of suicide): The likelihood of suicide is increased when the patient exhibits panic attacks, extreme anxiety or alcohol abuse. - Panic disorder (7 to 15 per cent lifetime risk of suicide): The suicide rate may be similar to that of mood disorders. Greater likelihood is associated with more severe illness. - Schizophrenia (10 per cent lifetime risk of suicide): Suicide is relatively uncommon during psychotic episodes. - Alcoholism (3 per cent lifetime risk of suicide): Abusers of alcohol/drugs comprise 15 to 25 per cent of suicides. Yet associated with nearly 50 per cent of all suicides. - Borderline personality disorder (7 per cent lifetime risk of suicide): This is associated with psychosis with bizarre suicide attempts. Everybody has at least theoretically thought about ending his or her own life. (You would have to be very unimaginative not to at least dispassionately consider it.) Yet as many as 1/3 of us has at some time thought seriously about committing suicide. Most decide to live because they eventually realize their emotional crisis is temporary and death is permanent.