Depression: Based on a True Story

"Ring, ring." The crisis operator answers the phone to a woman pleading to let her daughter know that she loves her. The woman spent her day writing letters to friends and loved ones, expressing her thoughts and emotions. From the loaded gun on the table to the rope hanging from the attic, it was a well-thought out plan (Lewis, Pamela, 2003).

Have you ever felt life was not worth living? Have you wished you were dead? Have you had any thoughts of taking your own life? It began October of 1998, while my husband and I were on our way home from the grocery store. The cellular phone rings. My husband answers. He then tells the caller that we are on our way there. His tone of voice sounded frightened and worried. I repeatedly asked, "What is going on? Why are you driving so fast?"

"Something has happened to your mother!", he exclaimed. I had fifteen minutes to prepare myself for the worst, yet I did not know exactly what I was preparing for. As we arrived to the scene, numerous police vehicles, two ambulances, the local rescue squad, private investigators, negotiators, and the SWAT team had one half of a mile from my house blocked off. As we came to a stop, I jumped out of the car crying and screaming, while trying to find answers as to what has happened. A police officer then pulled me aside. The young man explained that my mother was attempting suicide due to her depression.

As the number one public health problem, four to 8 percent of the U.S. population experience or have experienced a clinical depressed syndrome (Klerman, Gerald, pg. 27). Depression is a mental illness that requires immediate medical attention. Because depression is so widespread, it is often called the 'common cold' (Koop, Everett, 1996). The difference between a cold and depression is that depression, if not treated, can lead to the death of an individual.

Depression occurs when nerve cells, or neurons, fail to communicate with each other due to a chemical imbalance in the brain (Koop, Everett, 1996). A neuron is a specialized cell that conducts messages through the nervous system. Two neurons communicate with each other by electrical impulses or signals. The point of communication where electrical signals carry a message between two neurons is called a synapse. Separating the sending neurons and receiving neurons from the axon terminal are tiny, fluid-filled gaps called synaptic clefts. Chemicals called neurotransmitters dock at receptor sites, thus igniting the electrical signal of that neuron. After the signal is delivered, the neurotransmitters float back to the neuron that sent them. This process is called reputake.

Researchers have found many causes or reasons for depression. Usually, depression is caused by a deficiency in the neurotransmitter serotonin or norepinephrine (Morgan, Marie, pg. 75). Serotonin helps regulate mood, sleep, aggression, and appetite. Norepinephrine affects wakefulness, alertness, and also appetite. In some cases hereditary, personality traits, stress, and lack of supportive relationships are linked to depression. Other causes for depression are helplessness, sense of loss, isolation, and unresolved anger (Koop, Everett, 1996). Through your eyes, you see the world as a series of positive, neutral, or negative events. These events are interrupted through a group of thoughts that constantly flow through your mind. This is called your internal dialogue. Created by your thoughts is your feelings or mood. Before an emotional response can be experienced what you are feeling or what is happening to you (Burns, David, pg. 30). Therefore, the negative thoughts that process through your mind are actually the cause of your emotions.

Your negative thoughts, or cognitions, are the most overlooked symptoms of depression. Symptoms are feelings or behaviors that disturb normal functioning (Heitler, Susan, pg.47). A depressed person may show signs, such as a loss of pleasure or interest in usual activities, feelings of worthlessness, guilt, decrease in the ability to think or concentrate, and a loss of energy and appetite (Koop, Everett, 1996). The assessments of symptoms include specifying troubled behaviors and feelings, the history of the symptoms and diagnosing the problem (Heitler, Susan, pg. 49). Other symptoms include crying excessively, negative thoughts about the future and even thoughts of death or suicide (Koop, Everett, 1996).

Suicide is the deliberate taking of one's own life, which accounts for 5 percent of clinically depressed patients (Burns, David, pg. 383). Suicide rates have increased in children and adolescents since the 1990's (Burns, David, pg. 9).

Why do depressed individuals often think of suicide? Persuasive and pessimistic visions dominate their thoughts. To them, life seems to be a nightmare. When a depressed person thinks of the past, she only remembers moments of suffering and pain (Burns, David, pg. 384). Researchers have proven that the unrealistic sense of hopelessness is one of the most important factors in the plans for a serious suicidal wish or thought (Burns, David, pg. 385). A famous myth remains today: An unsuccessful suicide attempt is simply a means of getting attention and is not to be taken seriously (Burns, David, pg. 387). The fact is that all attempts are to be taken very seriously. Because a depressed individual's pain and suffering may feel unbearable and never ending, she may conclude that suicide is the only escape. In reality, medical treatment and attention will help the individual overcome depression.

Many researchers have described therapy as an opportunity for people to deal with their conflict of everyday living (Heitler, Susan, pg. 7). Consulting with a professional, such as a psychologist or a psychiatrist, can be a nice beginning for treatment. With a Ph.D. in psychology and other related fields, a psychologist serves the public through research, testing, and psychotherapy (Hauck, Paul, pg. 134). Psychotherapy is an important means of treatment for certain types of emotional or mental disorders. Usually working with the patient alone, a psychologist allows her to express feelings and emotions of life's battles. At the end of each session, the psychologist gives simple, step by step advice to the patient. A psychiatrist is a medical doctor who specializes in counseling clients with psychiatric, neurologic, and medical conditions (Reference International Publishers, LTD, pg. 18). During a period of one to six visits, the doctor will be discussed with the patient and followed upon regularly (Reference International Publishers, LTD, pg. 187). A psychiatrist also prescribes and administers medication, usually antidepressants, with the referral from a psychologist (Hauck, Paul, pg.135).

