Archive for Depression

Women Living With Fibromyalgia Review


There are many getting diagnosed with FM, or fibromyalgia, and haven’t ever heard of it. Then there are those that are certain that they have it, want to understand it, and are still attempting to find someone to give them the diagnosis. Whichever the case, Mari Skelly has written a great book that answers many of the top questions whether the diagnosis is still being sought or if it has already arrived.

Resources and Definitions

Two chapters specifically deal with where the reader can go to get other information. There were a good five pages of different resources, from support groups, to organizations, and other places that one can find more information on Fibromyalgia. There is a good glossary so that any words that are difficult to understand or that the reader just isn’t aware of can be looked up and defined. This can keep the reader from getting bogged down in the language, even though the book was written in normal layman’s terms.

Case Studies

What was really the key to the book, crucial in making it stand out among others on the shelf, were the case studies. These patient accounts really added a human feel to the book, and wasn’t too scientific or too basic. It was a perfect mix of telling in easy detail the who, what, where, and why of the condition. Some of the case studies used in the different chapters really focused on the way that it feels to have FM, and how the sufferers manage throughout the day. No one except those living with the condition can truly describe how it feels and what worked for them, and it’s those tidbits scattered throughout the book that really were nice to read.

Author Information

Mari Skelly has written several books on fibromyalgia and has been living with the illness (along with CFS as well) since 1993. Along with being a talented author, she is also a florist and a motivational speaker. She has also written the book Alternative Treatments for Fibromyalgia and Chronic Fatigue Syndrome.

Table of Contents

  • What is Fibromyalgia?
  • A Community of Women
  • The Relief of a Diagnosis
  • The Unique Concerns of Women with FM
  • Taking Care of Ourselves: Treatment Options
  • Our Mental and Emotional Health
  • Everyday Solutions and Things that Really Work
  • Dealing With People Closest To Us
  • Dealing With Doctors and Other Health Care Providers
  • Dealing With the Rest of the World
  • Money Matters: Paying the Bills and Getting the Benefits We’re Entitled To
  • What’s New? What’s Coming?
  • Life Goes On
  • Resources
  • Glossary

Book Information

Women Living With Fibromyalgia by Mari Skelly, published by Hunter House Publishers, 2002, ISBN: 0-89793-342-7, $14.95 Retail, 288 pages

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Vagus Nerve Simulator

A friend of mine called me last week. She had just caught the tail end of a report on the local ABC 7 report on another way to fight depression. She mentioned something about nerve stimulation. I quickly went online to see if the TV station had anything at its site. All it had was a short blurb. I can only imagine that this had to do with the vagus nerve simulator that I read about last year. Apparently doctor A. John Rush, a psychiatrist from the University of Texas Southwest Medical Center at Dallas was still having good results with his new treatment for depression.
Unfortunately, I was not able to catch that particular news item, but I can share some information on it. The vagus nerve simulator is a generator that is sometimes used to prevent epileptic seizures. The pacemaker-like generator in a person’s chest connects an electrode to the vagus nerve in the neck. That nerve goes to parts of the brain believed to control emotion. The nerve is stimulated for 30 seconds, every 5 minutes, 24 hours a day, 7 days a week.

In an earlier pilot study of only 30 patients, 40 percent of the treated patients displayed at least a 50 percent or greater improvement in their condition, according to the Hamilton Rating Scale for Depression. Half the patients also had at least a 50-percent improvement on the Montgomery Asberg Depression Rating Scale. The condition of several patients improved so substantially that they were able to return to work or other normal activities. All the patients who responded to the treatment have continued to do well.

According to the short blurb that I saw on the news website, Dr. Rush is declaring similar results with a new study. Unfortunately, I do not how many people are being tested in the present study.

I do know that some of the anecdotal information is impressive. One woman, for example, had lived with severe depression for years and had been hospitalized four times. She said the fog is now lifted and the results have been remarkable. Let’s hope that future studies bring similar results.

