Up Close With Dr. E

Many faces of clinical depression

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Today’s article begins with a quiz:

1. What medical condition do these people have in common? Abraham Lincoln; Winston Churchill; Sigmund Freud; Eleanor Roosevelt.

A Clinical Depression B. Diabetes C. Epilepsy

2. One in five of your friends, family members and co-workers have it, at this very moment.

A. Clinical Depression B. Anxiety Disorder C. Bipolar Disorder

3. It is falsely believed to be caused by sinful behavior and weak moral character.

A. Clinical Depression B. Panic Attacks C. Divorce

4. An illness experienced by everyone, at some point in their lifetime, which hits five areas: feelings, behaviors, thoughts, relationships, self-concept.

A. Clinical Depression B. Heart Disease C. Obesity

The correct answers: All A’s. Now that you have your brain warmed up, let us learn what makes the identification of clinical depression so difficult.

1. No two psychiatric patients present with identical signs and symptoms of clinical depression. To illustrate this point, here are three patients, each with a confirmed diagnosis of clinical depression. As you read, watch how each person shows, or expresses their depression, in their own unique way.

A. “Joe, the Builder”. Joe (39) is a carpenter, whose reputation has no equal - his work is precise, stylish, and durable. Regardless of what he builds, his quality is his signature. One month after his ex-wife took him to court over custody of his 12-year-old son, Joe began to have severe lower back pain. A medical evaluation showed no structural problems, so he was given pain medication and told to rest. When his pain worsened and he could not sleep, he began to have panic attacks. He decided to seek psychiatric care and was diagnosed with clinical depression. Prior to treatment, Joe had never expressed anger to anyone. His way of coping with any difficult emotion was to work, work, work. When he completed treatment, his need for perfection was gone, and his back pain gradually faded away.

B. “Nicole, the Faker.” Nicole (26) had seen many specialists for these problems: Chest pain, headaches, insomnia, difficulty swallowing, severe menstrual pain and stomach aches. When all medical tests came back normal, she was told her problems were “not real”, since her symptoms did not match any known medical conditions. When she saw a mental health professional, she was diagnosed with clinical depression.

C. “Steven, the Hulk”. Even though Steven was one of the biggest kids in school, by the time he was in junior high, he was the target for bullies. Because he was shy, Steven withdrew into a fantasy world where he pretended he was a starship captain who was searching for new planets. A former honor roll student, Steven began to make D’s and F’s. When he entered high school, he was caught setting a fire in the boy’s bathroom. He was expelled and required to undergo an evaluation. The mental health professional who evaluated him said, “ Since Steven had no signs of sadness, sleeping problems or episodes of crying, he could not be clinically depressed. His problems are due to poor parenting”. A second evaluation found the following: “You have a severe clinical depression. Like your mother, you were born with a vulnerability to depression. Your irritability, loss of anger control and your reckless behaviors are all strong indicators of clinical depression.

Here are 4 other reasons clinical depression go undetected:

1. Clinical depression is viewed as something which happens to other people, not yourself. This is due to the stigma of mental disorders.

2. The majority of people who suffer from clinical depression are unaware that they have the disorder.

3. Since many adults who have clinical depression, had it as a child, they have never experienced a time without the burden of the illness.

4. Clinical depressions do not have an ‘on’ or ‘off’ button, where they show up one day and then suddenly, disappear. Clinical depression is highly sensitive to environmental triggers or stressors (job loss, death, illness), which can make the depression more severe. This is the reason why it is so common for patients to make the first phone call to a doctor, only to cancel when their depression seems to be going away. It is hard to distinguish between the sadness caused by a difficult life event, from the sadness produced by a clinical depression.

References: 1. “Healing Back Pain,” John Sarno, 1991. 2. “Essential Psychopharmacology,” Stahl, 2000. 3. “Undoing Depression,” O’connor, 1999.

 

Dr. Richard Elghammer contributes his column each week to the Journal Review.

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