May 01--Some disabilities are easy to see. If a person is in a wheelchair, or on crutches, or using a cane, or has a service dog, others around him know that he might need special accommodations.
But what about illnesses or diseases you can't see?
They can be just as powerfully debilitating, but they are often poorly understood and frequently misdiagnosed.
May is national Mental Health Awareness Month. Over the next five weeks, The Sentinel will look at different mental illnesses, resources available in the area for those struggling and warning signs friends and family should be looking for. We will also share stories from people who are living with these disorders.
Depression
Depression is a mood disorder in which feelings of loss, sadness, anger or frustration exist to the point of interference with daily life, according to the National Institutes of Health.
Research suggests that between 5 and 8 percent of the adult population in the United States struggles with depression in any 12-month period.
That translates to about 15 million adult Americans suffering from episodes of major depression this year alone, according to statistics from the National Alliance on Mental Illness (NAMI).
"If you look in the Diagnostic and Statistical Manual for Mental Disorders IV, there's a definition," said Michele Emmett, a licensed professional counselor in private practice in Franklin County.
The DSM-IV, as it's known colloquially, is revised and re-published roughly every 30 years under the auspices of the World Health Organization (WHO).
"They have to get it right, make sure it's not just a cultural thing. This is a template for the world. They have to do it right," she added.
"Major depressive disorder is defined as major depression, recurrent or single episode, in a clinical course that is characterized by one or more major depressive episodes without a history of mania," she read from the manual.
"Sometimes major depression is called 'unipolar disorder,' in contrast to 'bipolar disorder.' This is just the down part," she explained.
Diagnosis
In order for a diagnosis of depression to be made, a person must suffer at least two weeks of a depressed mood or loss of interest along with at least four of the following criteria:
--having no feelings or feeling anxious
--feelings of sadness
--increased irritability
--appetite changes in either direction
--sleep disturbances
--loss of sexual interest or desire
--psychomotor changes (agitation, pacing, wringing hands, etc.)
--decreased energy -- tiredness and fatigue are common
--sense of worthlessness or guilt
--poor concentration
--thoughts of death, suicidal ideation, suicide attempts
People should look for those changes in themselves or loved ones, because they can indicate an underlying problem.
"Often people will feel physical pain. It's somatic, but they wouldn't necessarily think that if they're physically hurting that it's depression," Emmett said.
"If you suspect depression, you really need to go to your doctor and get it checked out. Anxiety, poor concentration, an inability to focus -- any of this lasting more than two weeks is key," she added.
Who's at risk?
Depression can strike anyone at any time for any reason.
"Basically everyone," is at risk, Emmett said.
"There are also mood disorders with medical conditions," she added.
One of the challenges in diagnosing depression is culture.
"In some cultures, depression may be experienced only in physical terms, people complaining of nerves. Chinese people complain of an 'imbalance.' You have to look out for cultural and ethnical differences because some people are unwilling to admit weakness in themselves, especially as it might relate to spiritual problems. You have to be really aware," of those influences, she cautioned.
Another difficulty in diagnosis is that although the core symptoms are the same for children and adolescents, some symptoms change with age.
"Social withdrawal, irritability, anger are much more common in children than tearfulness and sadness," she said.
Biology
Like so many other things nowadays, depression can also be blamed on genetics.
"Major depressive disorder is 1.5 to three times more common among first-degree biological relatives of someone with depression," Emmett said.
For people with a genetic predisposition to depressive tendencies, the symptoms may first present as something called "dysthmic disorder."
"Dysthmic disorder is a low-level, chronic lack of interest, but it doesn't meet the diagnostic criteria of really interfering with your functioning," she said.
"These are people who are never happy," she added.
A crucial distinction she made, however, was the need for a pattern of behavior.
"You have to realize, depression is part of the human condition. It's supposed to happen. Bad things happen, people get depressed," she said.
The difference is, "this is a pattern. It lasts more than two weeks and has no cause."
For people with underlying dysthmic disorder, a traumatic event -- death, divorce, a relationship ending, loss of a job -- can trigger a depressive episode and tip the person into full-blown depression to the point that it interferes with their daily lives.
Not all the same
Emmett, who has been in practice for more than 30 years, stressed that "not all depressions are the same and not all depressions have to be medicated."
"We do know, by research, that the most effective combination is psychotherapy or counseling with medication, but either alone can be an option," she said.
"It's a complicated diagnostic thing. Not all depressions are the same. There are different types, different degrees," she added.
"See your family doctor first, then a therapist, then talk about medication. Just as not all depressions are the same, not all medications are the same.
"It really is, still, unfortunately, a personal trial-and-error situation. If you are a person who has tried several medications and it's not working, maybe it's time to step in and see a psychiatrist (See box).
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