Antidepressants are drugs that are prescribed to treat depression and some anxiety disorders. The most widely prescribed drugs, tricyclic antidepressants, enhance the potency of the brain's neurotransmitters in the synapse. Some agents of tricyclic drugs are Imipramine, Desipramine, Amitriptyline, Nortriptyline, Protriptyline, and Doxepin (Burns, David, pgs. 430-432). Side effects, such as dry mouth, constipation and blurred vision, disappear after the first few days (Burns, David, pg. 432). MAO inhibitors cause elevations in the levels of amine neurotransmitters, thus, correcting the chemical imbalance in the brain. The most commonly prescribed trade names for MAO inhibitors are Marplan, Nardil, and Parnate. Similar to tricyclic drugs, the side effects of MAO inhibitors are dry mouth, lightheadedness, trouble urinating, a rash, and constipation or loose stools (Burns, David, pg. 440). MAO inhibitors, if not taken properly can produce serious effects. Blood pressure may rise of certain foods or drugs containing a substance called tyramine, which interferes with the brain's ability to regulate blood pressure, while taking a MAO inhibitor (Burns, David, pg. 441). Lithium carbonate is another antidepressant drug used to treat severe depression. Although lithium is simply salt, it does have many side effects, such as hand tremors, nausea, vomiting, and diarrhea, that usually taper off within a week or soon after (Morgan, Marie, pg. 78). Long term effects of lithium include blackouts, headache, slurred speech, weight changes, fatigue, and hypotension (Morgan, Marie, pg. 70). Valium is an antidepressant that suppresses anxiety and covers up symptoms rather than getting at the causes (Morgan, Marie, pg. 78).

Although addictive and may worsen depression, some doctors use minor tranquilizers or sedatives to treat anxiety and nervousness (Burns, David, pg. 444). Sleeping pills are used to help treat insomnia. These pills become highly addictive as they disrupt normal sleep patterns and greatly worsen the sleeping problem. For example, my mother was given the drug, Ambien, because she was having trouble falling and staying asleep. She awoke often only to take another pill because she was still not able to sleep well. Ambien gave her short-term amnesia and disrupted her sleep instead of helping her sleep. She ended up in the emergency room for an accidental overdose (Lewis, Pamela, 2003). I almost lost her again to a drug that was supposed to help her. There are at least a dozen different antidepressants that are effective for some patients, while for others, the results may be disappointing or harmful. Reoccurrences of depression can happen at any time a person stops taking medication as prescribed just because they 'think' they are better. In some cases a depressed person may need an increase or even a change in medication after an evaluation with a doctor or therapist. In the near future, researchers will hopefully advance the understanding of antidepressant drugs and how they affect the human brain.

It sometimes, seems that the more hopeless and severe the depression was, the more extraordinary and delicious the taste of happiness and self-esteem is. As you begin to feel better, the pessimistic thoughts will go away like the melting of the winter snow when spring arrives. You may even wonder how you ever could believe such thought in the first place. Because the change of negative to more neutral or positive thinking can be so dramatic, a person may be convinced that the depression has vanished forever. But that simply is not true because there is a mood disorder that remains. A depressed person who feels better must understand what caused the depression and be able to apply and reapply self-help techniques whenever needed. Acquiring self-confidence and self-esteem is a must to getting better. Focusing on happy memories and keeping positive thoughts will decrease the recurrence of depression. Lowering one's standards to prevent disappointment and learning from one's own mistakes will also help a person overcome depression.

My mother has beat the battle of depression after six months in Zellar, the old local mental institution, and years of learning how to cope with life's emotional stress. Trying to resume her original lifestyle was the most difficult obstacle to getting better. Her suicidal attempt was reported on the front page of the Peoria Journal Star. Not only did they have the wrong information about the depressing event, they also labeled her and tried to press charges against her for trying to take her own life. Returning to work, she was stereotyped as 'crazy' or 'insane' instead of strong and hopeful for fighting the horrifying condition. It has been five years since her breakdown and she now lives a wonderful and happy life. She states, "I am proud to be here today!" (Lewis, Pamela, 2003). If you know anyone who shows any signs of depression or has thoughts of death, help them. Be their friend and give them positive reinforcement. Show them they are loved and needed in your life and many others. Most important, get them help because not every depressed person knows they are depressed, therefore they may not be able to help themselves.

References:
Burns, David D., MD. Feeling Good: The New Mood Therapy. Avon Books Printing. New York, New York: 1980.

Hauck, Paul A. Overcoming Depression. The Westminster Press. Philadelphia, Pennsylvania: 1987.

Heitler, Susan M., Ph.D. From Conflict to Resolution.W.W. Norton and Company, Inc. New York, New York: 1990.

Klerman, Gerald L. Interpersonal Psychotherapy of Depression. Jason Aronson, Inc. Northvale, New Jersey: 1984.

Koop, Everett C., MD. Depression at Time of Diagnosis. Time Life Medical. Patient Education Media, Inc. New York, New York: 1996.

Lewis, Pamela. Interview. Edelstein, Illinois: 2003. Morgan, Marie. Breaking Through: How to Overcome Housewives' Depression.

Winston Press, Inc. Minneapolis, Minnesota: 1983.

Reference International Publishers, Ltd. Good Housekeeping: Family Health and Medical Guide. Hearst Books. New York, New York: 1979, 1980.

Jamie Herold

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