A Polypharmacy Approach

You underwent a major depression and the doctor treated you with antidepressants. You waited the six weeks, and you still were ill. Perhaps not as depressed as you were originally, but still bothered with insomnia, feeling sad and/or anxious and having little appetite. You tried another medication and felt the same. Now there’s a new term to label you: treatment resistant/ refractory depression (TRD).

Some doctors would next try a polypharmacy approach to eliminate the depression. This is as long as a person has been given a proper diagnosis such as unipolar vs. bipolar and has been on a significant dosage of the deemed correct medications for a long enough time period. Sometimes side effects may interfere with this dosage amount.

There are four approaches to treatment refractory depression:

1) Optimization-Maximizing the dose/serum level/time. Prescribing antidepressant medication in dosages that are too low and for lengths of time that are too short are common causes of treatment failure.

2) Substitution-Substituting one antidepressant for another within the same or different family (one selective serotonin re-uptake inhibitor (SSRI) for another one, for example). In some control groups, the latter has shown to have a better response rate.

3) Augmentation-Adding a medicine, such as lithium, that is not routinely regarded as an antidepressant when there is only a partial response to the primary antidepressant agent.

4) Combination-Using two primary antidepressants together. This therapy involves the addition of a second antidepressant agent to the regimen. Concurrent administration of two or more antidepressant agents (e.g., adding trazodone [Desyrel], desipramine [Norpramine] or bupropion [Wellbutrin] to fluoxetine) may yield a different response than that produced by use of either drug alone.

Doctors will have their different approaches depending on the patient’s particular circumstances, as well as their experiences with other patients’ treatment.

Below are just a few examples of these combinations. If you suffer from TRD, this will give you a start on your possible next step in treatment.

Dr. Scott Aaronson, M.D., psychiatrist in private practice, Newton Centre, MA. Supplements anti-depressants with the new atypical psychotics, such as Zyprexa and Seraquel. He reports a lot of success with supplementing anti-depressants with these new anti-psychotics, and gives the example of a depressed patient whose suicidal ideation was not relieved until she was placed on Zypreza, in spite of the prior use of several different anti-depressants.

A 21-year-old woman who suffered from severe depression and talked of suicide was given a combination of venlafaxine (Effexor) and bupropion (wellbutrin). She responded positively to the treatment

Underdosing is a frequent cause of treatment failure, so ensuring that adequate doses get an adequate trial is imperative. Increasing dosages of tricyclic (TCA) antidepressants even beyond recommended ranges may be considered when response to a 6-week trial at the high end of the recommended range is less than optimal; though there is little data supporting this tactic with SSRIs.

The significant number of depressed patients who don’t respond adequately to selected (SSRls) could benefit from the addition of a (TCA), an open trial at the Clarke Institute of Psychiatry confirmed. The patients had been treated with fluoxetine (prozac) for at least five weeks; their medication was augmented with the drug desipramine.

Antidepressants – Not a Science

For 20 years, antidepressants have given some if not entire relief to countless individuals. The word “some” or partial is used here since about 70 percent of people are improved. That leaves another 30 percent (a significant number) who are only getting partial or no help from this medicine: a.k.a. “the treatment resistant group.”

That’s one good reason why the search for new antidepressants continues.

Another reason for the hunt for new antidepressants is side effects-it can be a trade off of whether or not to deal with the depression, weight gain, sex problems and insomnia, to name a few. Thus, one explanation for recurrent depression: People decide the side effects aren’t worth the problem.

Recurrent depression occurs for other reasons as well. In a 1998 study, more than one-third (37 percent) of people treated for depression by primary care physicians suffered recurrent depression within 19 months. Seattle researchers followed 370 adults treated for depression by a large HMO in the Puget Sound area. Relapse was defined as suffering two weeks or more of significantly depressed mood and other symptoms of depression (sleep and appetite changes, lethargy, hopelessness, suicidal thoughts) from seven to 19 months after initial treatment.

The biggest risk factor for relapse was a previous relapse. In quite a few people, depression is a chronic recurring illness characterized by periods of normal moods and major depression. The other risk factor for relapse was low-level depressive symptoms despite treatment, notably, sadness. Compared with participants who did not relapse, those who had relapsed previously and reported sadness despite treatment were three times more likely to relapse again.

