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Depression is by far the
most pervasive, impactful, and costly medical problems we
have in this country today. Aside from the emotional and
spiritual life-toll that depression exacts from us, it has
been estimated that just the combined economic costs
associated with time lost from work and monies necessary to
treat it has exceeded $16 billion a year.
Everyone knows someone who
has suffered from a serious depression, even if it has not
be so “labeled.”
As anyone who’s actually
experienced it can tell you, it’s not the same as a bad mood
or a sad day. We have all experienced sadness, anger,
irritability, guilt, loss, unhappiness. Depression is that,
but also much, much more.
How Do You Know If I’m
Depressed?
My response to
that is usually, “You’re the one who knows best.” Then I ask
a series of questions that help to clarify it.
Depression has certain
features or characteristics. The primary one is a
“dysphoric” state—a feeling of being down, sometimes
experienced as helplessness, hopelessness, and despair. When
feeling this way it can be hard to participate in your life
the way you once used to or the way you may want to. There
may be an increase in crying or a desire to cry, even if the
tears don’t come (“dry tears depression”). People with
depression look, feel and present as “down.” They’ve lost
interest in things that used to give them pleasure—they
don’t see the point anymore.
We may see disrupted sleep
(insomnia, hypersomnia), a loss of appetite, a loss of
sexual desire (that is not related to particular sexual
changes or endocrine dysfunctions), fatigue during the day,
an increase in anxiety and irritability (called “agitated
depression”).
Depression can often be
seen with alcohol or drug abuse. Which came first is often
hard to diagnose and it’s always important to treat the
substance abuse first. Alcohol and drugs exacerbate rather
than help cure the problem. Alcohol and drugs can often
create depression. If the person was already depressed prior
to using alcohol or drugs, they will most certainly make it
worse.
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