Depression Is No Joke


It starts, often, like a case of the flu. Tired. Body aches, headaches, back pain. Nothing actually tastes good. It's hard to concentrate. You've got no appetite, or you only want sweets or chocolate.

No matter how long you sleep, you never feel rested, and it's harder and harder to get out of bed. Perversely, you may also have trouble getting to sleep, and you may find yourself waking in the middle of the night, unable to get back to sleep. Your digestion is often disturbed -- queasiness, constipation, diarrhea, or, thrillingly, alternating constipation and diarrhea.

Then it gets worse. There's a pain in your chest, an ache that feels like your heart has been cut out with a rusty number 11 tomato can. Your muddy thinking starts to get a little obsessive: you remember every bad breakup -- and blame yourself. You remember every time you did something dumb or hurt someone's feelings, and the shame is as fresh as if it just happened. And -- especially the first time it happens -- you begin to think it will never improve, you'll never be better, that the obsessive thoughts that you're worthless and a burden to everyone are true.

That's depression.

I know.

Robin's Williams' suicide last week has brought the whole topic of depression to people's attention again. It was quickly followed by a tremendous outpouring of grief and distress -- as well as the usual collection of damn fools who don't have the faintest notion of what depression, real depression, is.

So, okay, what is it?

First of all, people need to understand depression is something essentially physiological. It's not just a bad mood, being sad. (Look at that list of symptoms: that's not just me, that's been observed medically and is part of the standard diagnostic criteria for depression.) Understanding that there's a physiological basis for depression has been slow in coming, but the discovery of selective serotonin re-uptake inhibitors (or SSRIs for short) like fluoxetine (Prozac) made it clear that there was a neurological basis. (A good description of the studies that established this can be found in Peter D. Kramer's Listening to Prozac; an excellent follow-on is Kramer's Against Depression.)

That doesn't mean life events can't precipitate it. It turns out that in rats -- and very plausibly, in humans -- uncontrollable traumatic events lead to physiological changes that are exactly the ones that SSRI drugs help control.