The simple truth is that antidepressants are not a science. No one can say, “Oh, you are in mental pain,” take two of these SSRIs and a nap and you’ll be fine again. If it were so easy! Researchers are learning as they go. And in the majority of times, they get it right, if the percentages are correct. The results with Prozac are a good example. Many a person will praise this medication. And for those whom it has helped, it’s a godsend.

However, there’s another side to this issue as well. An article in May 2000 Boston Globe reports, “Just as the 14-year patent on Prozac is about to expire and the drug’s maker, Eli Lilly and Co., is preparing to launch a new version, a body of evidence has come to light revealing the antidepressant’s dark side. The company’s internal documents…indicate that the pharmaceutical giant has known for years that its best-selling drug could cause suicidal reactions in a small but significant number of patients.”

Similarly, a just-published book, “Prozac Backlash,” by a Cambridge psychiatrist, Dr. Joseph Glenmullen, has drawn Lilly’s ire for discussing Prozac’s link to suicide, tics, withdrawal symptoms, and other side effects of Prozac and similar antidepressants. In other words, even Prozac has its problems.


It’s no wonder that so many questions remain. Antidepressants work on the brain, a very much unchartered land.

Antidepressants work by slowing the removal of certain chemicals from the brain. These chemicals are called neurotransmitters. Neurotransmitters are needed for normal brain function. Antidepressants help people with depression by making these natural chemicals more available to the brain.

There are many different kinds of antidepressants, including: Tricyclic antidepressants (tricyclics) Selective serotonin reuptake inhibitors (SSRIs) and Monoamine oxidase inhibitors (MAOIs). Each work differently from each other. Each work differently when in combination with each other. And each work differently on one person versus another. The permutations are endless.

And, as noted, the antidepressants can cause decreased sexual drive and loss of ability to reach orgasm. They can also block menstrual periods, although this seems less common. Decreasing the dose of medication or switching to a different antidepressant is sometimes useful in dealing with these problems.

Viagra®, the much-publicized medication for male erectile dysfunction, appears to be effective in quickly treating sexual side-effects experienced by some men taking antidepressant medications. A study involving the University of Arizona Department of Psychiatry, the University of New Mexico and Massachusetts General Hospital, is testing 90 men experiencing antidepressant-related sexual side-effects by giving them Viagra® as a potential antidote. (A similar study designed to treat women also is in the early stages of consideration.). The question is whether or not to take one pill to counteract another.

Taking anti depressants during pregnancy is also getting mixed reviews. A 1999 study of women who took antidepressants during pregnancy reported that neither Prozac, an SSRI, nor tricyclic antidepressants posed a higher than normal risk for birth defects or miscarriage.

According to a June 25, 2000 New York Times article, “few experts deny that antidepressants can alleviate the sadness, confusion, anger, insomnia, self-recrimination, dread and loss of interest in everything of postpartum depression. Yet many mental health professionals and women’s health advocates worry that these drugs are being over subscribed, especially to pregnant and breast-feeding women.”

According to a panel of psychiatrists at the recent National Depressive and Manic Depressive Association Conference, the SRRIs are “incredibly safe” during pregnancy. Effexor is the worst. Lithium’s dangers are overstated while Depakote and Tegretol are dangerous. According to Fredrick Goodwin MD (who co-authored the definitive book on bipolar disorder with Kay Jamison), the anticonvulsants involve a five percent chance of neural tube defects (such as spinal bifida) while lithium runs a one in a thousand chance of heart problem, which is correctable. (McMan’s Depression and Bipolar Weekly2#30

On the flip side, however, you have women who either suffered severe postpartum depression and are concerned about a relapse (which is a logical concern, remember the study quoted above) and want the medication to combat reoccurrence. Or, you have women who have successfully been on an antidepressant and don’t want to take the risk of getting off of it.

