Down but Not Out

No one knows what triggers depression. No one knows for sure why the brain chemistry becomes imbalanced. One factor is an imbalance in the chemical messengers in the brain. Age, sex, upbringing and major life stresses, including chronic illnesses, can also tip the balance. Antidepressant drugs work to restore this balance.


Women suffer depression more frequently than men. Typical symptoms include crying, withdrawal, inability to experience pleasure, loss of energy and perhaps even feeling they would be better off dead. Women have to cope with the mood-altering hormonal effects of the menstrual cycle, pregnancy and childbirth, which produce special problems.

New mothers expect to feel joy and exhilaration after giving birth. But because of the enormous hormonal changes and the challenges of dealing with an infant, some women will feel short-lived sadness, often recovering from this on their own. Others may progress to a full blown postpartum depression that requires medical evaluation and intervention for recovery.


Some men exhibit the same symptoms of typical depression as women, but many depressed men exhibit atypical symptoms. Some depressed men have what has been called hidden depression. They may manifest depression by becoming irritable, pessimistic or critical of others, having difficulty getting along at work, becoming aggressive or abusing alcohol.


Depression is not a normal part of aging. It may be a reaction to the loss of physical and mental vitality; the loss of important others, such as friends, spouse and family; or having to give up a career. Unexplained crying and persistent sadness are often clues, as are multiple vague physical symptoms, such as persistent fatigue, headaches, loss of appetite, chest pain or upset stomach. If medical illness has been ruled out, depression is often the correct diagnosis.


It's normal to feel blue when you've been diagnosed with any chronic illness. Any chronic condition can trigger depression, but risk increases in direct proportion with the severity of the illness and the life disruption it causes. But it's not normal to stay depressed. Depression is one of the most common and potentially dangerous complications of every chronic illness. It is particularly common in those with recent heart attacks, hospitalized cancer patients, recent stroke survivors and those who have multiple sclerosis, Parkinson's disease and diabetes.

Today we know the link between depression and chronic illness is a two-way street. Chronic illness is depressing. And the depression often exacerbates the illness. Treating depression often improves the outcomes in those with other chronic illnesses.


Depression in children often is not recognized. Emotional and physical abuse, personal loss or having a depressed parent can increase the risk of a child developing depression. Children often do not show the typical symptoms of depression. They may show their depression behaviorally. They may become irritable, aggressive, have difficulty in school, withdraw from friends, or lose their usual playfulness.


Adolescence is a very difficult time in life. Major hormonal changes are experienced at this time with higher highs and lower lows. Family ties are being loosened, but the teen has not yet established himself or herself as an individual. Look for problems at school, difficulty in bouncing back from life's disappointments or any other sudden change in mood or behavior that is out of the ordinary. Sometimes depressed teens turn to drugs or alcohol to feel better, which ultimately makes matters worse.

Good News

There is good news about depression. Once major depression is recognized, it can be treated successfully with medication or psychotherapy or both. Not everyone responds to the same therapy, but if a person doesn't respond to the first treatment used, he or she is likely to respond to another approach.

Medication compliance is important to the successful treatment of depression. The goal of treatment is complete symptom remission, not just symptom improvement. All patients prescribed medication should remain on the treatment through symptom resolution and then continue treatment for some additional months.

All patients on medication should have follow-up visits with their physician in the initial diagnosis and treatment phase.

A Simple Tool

The Wakefield Scale is an easy-to-use screening tool that can help you determine whether you need to contact your primary-care physician to discuss possible treatment.