Living with clinical depression: the ‘common cold’ of mental health

by Sam Kean

Guilt still stings Carrie Nelson, usually in the mornings when the weight of a full day is on her mind.
Lying awake in her bed, she doesn’t cry for past deceptions or for hurting her family or boyfriend.
Instead, she cries from guilt turned inward: constant thoughts that she’s a liar, that if people really knew her, they would loathe her even more than she does herself.
For 21 years, clinical depression has been a part of Nelson’s life, although she didn’t always know it.
Undiagnosed until she was a high-school senior, depression erased all memory of her childhood. She said her mind “blocked it out in an attempt at self-preservation.” Just as victims of abuse often repress memories, Nelson blocked out her self-abuse.
A teacher noticed Nelson’s mood swings and, fearing for her health, contacted a counselor. Nelson said it saved her life.
The diagnosis of depression made sense to Nelson, but still shocked her. When depressed, she said, “you don’t realize when you’re slipping.”
Four years later, Nelson, now a University conservation biology student, has dissolved most of the ties to her past. These days, she talks of working at an international animal preserve or doing Peace Corps work in Africa after graduation.
Yet she lives with the knowledge that her depression can never be cured. Her childhood demons still have the power to wipe out whole days of her life.
A common condition
University senior psychologist Rodney Loper said depression pervades all social and economic classes, earning it the nickname, “the common cold of mental health.” In fact, one in 10 Americans are diagnosed with depression at some point in their lives.
The causes for the disease are as numerous as the number of people affected.
“Depression,” Loper said, “is the conversion of many pathways — genetics, trauma, cognitive patterns and personal setbacks.”
The interaction between the mind and body plays a significant role as well, he added.
But the consequences of untreated depression are largely the same: devastated self-esteems, health problems, chronic underperformance, distressed relationships, family pains or suicide.
Because of increased awareness, society is more accepting of depression now than in the past, Loper said.
But some cases, like Nelson’s, drift by undetected for years because the stigma of being labeled “mental” or “weak” still remains.
Doctors discovered Nelson had low levels of seratonin, a mood-regulating chemical. She literally could not be happy.
A psychiatrist prescribed Prozac and, for the first time, the darkness in her mind lifted. Her mood improved and she even let herself believe compliments.
But hearing stories like this makes others misunderstand anti-depressants, Nelson said. Drugs don’t make her high or alter her personality. Instead, Prozac makes it possible for her to feel happiness.
“I still suffer from down days just like any ‘normal’ person. That’s the point. It makes me capable of feeling like a ‘normal’ person.”
Because Nelson’s depression was linked to her brain chemistry, doctors told her a relapse was likely and recommended she take Prozac regularly.
But Nelson chooses not to.
“You lose what little control you have (with drugs),” she explained.
Instead, she struggles with each new day. And sometimes the self-hatred wins.
University senior psychologist Glenn Hirsch said many people who are depressed have an aversion to drugs and simply want to get by. To them, the high cost and stigma of a dependence on pills is not worth it.
But anti-depressants, Hirsch emphasized, simply restore the person’s brain to its normal capacity, giving them “the mental energy to deal with their issues.”
A fear of side effects also turn people off from anti-depressants, said University social worker Tom Beaumont. But, he added, side effects are not common and usually decrease with time.
Most people who suffer from depression, though, do not require drugs. Instead, they rely on counseling to challenge habitually negative thought patterns.
They tend to blame themselves for problems beyond their control, Loper said. At the same time, people with depression dismiss their positive achievements. Current research suggests thought patterns alone can drive down levels of mood-lifting chemicals in the brain.
Students at risk
College, Beaumont pointed out, presents unique problems.
A drive to be perfect and a loss of idealism about University life can pull students into depression.
The University counseling center’s busy schedule reflects the fact that depression is largely treatable. But it also reflects health industry changes that have cut the availability of long-term depression treatment.
But Nelson found treatment. She approaches therapy in the same off-and-on manner in which she takes anti-depressants. Counseling helped her address family struggles and low self-esteem her brain chemistry prevented her from facing. She improved her ability to cope and it eased her emotional detachment, she said.
Yet she cannot quite accept that depression is not her fault. She knows this thought isn’t logical, but sometimes logic makes little difference.
This led her to an unspoken vow: not to tell anyone — family, friends, roommates — about her depression. Though she said she would like to tell everyone, she fears rejections that would reinforce the harsh view she has of herself. So far, only those closest to her have any idea of what she has been through.
For those in Nelson’s situation, Crisis Connection offers a solution.
The inside of the 24-hour crisis hotline does not resemble a telemarketing firm with rows of employees and phones buzzing madly. Instead, the counselors, many of them volunteers, sit on couches and chat quietly between calls.
Director Frank Togas said Crisis Connection receives more than 100 calls each day, mostly from people facing situational depression: depression triggered by definite causes, such as personal loss or holidays, which usually subsides quickly.
Though trained to deal with crises, counselors listen more than they talk because sometimes “hearing yourself say (your problems) out loud is enough” to ease them, Togas said.
Calynn Hendrickson, a Crisis Connection phone counselor, agreed. She said a 10-minute conversation is often enough to reassure college-aged people about pregnancies or relationship issues.
However, some calls do turn desperate. When self-harm is a possibility, counselors access the risk level and try to establish a rapport with the caller. Often, they make a pact with the person not to harm themselves, but they do so knowing the other person is not bound to it.
Often, crisis calls stop people from harming themselves because calling indicates a desire to be stopped, Togas said. Yet some people hang up as anonymous and unstable as when they first called.
Nelson’s own life has been pushed to the point of wanting to die. Thinking back to such times, she said, ending her life seemed easier than facing constant pain.
In many ways though, college has been the fresh start she hoped it would be. Depression will force her to repeat a few classes, but she will graduate next year. Africa is still a distant — but no longer impossible — dream.
When asked if any good has come from her depression, Nelson wavered. It has strengthened her convictions about protecting the environment, but has also severed her life in two.
In the end, Nelson said she has given up hope of ever being truly happy. But, after working through so much, she qualifies the statement.
“I’m content,” she said. And although it’s hard work, she can let herself imagine being content in the future too.