Once again, not a very cut and dried situation. For the time being, any woman taking any medication regularly–whether it’s for depression, headaches or a topical crème for skin rashes — should discuss this with her doctor when considering getting pregnant. This gives her the opportunity to weigh the pros and cons of staying on or starting a medication or changing medications based on studies to date. This session with the doctor can also give the mom-to-be the chance to determine whether the doctor is someone she respects, wants to take of her for nine months, and to deliver her baby into the world.

Treatment Resistant Depression

Beth is depressed. Clinically depressed and depressed about being depressed. She’s one of millions of people who have not responded to the magic of antidepressants. She’s been there and back for Prozac, Effexor, Wellbutrin, Parnate, Lithium…you name it. Beth is not alone. According to an article in US News and World Report, by 2020 depression will be in second place-after heart problems-for disabling diseases. Already the World Health Organization puts the disease in first place for women and fourth place overall.

In the US, depression strikes 18 million people at any one time. And many of these people are helped by antidepressants. But, says the article, 30 percent of these people do not respond to this medication and 70 percent who do respond do so only partially or for only a certain length of time. Yes, the antidepressants have helped a considerable number of people. However, it’s not the fountain of youth for everyone. Nearly six million people continue to suffer for indefinite periods of time.

Likewise reports American Family Physician magazine, partial response and nonresponse to antidepressant medications are common problems in patients with depression. This publication puts the number between 10 and 30 percent of depressed patients who are taking an antidepressant and are partially or totally resistant to the treatment. Recurrence of depression while still taking medication (i.e., breakthrough) can also occur.

Why are some people not helped by the medication? The article notes several reasons: Treatment failure, including undiagnosed or misdiagnosed medical conditions such as hypothyroidism and anemia. This would indicate that a person who does not respond should be reevaluated by a physician to ensure the initial diagnosis of depression was correct. Another reason medication doesn’t work is that nonpsychiatric drugs such as methyldopa (Aldomet), beta blockers and reserpine (Serpasil) can cause or exacerbate depression. Finally, adverse effects and poor compliance may be additional obstacles to successful treatment. Side effects can be too severe to either stay on the medicine or go up to a high enough level to be advantageous.

Even the term “depression” causes a problem. People wrongly associate the word with despondency and ignore the illness or treat it too lightly. National Institute of Mental Health neuroscientist Philip Gold says (as reported in US News and World Report) “People confuse it with the everyday sensation of feeling despondent and dismiss it. In fact, it takes an incredibly strong person to bear the burden of the disease, which ought to be given a more appropriate name.”

Treatment resistant depression puts the ailing person in an undesirable position. First she is depressed because of clinical reasons. Then, on top of this, she is burdened with the fact that she isn’t responding and doesn’t know how long the depression will last. She has to be strong and patient, two very difficult words in the depressed individual’s lexicon.

A 31-year-old woman tells a doctor that she’s been in treatment for depression for 10 years. She has been on almost every antidepressant and has participated in several research studies. She was also in the hospital for ECTs for about three months. It’s stories like this that demonstrate the strength and fortitude of depressed people. Unfortunately, like the NIMH scientist says, depression is seen as a weakness. How many many times do you hear people say, “I don’t understand why you aren’t getting better. I get depressed from time to time and in a day or two it passes.” Well it didn’t pass for this 31-year-old woman, nor for millions of people in the US.

What’s the answer to the chronically ill? To keep on trying new medications and approaches as they are released. After all, what choice do we have?

In the next several articles, I will be discussing some of the traditional and alternative approaches to treating depression. If you have any personal experiences to share on treatment resistant depression, please send me a message. When we come together to fight the monster it makes things a little bit easier.

Postpartum Depression / Postpartum Thyroiditis

Cassandra was thrilled. This was her first pregnancy and everything was going well-both physically and mentally. She was in good shape and hadn’t gained too much weight. Her spirits were sky high, anticipating with pleasure all that the baby would bring.

The delivery went well, no complications and a shorter time than expected. Cassandra looked forward to coming home and spending time with her new baby Carolyn. About three weeks later, all hell broke loose. Cassadra began to feel depressed, lethargic and even had thoughts of suicide. No matter what she tried, she couldn’t shake these negative feelings. Her problems went well beyond the “baby blues,” a short-term mild state of depression.

