Today marks the debut of Segullah’s UP CLOSE series on depression. These posts (weekly throughout March) are excerpts from a conversation amongst Segullah staff members, including myself, who live with clinical depression. We have taken pseudonyms for privacy purposes. I’m currently moderating a similar series of posts at By Common Consent.

Every human being is occasionally “depressed” in the sense of feeling down or discouraged. But depression as a debilitating illness is increasingly widespread and causes untold difficulty for its victims and their families. National Book Award winner Andrew Solomon offers this summary in The Noonday Demon: An Atlas of Depression:

I am convinced that some of the broadest figures for depression are based in reality. Though it is a mistake to confuse numbers with truth, these figures tell an alarming story. According to recent research, about 3 percent of Americans—some 19 million—suffer from chronic depression. More than 2 million of these are children. Manic-depressive illness, often called bipolar illness because the mood of its victims varies from mania to depression, afflicts about 2.3 million and is the second-leading killer of young women, the third of young men. Depression as described in the DSM-IV is the leading cause of disability in the United States and abroad for persons over the age of five. Worldwide, including the developing world, depression accounts for more of the disease burden, as calculated by premature death plus healthy life-years lost to disability, and anything but heart disease. Depression claims more years than war, cancer, and AIDS put together. Other illnesses, from alcoholism to heart disease, mask depression when it causes them; if one takes that into account, depression may be the biggest killer on earth.

Depression is a complex issue that cannot be adequately discussed in one or even a dozen posts. (Solomon’s tome on the subject, one among many, includes over 400 pages of probing, detailed text and nearly a hundred more of footnotes and documentation.) This Segullah series will only touch lightly on a few facets of this issue, in roughly the following order:

–recognizing clinical depression
–depression and spirituality
–successes and challenges of treatment
–living with depressed family members (spouses, children, siblings, parents)
–suicide and other complications

I’m grateful to the participants in this conversation for their generosity and candor on such a sensitive topic. It goes without saying (but I’ll say it anyway) that our group is taking considerable risk in publicly sharing some of our most intensely personal experiences. Our purpose in doing so is to offer a measure of companionship for readers who live with depression (diagnosed or not), and a measure of perspective for those who don’t. Please be respectful in your comments—this is not an occasion for confrontational dialogue.

Finally, please note that the content of these posts is for general informational purposes only and does not constitute advice, medical or otherwise. If you are experiencing symptoms of clinical depression, contact a health professional without delay.


  1. Stephen M (Ethesis)

    March 1, 2010

    Hmm, what about dealing with situational rather than biologic depression?

    Though note:

  2. Kathryn Soper

    March 2, 2010

    Stephen, yes, studies have shown that melancholy individuals have sharpened abilities of perception, and history has shown a connection between melancholy and artistic ability.

    That’s all fine and good until depression builds to the point where heightened powers of perception distort reality rather than illuminate it, and creative energies are sapped by the black vacuum of despair.

    Your question about separating situational from biologic depression is a common one. Certainly there are cues to interpret in this matter–someone with a family history of depression is likely to be more biologically susceptible; and any human being under extreme stress also becomes susceptible. But there’s no line of demarcation between “chemical” and “non-chemical” depression. Every manifestation of depression is matched by changes in brain chemistry. There’s a chicken-and-egg effect that makes it nigh impossible to discern whether emotion causes those biologic changes, or vice versa. Most people with chronic major depression have their first episode in connection with a traumatic life event–that doesn’t mean they don’t have genetic predisposition. In sum, cause and effect cannot be clinically separated.

    Before I sought treatment for my depression I quizzed a close friend of mine who is also a mental health professional. “How can I tell whether it’s caused by emotion or biology?” I asked. I was really, really hoping that I could pin it all on physiology so that I wouldn’t feel culpable.

    She wisely pointed out that no matter what the initial trigger for depression, treatment is the same.

    More on this later, because it’s such a central issue.

  3. m&m

    March 2, 2010

    This distinction for me helped, though, because I didn’t really understand that situational stressors themselves could be triggers. I remember distinctly a conversation about that with my doc. I think, too, that awareness of what might cause depression could help with counseling treatment, no? I’m certainly no expert, but I can’t help but wonder if some people dismiss their symptoms because “I don’t have depression in my family, my genes, my history” — rather than realizing that it can sneak up on anyone depending on the situation.

  4. Kathryn Soper

    March 2, 2010

    Sure, it’s helpful to understand that people without family history of depression can also suffer from it.

    But again, there’s no test to determine whether you have “chemical” depression, because all depression has a chemical component. Whether chemistry imbalance is a cause or an effect, it’s consistently part of the physiological scenario.

    And even if someone has strong genetic predisposition for depression, that doesn’t mean they won’t benefit from counseling–quite the contrary.

  5. m&m

    March 4, 2010

    I don’t disagree w/ anything you have said, esp that anyone can benefit from counseling (and also might benefit from meds, whether the ’cause’ is primarily biological or not – in the end, I think it’s always an interplay of the two anyway).

    My comment comes from the clarity I got from my primary care doc who helped me understand how stressors can trigger chemical problems. That was an aha for me.

  6. marintha

    March 4, 2010

    You might be interested to know that some of the new anti-depressants are being used really successfully to treat fibromyalgia. Drugs like Celexa target the pain centers of the brain. They’ve helped two of my family members.

  7. m&m

    March 4, 2010

    Thanks, Marintha…it’s interesting to see how CFS, fibro and depression have some common factors and brain centers.

    (Fortunately for me, I have less pain than some…more on the fatigue side than the pain side of the spectrum…but thanks for thinking of me.)

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