Depression

WHEN TO SEE YOUR DOCTOR

* You feel a sad, worried or "empty" feeling that never goes away.

* You're thinking of suicide.

* Relationships and activities you once enjoyed have lost the "joy." Even sex has lost its savor.

* You can't sleep, you're sleeping too much or you're waking too early in the morning.

* You're feeling down and you're having trouble concentrating, remembering or making decisions.

* You're feeling down and you're drinking more than usual.

* You're experiencing crying spells.

What Your Symptom Is Telling You

Remember that black cloud hanging over Joe Btfsplk's head in the comic strip "Li'l Abner"? No one needed a caption to know what it meant. Readers of all ages instinctively recognized Joe's pessimistic mood. Like the Sunday comics that appeal to us because of their universal humor, there's a universal sad side to life, too.

The pain of grief and the lingering sadness you feel after the loss of someone you love are part of the human package. So are personal disasters like a divorce or losing a job. Depression under these circumstances (even depression lasting several months) can be perfectly normal, says Paul Wender, M.D., distinguished professor of psychiatry at the University of Utah School of Medicine in Salt Lake City.

If you have low self-esteem or are easily overwhelmed by stress, you may also be prone to depression. And depression can have a physical cause, too. Researchers have found that many people with major depression often have an imbalance of certain chemicals in the brain.

Symptom Relief

No matter what the cause, there are many effective ways to lighten your own shade of blue.

Put guilt in perspective. If your depression springs from a sense of wrongdoing, beating yourself up over it won't help, says Heather Andersen, a registered nurse with a master's in nursing and a lecturer in the School of Social Work at the University of Washington in Seattle. "It's important to take some kind of action," she says. "Guilt actually deals with the mistake, but toxic guilt or shame says 'I am the mistake.' "

Lighten the load with regular routine. "Regularize your sleep/ wake cycle," suggests Ellen Leibenluft, M.D., a Bethesda, Maryland, psychiatrist. "Cut out the naps. That will make it easier for you to regulate your sleep cycle and structure your time. You'll get more work done, which boosts your self-esteem and makes you feel better. But if your schedule asks you to be in three places at once, cut it back—you're overstressed."

Put down your morning picker-upper. That sweetened cup of coffee may pack a double depressant, says Larry Christensen, Ph.D., a psychologist at Texas A & M University in College Station. "Sugar and caffeine can be tremendous contributors to depression." Many people who eliminate them feel the difference within four or five days to a week, Dr. Christensen says.

Designate drinking—to others. A low period is a good time to forgo alcohol, says David Dunner, M.D., professor of psychiatry and co-director of the Center for Anxiety and Depression at the University of Washington in Seattle. Despite its short-term numbing effects on your feelings, alcohol is a potent depressant.

Exercise the blues away. "Many people find that exercise has an antidepressant effect," says Dr. Leibenluft. Exercise regularly, within the bounds of what's okay for you medically.

Arm yourself with education. Read a good book about depression, recommends Dr. Dunner. His top titles? The Good News about Depression by Mark Gold, Feeling Good by David Burns and Moodswing by Ronald Fieve. Or contact the D/ART (Depression Awareness, Recognition and Treatment) Program for information. Write to D/ART, National Institutes of Mental Health, 5600 Fishers Lane, Room 10-85, Rockville, MD 20857.

Turn off the tube. Watching TV is seductive and can be closely tied to depression, says Robert Kubey, Ph.D., a psychologist and associate professor of communication at Rutgers University in New Brunswick, New Jersey. "One of the primary symptoms of depression is lethargy, lack of zest and lack of energy," he says. "Heavy TV use can make it more difficult for some people to break out of the depression." Dr. Kubey is also coauthor of Television and the Quality of Life.

Kick the habit. Smoking is another habit linked to depression, but if you're deep in the blues, you'll need more help to quit. "You may need to seek professional help," says Naomi Breslau, Ph.D., director of psychiatry research at Henry Ford Hospital in Detroit. "It takes many tries, so don't give up!"

Go easy on yourself. "Don't make major decisions when you're depressed," says Dr. Dunner. Changing jobs or getting married or divorced ought to be seriously considered only after the depression has lifted. Feeling better takes time, so don't expect too much from yourself too soon.

Treat your senses to scents. Research has shown that there is a direct and powerful connection between smell and emotions. Even subliminal amounts of scent can change brain waves, say researchers at the Smell and Taste Treatment and Research Foundation in Chicago. The odor of jasmine may actually improve a depressed person's level of energy, for example, according to Alan R. Hirsch, M.D., neurologic director of the foundation. Buy some jasmine oil at a health food store and try his suggestion: "Take a little and put it on your arm or hand and just sniff when you feel your energy level is low."

When Depression Lingers

Tried everything and still buried in the blues? When depression just won't budge, there are still more sources of relief. Your doctor can help you decide which of these approaches may work best for you.

Review your Rx. Certain prescriptions, including blood pressure medications, antihistamines and steroids prescribed for asthma, can trigger depression. An over or underfunctioning endocrine gland, such as the thyroid, can also bring on the symptoms. Talk to your doctor about these possible effects of your prescription medications.

Consider counseling. A trusted therapist can offer tremendous insight into your problems. Interpersonal therapists focus on the disturbed relationships that can cause or intensify your depression. Cognitive or behavioral therapists can help you change the negative styles of thinking and behaving that often accompany the blues.

Change your chemistry. Your doctor may prescribe an antidepressant medication. Antidepressants have a proven track record and are not habit-forming. Two traditional types are tricyclics and monoamine oxidase inhibitors (MAOIs). You might ask your doctor about fluoxetine and bupropion, two antidepressants that generally lack the side effects sometimes associated with the traditional drugs.

Bolster your Bs. New research suggests that increased levels of the B vitamins thiamine, riboflavin and B₆ may make tricyclic antidepressants work better in elderly people, according to researcher Iris Bell, M.D., Ph.D., a psychiatrist at the University of Arizona Health Science Center in Tucson. But as with all medications, take vitamins only in consultation with your doctor. Vitamin B₆ can be toxic when taken in high amounts.