And, indeed, postpartum depression is much more severe than the baby blues. Typically, the mother is inexplicably sad, has mood swings, weeps for no reason, and displays irritability and fatigue. How do you tell if the sadness you feel is a minor problem or a more severe concern? Answer the questions below, which were developed by the Postpartum Stress Center. The more questions you answer “yes,” the more likely you are to be suffering from postpartum depression. And, the more important it is to seek help. Do you…

Have trouble sleeping?

Find you’re exhausted most of the time?

Notice a decrease in your appetite?

Worry about little things that never used to bother you?

Wonder if you’ll ever have time to yourself again?

Think your children would be better off without you?

Worry that your husband will get tired of you feeling this way?

Snap at your husband and children over everything?

Think everyone else is a better mother than you are?

Cry over the slightest thing?

No longer enjoy the things you used to enjoy?

Isolate yourself from your friends and neighbors?

Fear leaving the house or being alone?

Have anxiety attacks?

Have unexplained anger?

Have difficulty concentrating?

Think something else is wrong with you or your marriage?

Feel like you will always feel this way and never get better?

It is believed that 20 percent of women get postpartum depression, but in different degrees of seriousness. There are several possible reasons. A hereditary predisposition (i.e. family history of depression or anxiety), chronic sleep problems from all-night feedings, major hormonal changes, medical complications in either mother or infant, tendency to have a lower self-esteem, previous postpartum or other clinical depression, absence of support from family and friends, and isolation. Postpartum depression typically occurs one to three months after the birth, but may appear right after or up to one year after the birth of the child.

Most women make a full recovery. However, they could be at risk of recurrent episodes of depression with subsequent pregnancies, at menopause, or during times of high stress. Similar to other types of depression, early identification and treatment are the keys to successful recovery. Unlike the baby blues, postpartum depression doesn’t disappear spontaneously.

Treatment for postpartum depression is a combination of anti-depressants and psychotherapy. Breast feeding may be a concern with some medications, but there are alternatives. Electroconvulsive therapy may be used in situations when the depression is resistant to medication. Support groups for postpartum depression are also beneficial. Belonging to a group lets a woman know that she isn’t alone in her experience, and that she will recover.

Regardless of the method of treatment, the first and foremost step to take is getting medical and psychological assistance. Call your OB/GYN or family doctor if you have any depressed thoughts or behavior.

Postpartum thyroiditis

About five to ten percent of women suffer from postpartum thyroiditis where there is a transient hyperthyroid state followed by hypothyroidism. The symptoms may go unnoticed or attributed to other postpartum issues such as breast feeding or recovering hormones. While most postpartum thyroiditis patients regain normal thyroid function, as many as 25 to 30 percent of individuals develop permanent hypothyroidism.

In the overactive stage you may feel hot and tired with a fast pulse together with increased sweating and nervousness. These symptoms are often mild and go unrecognized. The over-activity is always transient and only lasts a few weeks. The under-active symptoms include tiredness, feeling the cold, depression, dry skin and aches and pains. These symptoms are often more severe. The depression is usually mild to moderate. Many of the symptoms are very general such that the doctor may not at first think of thyroid disorder. However postpartum thyroid disease is now being diagnosed more frequently.

Again, be sure to call your doctor whenever you have any symptoms of thyroid problems. When left alone, depression will most likely get worse.

Another Set of Initials to Reek Havoc

When I was growing up, the “m” (menstruation) word was not mentioned in polite conversations, let alone mixed company. I remember telling my mother that I got my period and her happily telling my dad. I was embarrassed and excited at the same time.

Well, that has surely changed. You see print ads and TV commercials extolling the use of one menstrual product over another. And those three letters “PMS” are heard anywhere from news shows to comedy routines. They are as well known to the masses as TNT and ABC.

There’s another set of initials that has not yet received such notoriety. This is PMDD or premenstrual dysphoric disorder. PMDD is a much more severe form of the collective symptoms known as premenstrual syndrome (PMS). It affects about 5 percent of women of reproductive age and is considered a severe and chronic medical condition that requires attention and treatment. PMDD usually begins when a woman is in her teens to late 20s, although women who seek treatment are usually in their 30s. Depression is one of the most common symptoms. PMDD is a term that was created in recent years by the American Psychiatric Association.

