1) The article discusses depression prevention and answers common questions about the disease. It notes that depression is increasingly common, affecting about 20% of Americans at some point, and more people are being diagnosed at younger ages. 2) Many people are depressed and don't realize it, mistakenly attributing their symptoms to other issues like family or work problems. Proper treatment of depression usually involves both medication and therapy. 3) Some key signs of depression in children include irritability, changes in appetite or sleep, loss of interest in activities, and declining school performance. Left untreated, childhood depression can be devastating. 4) Friends and family can help a depressed loved one by being understanding, avoiding triggers, performing

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By Richard O’Connor, Ph.D., Special to Lifescript
Published September 03, 2009
Bookstores hold volumes on coping with depression. But you won't find much out there about
prevention. As a psychotherapist with depression, I'll answer 7 questions that shed new light on this
disease. Plus, are you depressed? Take the quiz…
When it comes to depression, the emphasis is too often on treatment after someone has hit rock
bottom. There's a sense that the illness happens to you without warning.
But I think there is a sign: People lead depressed lifestyles before they feel blue. If they believed
they could avoid hitting bottom, their recovery could be much faster.
I wrote Undoing Depression (Berkely Trade) because I wanted to help prevent people from suffering
what my family and I have gone through when I was depressed.
Above all, I wanted to give people hope, something that those with the disease lack. There's good
reason to be hopeful: 80%-90% of people recover if they get proper treatment.
Here are answers to 7 common questions about depression:
1. Is the incidence of depression increasing?
Yes, it's no exaggeration to call it an epidemic. At any given time, 20% of the population – one in five
Americans – suffers from some form of depression.
Take the phone book and start with the letter A. Go on through to the end of the Es. That's how many
people from your community are clinically depressed.
Research suggests that more people are depressed, more of the time, more severely, and starting
earlier in their lives than ever before.
People born after World War II are more likely to develop depression and develop it at a younger age,
than the previous generation. Baby boomers seem to be at higher risk.
This isn't because of a growing awareness of the disease. Nor is it only a phenomenon of American or
Western culture. It's true growth.
One study comparing the global incidence of depression found that in each successive generation, the
ailment was likely to begin at an earlier age. Over a lifetime, the risk increases.
2. Are a lot of depressed people and don't even know it?
Absolutely. Something that touched me deeply at our clinic was the large number of people who don't
know they're depressed.
People call for help, not because of depressed feelings, but because something is wrong in their lives:
Their children won't listen; there's a marital problem; they're having trouble at work.
7 Revealing Depression Questions Answered
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2. It doesn't take much digging to learn that the person has been depressed for some time. The family or
job issue is a manifestation, not a cause, of the depression.
There are millions of people like this. They may go to their doctor for aches and pains, sleeplessness
or lack of energy, and they get a useless prescription, medical procedure - or worse, they're dismissed
as hypochondriacs.
Depression is a disease, but the word “disease” makes us think about infectious illnesses. Both are
caused by a complex set of factors, but depression is more like heart disease – it develops gradually
over time.
Genetic and biochemical factors may determine a different stress level for each that, once reached,
puts her over the edge into depression.
Childhood trauma, stress and loss may bring us closer to that edge.
3. How has media attention affected the public's awareness of depression?
Depression doesn't receive nearly the media attention it deserves. It's the second-most costly disease
to American society, just behind cancer.
More brave individuals – Mike Wallace, Joan Rivers, Larry King, Brooke Shields to name a few – are
coming forward to talk about their depression, which is helping to reduce the stigma.
4. Why are more children being diagnosed with depression?
Because of better observation, not necessarily a real increase.
Until 1980, most mental health professionals were guided by a theory that said, in essence,
depression is caused by a punitive superego.
The thinking was that people don't develop a superego until adolescence; therefore, pre-adolescents
can't suffer depression. It sounds silly today, but that's the way the mental health community
thought.
About 10% of children will suffer a depressive episode before age 12, but the disease is difficult to
recognize. They usually don't know that the way they're feeling isn't normal.
Depression in children and adolescents is also confusing because they can't express their feelings as
directly as adults can.
Irritability is a key indicator. Children may seem easily frustrated, cranky or moody. Boys may simply
appear unusually angry or sullen.
Other signs:
Change in appetite or energy level•
Sleeping a great deal more or less than usual•
A drop in school performance•
Excessive worrying•
Loss of interest in things or activities that used to give pleasure•
If untreated, depression can be permanently devastating to children.
5. How can you help a depressed person?
What does a depressed person need most? Understanding, patience and acceptance from those close
to him or her. Here are some ways you can help:
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3. Try to be considerate, thoughtful and empathetic. If your spouse had a broken leg, you'd
expect that his abilities would be restricted, that he'd be in pain and that he couldn't heal
himself quickly just because you want him to. Think about depression the same way.
•
Don't be provocative. Every relationship has hot buttons that can trigger a fight at any time:
dirty socks on the floor, a misplaced remote control, an empty gas tank in the car. You know
what your partner's buttons are. Don't push them while he or she is depressed.
•
Be nice. Small acts of kindness are appreciated and do help, even if the person doesn't
reciprocate. When I go to bed, my wife makes a point of kissing me goodnight. Even though I
sometimes don't act very glad to see her, I'd feel worse, lonely and unloved without her
attention.
•
Remember that actions speak louder than words. Easing your partner's burden in small ways
can significantly help. Offer to do the shopping, empty the garbage, do the laundry, or take
the kids out for pizza. More than words, these actions communicate that you understand how
difficult these mundane chores can seem at times.
•
Educate yourself on depression. Be willing to talk to the therapist treating your friend or
family member. It's amazing how seeing information in print or hearing from an authority can
change your perspective. It also shows the sufferer that you care enough to take the time to
learn about the disease.
•
Create "advance directives," a contract loved ones arrange while the sufferer is not
depressed, describing what to do when depression sets in. It can be detailed in stages:
Stage 1: Leave me alone.
Stage 2: Be kind, patient, and attentive.
Stage 3: Insist I call my therapist.
Stage 4: Take me to the hospital. One patient I’ve worked with loses her ability to see color
when depression sets in. From experience, she has learned to tell her husband when this
happens because otherwise, she won't let him know when it gets worse.
•
6. Will therapy or medication help?
Therapy and medication are the solution, and anyone seeking treatment should be open to both.
Medication can help faster than therapy alone but can counteract the out-of-control mood swings that
will come during recovery.
Therapy can help us resolve the problems that led to the depression and teach us how to prevent
future episodes.
Research shows that medication and therapy together are more effective than either alone.
Some people recover with one or the other, but I strongly recommend both. After recovery,
sometimes a maintenance dose of medication or a periodic check-in with a therapist is helpful.
7. How does depression differ from manic depression?
Manic depression, or bipolar disorder, is a different animal. Striking 1% of the population, it's more
genetically linked than other forms of depression and responds uniquely to a single medication:
lithium. People with other forms of depression don't respond to lithium and don't experience the
manic highs that are characteristic of the disease.
Sometimes it's difficult to differentiate between depression and manic depression. For a definitive
diagnosis, talk to your doctor.
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4. Want more? Get your own copy of Undoing Depression and Happy at Last, or visit
UndoingDepression.com.
Have a question for Dr. O'Connor? Email him here. Please be sure to include your first name and last
initial. Plus, meet Dr. Richard O’Connor.
Could You be Depressed?
Depression affects 20 million people in any given year and is a serious enough disorder to compromise
one's ability to function normally day to day. Find out if you're just blue or if you might be clinically
depressed.
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