Monday, February 16, 2015

It's time to end the social stigma about depression

Depression is a silent killer.

It kills hopes and dreams. It drains willpower and physical energy. It destroys relationships. It separates us from loved ones. It wastes man hours, costs us productivity, and leaves people dysfunctional. At its very worst, it makes its victims so hopeless with despair over their situation, feeling that there is no way out, that they take their own lives.

Depression doesn't discriminate. It affects the young, the old, and those in the prime of their lives. Men or women, straight or gay, no matter your religion or skin color - depression doesn't care. The rich can't buy a preventive barrier, and the poor are even more likely to suffer from it.

Depression can be as simple as "feeling a little under the weather", if it's persistent for more than just a couple days. It can make everyday chores like laundry and dishes be major obstacles. It can make you feel like you're lost, treading water, unable to get your head up enough for fresh air and sunshine. It can be triggered by weather or diet or illness or any number of things.

I've seen family and friends and co-workers be victims. And I, too, have fought my own battle. Nearly 10% of the population will face depression at some point in their life - and some 80% of those affected will never get diagnosed and/or receive treatment. If you think you don't know anybody who's battled depression, you may not recognize the signs: 

Many people who suffer from depression do not seek help because of the stigmas that surround this illness, coupled with denial. "I don't want people to think I'm nuts." "I'm not depressed, I'm just tired/overworked/it's been a rough week/I'm not eating right."

My grandfather had Alzheimer's for several years before his death. My great-aunt had dementia in her final months. These are also mental illnesses, degenerative brain functioning often accompanied by depression - and yet they are not regarded with the same stigmas and denial that depression is. Perhaps it is because Alzheimer's and dementia are most commonly seen in the elderly, and are accepted as one of the many ways that the body breaks down late in life. Although there is no cure for Alzheimer's, we hasten to put advanced victims into care facilities where they can have the kind of round-the-clock care necessary for them. People are patient and even kind with those under the grips of Alzheimer's or similar mental diseases; but do not treat those with depression the same way.

Your relative has Alzheimer's? "Gosh, that's terrible, what a shame, they'll be in my prayers."

You think you have depression? "Snap out of it!"

If only it were that easy.

Depression is frequently not as visible. Sometimes it is quite mild - minor mood swings, insomnia, lack of energy - and people mistake their depression for something else. Many people are functional "enough" with depression that they manage to cover up any signs of their illness. Depression can accompany or even mask other diseases.

A few years before my father died, he suddenly fell ill with acute depression not long after returning from a trip abroad. It was like somebody had flipped a switch on his personality. He went from a colorful, gregarious, bold personality to a man that could barely function around his own home. His sleeping habits were poor, he lost his appetite, he lost weight. He had to be forced to take a shower, get dressed, and have his bed made daily. He couldn't even stand to watch any TV - partially because he was unable to follow a 30-minute program for the whole show, but also because he'd simply lost interest. He'd lay on his made bed in the dark bedroom and stare at the ceiling all day. His behavior was like a combination of Parkinson's and Alzheimer's - he was forgetful, his hands would shake, his handwriting became terrible, his short-term memory wasn't functioning correctly. Accompanying the depression - and making it more difficult for the doctors to correctly diagnose him - was that he began to suffer from paranoia as well. He didn't have hallucinations, but there was clearly something very, very wrong with him.

It was frightening. 

No, not just frightening: terrifying. It was a complete 180 of his personality, and there wasn't anything we could personally do to help "fix" it.

I saw him like this for the first time just a few weeks after it began, and the changes were huge, and startling. He'd gained circles so dark under his eyes that it looked like they'd been smudged with charcoal. He wore an expression of fear as he slowly shuffled around his own home - the paranoia that accompanied his depression crowded out rational thought. His voice wasn't the same, and when he did speak, it was in fear of what what happening to him, beyond his control.

You don't know how to react when someone you know is that far gone, when they're not responding very much to medications, when all you can feel about the situation is a feeling of helplessness. And you try your damndest to contain your natural reactions of irritation as their abnormal behavior grinds away at your ingrained expectations of what their behavior should be.