PMDD is not the same as PMS because it greatly impacts one’s work, schooling, social, and relationship activities. PMS leads to short-term mood changes; PMDD is usually more more acute and has different symptoms, including:

Feeling blue, hopeless ,tense or anxious Having mood shifts with frequent tearfulness Being constantly irritable and angry Having a decreased interest in usual activities Concentrating poorly Lacking energy Binging on foods or having a loss of appetite Experiencing problems sleeping Having no interest in sexual relations Experiencing physical symptoms like breast tenderness, headaches, bloating, weight gain, or joint/muscle pain.

To be considered PMDD, the symptoms must be present in severe form, but only during the last two weeks of the cycle. Some women also experience these symptoms during ovulation. If it sounds a lot like clinical depression, it’s because it is. The only difference between the two is that PMDD lasts for a shorter length of time and that PMDD is closely linked to a female’s menstrual cycle.

Although any woman can develop PMDD, some women may be at a greater risk:

Women with a personal or family history of mood disorders Women with a personal or family history of postpartum depression Women with a personal or family history of depression

Although the definitive answer about cause is still unknown, studies indicate that PMDD could be caused by an abnormal, biochemical response to normal hormonal changes. Some research shows that the routine increase in estrogen and progesterone before menstruation causes, in some women, a serotonin deficiency that induces PMDD. Once again it appears that serotonin levels may play a role in depression.

If you expect that you are suffering from PMDD, don’t ignore it. The mental pain can be just as debilitating as clinical depression. Talk to your primary care physician, psychiatrist or OB/GYN about your symptoms. Keep a diary of symptoms and their timing to establish a cycle of reoccurrence.

The treatment for PMDD is similar to that for major depression: the use of antidepressants and psychotherapy. A woman with PMDD needs to take antidepressants on an ongoing basis, not just during the time when her symptoms appear. Psychotherapy can help her cope with the symptoms and with other challenges in her life.

How do you know if you are suffering from clinical depression and not PMDD? According to the site Women’s Health Interactive, you can differentiate between the two in the following ways.

The mood swings experienced around periods aren’t a mental disorder. These may be obvious to us and to our loved ones, but probably aren’t particularly noticeable to other people.

In a woman who already has a mood disorder such as major depression or anxiety, the disorder may make premenstrual symptoms seem worse. However, that doesn’t mean she has PMDD. A medical condition such as a thyroid disorder, cancer, endometriosis, or other infections may intensify premenstrual mood symptoms, but again, that doesn’t mean a woman has PMDD.

PMDD symptoms are clearly linked to the menstrual cycle, and disappear during menstrual flow.

Laboratory testing and medical and mental examinations can distinguish PMDD from other physical and mental conditions.

The Women’s Health Interactive site also has a quick-self test that you can take to determine whether or not you are suffering from PMDD. The questions are from the Diagnostic and Statistical Manual of Mental Disorders (DSM IV), 4th edition, 1994.

DMDD can be extremely painful and cause a major disruption in a woman’s life and career. If you have any reason to believe you suffer from this illness, make an appointment with a doctor now.

One Step at a Time

Recently, I was reading Nickelodeon Magazine with my second-grade son and cringed when one of the articles mentioned “going to the loony bin.” When he asked me what this meant, I was glad to have the opportunity to provide an unbiased and unhurtful explanation. Several nights later when we were watching the actual Nickelodeon TV show, another term came up—the funny farm. Again I explained to my son that this was another negative way of saying a hospital for people who have a mental illness.

The more things change, the more they stay the same. I remember as a kid teasing my friends that they would end up at a funny farm or making the universal sign for craziness—moving the index finger in circular motions by the side of the head above the ear. I can still remember the lyrics of a then popular song: “They’re coming to take you away (ha, ha, ho, ho) to the funny farm where life is beautiful all the time… Little did I realize I would end up one of those who would go to this “funny farm.”

