I don't think it's ever going to be alright again."
Two years ago I found myself in a dark place that didn't seem to have a way out. I went through those motions I could manage and abandoned virtually everything else, convinced I was completely alone. I remember missing the deadline for an application to return to residence because I didn't want to leave my bed at three o'clock in the afternoon, sure that I wouldn't be returning to school the next year.
I had given up.
Clinical depression is so much more than simple sadness--it is a prolonged period during which life seems muted, turned down. Symptoms include depressed mood, diminished interest or pleasure in activities, significant weight loss or gain, insomnia or hypersomnia, feelings of worthlessness and recurring thoughts of death. In order to constitute a Major Depressive Episode, some or all of these symptoms must be present during the same two week span, though depressive episodes are often months long. On paper, written on the page in front of you, these symptoms sound clinical, even sterile. But in a depressed state they can feel like an unbearable eternity.
Depression can also manifest itself in a variety of ways, including melancholic depression (in which a majority of physical symptoms are present) and dysthymia (a constant, low grade depression). In either case, depression can be as debilitating as a more obvious physical injury.
Unfortunately, depression is one of the most common of all psychological and psychiatric problems, affecting millions of people every year.
"We talk about point prevalence, how many people are depressed today, and that number is likely around three or four per cent," explains Dr. Keith Dobson, a professor and depression researcher with the University of Calgary. "Over a lifetime, around 10 to 15 per cent will experience depression, it's certainly one of the most common of the mental illnesses. And further, there's a well known gender difference, with women twice as likely to experience depression."
Its cost in treatment and lost time runs well into the millions and, despite the efforts of physicians and awareness groups, some stigmas stubbornly remain. Asking for help can be an agonizing internal battle, struggling to admit your own need and finding the strength to accept treatment. Racked with feelings of irrational guilt, I actually blamed myself for my depression. Feeling weak and unlovable, I hid from my friends and the world around me, afraid of telling anyone the truth.
The good news is awareness is growing, with education on depression reaching general practitioners across the country. One of the most satisfying moments of my life was when I told my GP I needed help.
"My general advice to people is to use their family doctors," says Dr. Dobson. "They are the gatekeepers of our health care system and, of course, it's free. There's been a lot of information given to family doctors now about what depression is, though it is still important to make sure family doctors have the right kind of services that they can refer patients to. These people who come in are feeling poorly and yet the nature of depression is such that people are not assertive. Sometimes they find themselves suffering in silence."
For many students, the University Health Clinic in MacEwan Students' Centre 370 is the most immediate point of contact. Ascending those stairs in the middle of Mac Hall could easily be the difference between pain and relief. With general practitioners and an on-staff psychiatrist, the Health Clinic is, quite simply, a place to get well.
"In this setting, most of the GPs are really excellent," assures Dr. Jodie Oosman, Health Services' resident psychiatrist. "They have a lot of experience with mental health issues and the office affords me the opportunity to interact with the rest of the staff. Students should know that physicians can help. With depression there is always some kind of supportive therapy, never just medication."
Though treatment is becoming more available and socially acceptable, the origins of depression are still highly personal. As Dr. Dobson explains, depression is a complex interaction of factors often instigating a vicious, self-perpetuating cycle.
"In a nutshell, people get depressed as a result of a complex interaction of various factors," he explains. "Generally, we think about cognitions which are stable beliefs--believing you are incompetent or believing the world is difficult or you can never get ahead in life--basic attitudes about yourself and life. Then there's some kind of life event which interacts with this belief and it's that interaction which sets up other kinds of thoughts which we can think about as more situational, automatic thoughts, because they pop up automatically. In depression, we've shown consistently that these automatic thoughts tend to be negatively distorted. But it is these negative thoughts which we believe lead to sadness, behavioural avoidance, shutting down, hiding from people. When people are sad we also know it increases the frequency of these thoughts and when people avoid that increases negative life events.