An early consultation with a doctor at a major clinic suggested that he might have Lewy Body Dementia, the same dementia-related disease that Blackhawks great Stan Mikita is suspected to suffer from, as announced a few weeks ago. As it turns out, that doctor was wrong - nearly 25% of LBD cases are mis-diagnosed. In the meantime, he went to the local hospital, and was repeatedly treated by the VA system. They tried out just about every drug on the market on him. Eventually, many months after the depression first manifested, they would find a set of treatments that worked for him, but by the time he was finally starting to approach a new kind of normal, he'd been suffering a bunch of other health problems, including lung cancer, which were slowly destroying his overall physical health.

When it comes to depression, we all too often make light of the person suffering ("snap out of it") or we ignore the symptoms - and the problem, unless it becomes undeniable. But when it comes to depression, it shouldn't be ignored. Depression is not only about the victim, but how it affects others - and how it is affected by others.

If depression is mild, it may be as simple as a sick day at work spent home in bed, or some briefly ignored housework. Most people with depression can still be quite functional - get up, go to work, even perform their jobs well and with a smile on their face. But then they go home and have a hard time facing chores around the house. They turn down social invitations not because they don't want to go, but because it feels like a tremendous effort to do something like getting dressed up and heading across town. They may ignore their own fitness, giving up on physical routines or eating poorly -- and this is a bit ironic, as exercise generates endorphins, which helps a person feel more positive.

At these levels - when the victim is still functional at their job, and puts on a happy face in public - most people don't realize how much the person is suffering. Not every person feels hopeless or so far gone that suicidal thoughts enter their head; many simply feel exhausted, run down, say that they have a "lack of energy". At stronger levels, it becomes far worse; and once depression is undeniably noticeable, it strongly affects the people around the victim - family and caregivers who need to spend much of their time and effort keeping that person from hurting themselves and in safe conditions.

Depression affects individuals, but it's a community disease. For all the research that has been done, we still don't know enough about how the brain works or what causes depression - only that it can't be predicted or prevented, only treated once it begins to manifest signs.

That is why movements like #BellTalks are important. The stigma around depression has to be removed. Depression affects nearly 10% of the population at any given time, and being afraid or ashamed to seek help at the early signs can lead to far worse conditions.

People who have to help or live with those with depression need to have resources and places they, too, can turn to for support.

The hardest part about depression is that we're so conditioned to the stigmas that surround mental health that people are afraid to ask for help, or they wrap themselves in denial. It's very easy for us to tweet out a message of support, or say, "Pick up the phone and talk to a hotline". If it becomes a huge effort to do some mindless easy task like wash an evening's dishes, how easy do you think it is for that person to pick up the phone to a stranger, or even to a friend, and say, "I need help"?

Sometimes, it's a friend or family member or coworker that has to have the strength to pick up the phone, and say, "How can I help my friend/coworker/family member?" Or even to just sit down and tell that person, "I've noticed you seem to be struggling a bit lately. What can I do to help?"

As we've seen rather all too frequently, some of the people who are in the spotlight - celebrities and sports figures who it would appear to have it all, to have their lives together - have shown us that depression doesn't discriminate, and that depression can be more powerful than fame and money. Robin Williams, a universally-beloved comedian who had a rich and varied career, took his own life at 63 last summer. Kurt Cobain, at the height of Nirvana's rise to fame, ended his own life. Famous athletes - ranging from old-timers like Cy Morgan (MLB) to more recent ones like Rick Rypien and Wade Belak (both NHL) have done it.

That's the greatest misconception about depression: that people who suffer from it are weak. If anything, people who suffer from depression and manage to overcome it are incredibly strong. It takes a lot to succeed against your own brain when it's telling you that things are wrong with you, and your body is working against you.

That's why it is so important for leagues like the NHL and NFL - which lead pro sports in head injuries - to take mental health very seriously. It's why we have to end the stigma around mental health, depression, and anxiety - why we have to stop making feel as if they will be rejected or ridiculed when what they really need is help. People who are bullied or harassed will often fall victim to depression, which is why it is good that a lot of effort is being expended to stop bullying, sexism, and homophobia.

Mental health is a community issue. It's time we started treating it like one.

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US: for more information on depression, anxiety, and other mental diseases: National Institute of Mental Health

US & Canada: National Suicide Prevention Hotline: (800) 273-8255 (800-273-TALK), available 24/7, online chat also available
US (LGBT-specific): The Trevor Project
Australia: Lifeline & Kids Help Line (for those 5-25)
Ireland & UK: Samaritans
UK: PAPYRUS Prevention of Young Suicide 
New Zealand: Lifeline New Zealand