And it isn’t only the children’s shows. As recently seen, programs such as ER and Ally McBeal are not accurately portraying mental illness. And the ABC TV show Wonderland only made a few airings before going down the path to nonexistence. No one knows for sure, but the fact that there was outrage from the general public as well as from various mental health organizations may have had a lot to do with the show’s demise.

It’s a good sign, I believe, that organizations and individuals are becoming more forthright about getting the facts out about mental health. During Mental Health month, a wonderful series of ads were run by the Oak Park (Illinois) Township Community Mental Health Board, Oak Park Board of Health, and Oak Park Department of Child & Family Services. Under the overarching theme “Changing Minds,” the ads addressed different topics as:

–Mental illness is not a natural part of the aging process –Depression is more than just “a case of the blues” –Would you tell a guy with cancer to snap out of it? –Are the best years of your life being crippled by panic and fear? –Is this the face of severe mental illness? (run with a photo of a smiling woman)

And my favorite: “Sometimes the stigma is worse than the illness.” With copy that reads:

“A person with mental illness has enough obstacles to overcome without being shamed, labeled, pigeonholed or discriminated against. Mental illnesses are physical, biologically based brain disorders. They’re not caused by bad character or poor child-rearing. Show some compassion in dealing with mental illness. It could just as easily be you.” AMEN!

Slowly, individuals, as well as organizations are starting “to come out of the closet” about mental illness. Yes, it may have reeked of politics, but it did not hurt to have Tipper Gore discuss her situation and urge Americans to recognize mental illness as a treatable problem without “stigma and …shame.” And last year a Georgian went on a 1,000mile trek to help end the stigma of mental illness. Said someone who watched Stewart Perry walk by, “If Stewart can do it…so can we.”

And what about me? Can I break my fear of talking about this illness with anyone else besides my family and closest friends? I have to remember that there’s no shame in being mentally ill. I also have to get rid of the guilt because I cannot carry my usual load of obligations. (If I had a debilitating physical illness I wouldn’t feel this guilt!) And I have to squash the stereotypes in my own mind. Remember, as a child I also made fun of the loonies. And now I’m one of them!

Why Do Women Get Depressed?

As noted in an earlier article, women have a far greater chance of becoming depressed than men. Why? That’s the $2 million question. If that were answered, a lot more women could be spared a lot of agonizing pain. No one fully understands what causes depression-in women or men.

Most likely it’s a combination of factors that causes the onset of depression–the result of genetics, biochemistry, and psychological conditions. Studies show, for example, that women who are genetically inclined to depression are more apt to become depressed after a trauma in their life. The genetics factor is one that impacts both women and men. Depression runs in families, often for generations. Over the past decade, scientists have determined that the neurochemical deficiencies seen in depression are transmitted genetically from parents to offspring.

For any animal to function effectively, the nerve cells in the brain must communicate. Each nerve cell is separated by small gaps. “Neurotransmitters” send messages to a “receptor” on the other side of the gap. It works like a jigsaw puzzle: each neurotransmitter fits into a conforming receptor. When the level of neurotransmitters is low, messages break down and communication slows considerably. From research, it seems that depression is strongly related to what’s taking place at these connections.

Clearly, social factors also impact on a woman’s tendency to have depression. It is not surprising that more women (and–as we saw in the last article-adolescent girls) have low self-esteem, tend to put blame on themselves for others’ actions, and take on an excessive amount of responsibilities-mother, wife, housekeeper, employee, den mother, caregiver to ailing parents, etc., etc., etc. And if women begin to feel the warning signs of depression, they are so busy taking care of everyone else they don’t take care of themselves. It’s a wonder that their aren’t even more depressed women!

Depression is often associated with a trauma or major change in one’s life, which makes the person more psychologically susceptible to the disease. Mary, age 31, was raised in a household where her mother and father both suffered from depression. She married at an early age and went through a divorce several years later. She then began rearing her children on her own-with little or no financial support from the father. Although having minor depression a few times during her life, she hadn’t experienced a major depression.

