“I saw, in gradual vision through my tears, The sweet, sad years, the melancholy years,…”
— Elizabeth Barrett Browning (1806–1861), British poet.
Sonnets from the Portuguese (1850)
The Victorian poet continued, “Those of my own life, who by turns had flung a shadow across me,” and while this is English of another time, it’s clear that it’s a reference to depression. Right here and now, two weeks before Christmas Eve and I’m writing about clinical depression? It may not be as unrelated as you think.
Definition. Depression is not mere sadness. Just about everyone gets “the blues” once in a while; others a little more often than others. But the cause of sadness is usually unearthable – an unfortunate event, an accident, a slight, failing grades, a nasty marital fight –and proximate. If you will ask a psychiatrist, the good clinician will agree that Christmas is a classic trigger to a major depressive illness. In this season, there is the heightened expectation of happiness and excitement. After all, it is the time of reunions and all-night partying. If the anticipation leads to nothing or disappointment, the depression-prone individual suffers. Christmas to her becomes miserable. Sensitive souls feel the emptiness of gift-giving and the crass materialism that goes with it. Others find the tiangge (flea market) shopping and traffic intolerable.
Symptoms and Signs. Are you depressed? In major depression, the person is affected to an extent that his work and private life are all but impaired. Duration is critical because normal dejection lasts for a few days before the person somehow snaps out of it. In real depression, the condition carries on for more than two weeks. A man or woman suffering from clinical depression must exhibit five out of the following nine symptoms, including one of the first two listed:
Loss of interest and pleasure in usual daily activities (anhedonia).
Loss of appetite and weight changes (loss or gain).
Insomnia or hypersomnia (too little or too much sleep).
Restlessness or sluggishness.
Feelings of worthlessness or guilt.
Inability to think clearly, make decisions, or complete tasks.
Thoughts of death or suicide.
Possible Causes. Currently, researchers believe that in depression there is an imbalance of neurotransmitters norepinephrine and serotonin. These are natural chemicals needed in the communication of brain cells with each other. Genetics has been implicated. Scientists have shown that depression like diabetes and hypertension filter through generations. Finally, and this brings us back to the holidays, environmental cues can push a susceptible person into depression.
Treatment. There are two things to remember about conquering depression. First, there are no “happy pills.” Medications for depression are not “uppers” or stimulants. If that were so, there’s going to be a seller’s market for fluoxetine or sertraline. Second, self-medication is out of the question. A person with true depression must be seen by a psychiatrist. Treatment comes in the form of medication, psychotherapy, electro-convulsive therapy (ECT) or a combination of these. The usual drugs used are from three groups: TCAs (tricyclic antidepressants), MAOIs (monoamine oxidase inhibitors) and SSRIs (selective serotonin reuptake inhibitors). Your doctor will determine what will be best.
Christmas and depression – certainly it’s a sad combination. But, recognized early, it can be treated before it becomes life-threatening (violence to self and others).