"The classic student example is perfectionism. If your general belief about yourself is that you must be perfect, have to succeed at everything you do, and then you experience a failure, whether it's a midterm or a social rejection or whether your parents are being hard on you because they think you aren't working hard enough, this leads to negative thoughts. And it's those thoughts that lead you to be sad, depressed, hopeless, potentially studying less, feeling paralyzed. These reactions actually increase the likelihood of these events and so negative thoughts can become self-fulfilling.
"Large events are more likely to have that effect of course, but it could be just a series of small things," Dr. Dobson concludes. "It may not be completely failing a course, it might be getting a lower grade than you're expecting."
Two years ago, away from home for the first time, I found myself overwhelmed by a new city in which I found myself completely alone, barely able to get out of bed to attend my co-op job. Life became a frightening prospect. My life was distorted and exaggerated in my mind, I could feel events and my own failings conspire against me. In the throes of a depressive episode, one of the most difficult exercises is recognizing your own sickness and realizing you need help.
With mental health, awareness is key. Recognizing and finding new ways to deal with these events constitute, by in large, available psychological treatments. In many studies, certain individuals have been found to be largely "immune" to depression, resisting mood induction techniques designed to depress experimental subjects. By understanding these individuals, psychologists hope to determine those strategies most effective in dealing with stressful events.
"There are certainly risk factors," cautions Dr. Oosman. "If there's a family history or if you have suffered from another kind of mental illness, you are more likely to have another. Being aware is important, you have to watch out."
Ignoring the warning signs, I was well aware that members of my family suffered from depression and alcoholism. I continued to suffer, ignoring the most likely reason out of fear.
Depression can occur as a result of other mental illnesses such as bipolar disorder and social anxiety disorder. Making yourself aware of your own family history is an invaluable tool in dealing with, and hopefully avoiding, depression. Conditions such as bipolar disorder cannot be cured by psychological treatment alone, instead requiring the use of antidepressant and mood stabilizing drugs.
Unfortunately, for many people who recognize their need and want to seek psychological or psychiatric help, resources are inadequate. Even with community organizations like Alberta Mental Health providing care without requiring referral, many psychological services are still not covered by Medicare and the waiting lists can be an agonizing period of time.
"Students generally have much better access to counselling services," says Dr. Dobson. "However, in general, treatment is not easy to get. Services are spread quite thin."
Despite the difficulties associated with obtaining the necessary help, one of the most valuable sources of support are the people around you. Though a depressive episode can leave you feeling alone, it is important to realize you are surrounded by many sources of support.
For many people, religion is an important part of their lives and, though it may not always be able to assuage the pain of depression, it can be a valuable resource. Religion can promote acceptance of negative life events, enforce a set of positive principles and, most importantly, provide a sense of support.
"I encourage them to tell their story," says Rev. Tim Nethercott, a United and Presbyterian minister with the U of C's Chaplain's Centre whose experience with depression has helped him appreciate its complexity. "What we can offer is 'supportive counselling,' keeping in touch with people over a long period of time. These people dropping in and out are our community."
Religious or secular, one of the most important resources available to someone suffering from depression is a sympathetic ear. The experience of depression is a profoundly lonely one and having someone to stand by you can make all the difference in the world.
"The best thing a friend can do is offer to listen, to reassure them that it's nothing to be ashamed of," says Dr. Oosman. "A lot of people miss that opportunity to speak to someone without being judged."
Two years later, I write this article in an office that feels like home, surrounded by people I trust and respect. Though I still feel that suffocating weight my father referred to as the "black dog" every now and then, my experience has taught me to take these times with eyes wide open, asking for help whenever I need it. What continues to prey on my mind is the possibility other people, just like me, continue to suffer alone, feeling as though there is no end in sight.
I want them to know this isn't their fault, to know they haven't done a thing to deserve an experience this terrible. I want them to know there are always people capable of helping you, people as close as you need them to be.
Most of all, I want them to know it's going to be alright.
For guidance and counselling contact:
University Health Clinic, 220-5765
Chaplain’s Centre, 220-5451
Counselling Crisis Line, 220-5893