Then her son became very ill and had to be hospitalized several times, with no assurance that he would recover. Mary started declining-getting more and more anxious, frustrated and depressed. Her son finally improved, but the damage was done. She admitted herself to a psychiatric center for treatment.

Mary is not alone. In a study of 680 pairs of female twins, recent stress (a divorce, illness, bereavement, or legal problem) was the best predictor of depression. Other studies have found that as many as 86 percent of major depressions were set off by a life crisis.

Sometimes a depression is not caused by any trauma, but triggered by a physical illness or condition. As women know, it may be associated with hormonal changes after childbirth or during menopause. Many researchers have attributed the increased rates of depression among women to the female reproductive system and the menstrual cycle. It’s a depression that can hit anywhere in a female’s life–be it the teenage girl who can’t stop crying, the new mother who finds herself unable to cope, or the middle-aged woman who is going through menopause.

Scientists have recognized the correlation between depression and hormones for a number of years. This connection makes good sense since hormones affect neurotransmitter activity, and neurotransmitters affect the timing and release of hormones.

Premenstrual Syndrome (PMS) has become a commonplace condition-you even see TV commercials about it. Women experience a number of problems from mood swings to physical discomfort. A number of studies reveal that women with PMS have lower serotonin levels right before their periods than women who don’t have PMS. There’s another condition called Premenstrual Dysphoric Disorder (PMDD). PMDD symptoms can cause tremendous distress and include depression, anxiety, and loss of energy, as well as changes in appetite and sleep patterns.

Hormones also play a major role in postpartum depression. Up to several months after giving birth, a woman may go into a deep depression. It may become too difficult to take care of herself let alone her newborn. Women who have suffered from major depression in the past are more susceptible to this illness. Do not confuse postpartum depression with the “baby blues,” which occurs a couple of weeks after delivery; this is a milder form of depression that goes away within a few weeks.

Menopause is also a trigger for depression, especially if the woman has suffered from the illness in the past. Women are at greater risk for developing depression in the five years before and the five years after menopause when they have experienced prior depressive episodes or have PMS. Menopause is a time of changing hormones, which affect brain chemicals related to mood.

Another hormone, melatonin, may be associated with season affective disorder, which is three times more common in women than in men. Researchers are now studying the effect of melatonin with SAD, as well as the correlation between melatonin and other hormones.

Clearly, it’s difficult to point to any one factor as causing depression in women. Biological and social influences not only coexist but most likely reinforce one another.

Depression in Children

You believe that your daughter is suffering from depression. Her erratic behavior is more than the normal ups and downs of a teenager. What can you do?

First and foremost, accompany her to a mental health professional, preferably someone who specializes in adolescence. You cannot, nor should not, try to handle this situation on your own. This is especially true if she is showing suicidal tendencies. If your daughter were suffering from a physical illness, you would bring her to the best specialist in town. It’s no different with depression.

Additionally you can:

Let her know that you are there, no matter what. You care and you want to understand what she’s going through.

Persuade her to share her thoughts and feelings.

Listen. Listen. And listen some more. And keep an open mind and heart. There is no right and wrong here. Only a daughter who is suffering. You may only have half the answers, but by being there you will make a difference.

In order to instill hope and to provide support, share some of your own experiences that were not pleasant but that ended positively. This will also help her open up and speak about her own problems.

Don’t minimize her troubles. Her worries may seem little to you, but they are very real to your daughter.

Encourage her to talk to other adults, including relatives, teachers, coaches and clergy to get different perspectives.

Take her to a place that she usually enjoys such as a favorite restaurant, shopping center, movie or sports activity. She needs a chance to unwind and remember what it is like to have fun. If she can’t relax, don’t force her.

These will not be easy times. If your teenager was rebelling before, she may rebel even more now. Everyone is the enemy until she gets things figured out. So expect rebuffs. Don’t be surprised if she responds to you in an irritable and negative way. Patience, so it’s said, is a virtue. And in this case, it is indeed.

Most of all, let your daughter know how much you love her. Give her distance when she wants to be alone. And be there when she reaches out to you. A kiss and a hug can easily take the place of a thousand words.

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