“Why are you so sad,” a woman asked her friend in the swimming pool in Makaha one afternoon. After all, you live in Hawaii where the sun shines nearly every day, and it’s warm and beautiful. I can’t imagine anyone being depressed when they live in paradise.”
But depression is not tied to weather. In fact Nevada ranks high in rates of depression. Experts say the economic issues are often at the heart of feeling depressed, yet again it is not the major cause of clinical depression, which involves a constellation of factors.
During the past ten years the use of anti-depressant drugs has increased 30% in the United States, signaling depression to be the country’s number one mental illness. What creates the rise in depression among both adults and children and what are the risks for the country’s future and for individuals, their families and their communities?
Feeling depressed is not the same as the mental health classification of depression. Some of the symptomsincluded in the DSMIV Manual, the major reference for diagnostic criteria, are the following:
- depressed mood most of the day, nearly every day;
- markedly diminished interest or please in all, or almost all, activities most of the day, nearly every day;
- significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day;
- insomnia (difficulty falling asleep or remaining asleep) or hypersomnia (oversleeping) nearly every day;
- psychomotor agitation or retardation nearly every day;
- fatigue or loss of energy nearly every day;
- feelings of worthlessness or excessive or inappropriate guilt nearly every day;
- diminished ability to think or concentrate, or indecisiveness, nearly every day;
- recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
Added to these symptoms are psychological behaviors that can often accompany depression. One of these is passive-aggressive behavior. This person’s depression is reflected in an inner anger, often not expressed directly, but in ways similar to that conversation where one may ask “How do you feel?” and get the proverbial, “I feel fine,” when the depressed individuals are actually feeling angry and hopeless and cannot or will not discuss their issues or accept responsibility for their own behaviors. Displacement, or blaming others, is often the recourse used by depressed individuals for masking their own anxiety and long-term sadness. They often exhibit angry outbursts when frustrated.
Some of the factors contributing to the rise in depression include physical or emotional abuse early in life that becomes manifested as depression in later years. Certain medications to treat diabetes and high blood pressure can trigger depression. Other triggers that can exacerbate depression and enhance the symptoms include conflict, death or loss, genetics, major events, drug abuse, serious illnesses and various personal problems.
How does the increase in depression impact the rest of us? Coping with passive aggressive behavior can create sadness and problems relating for others. The inability to make sound and consistent decisions, which is one of the hallmarks of depression, can affect individuals and groups who rely on each other to take action. On the socio-political scene, the impasse in political arenas on matters such as health care, gun control, foreign wars, and taxes creates frustration and stress, which can trigger depressive episodes, thereby giving rise to acting out behaviors that can turn to violence.
Depression is a mental health condition that requires consistent treatment of counseling, medication and understanding how the depressed person may interact with others. By knowing the potential for misunderstandings, due to the symptoms and problems associated with the illness, families and groups can develop appropriate safeguards for aggressive and passive aggressive responses that can inhibit effective socialization and decision-making and in extreme cases provoke violence, such as often occurs in mass shootings and suicides.
Hawaii may be beautiful and a paradise for many, yet just like anywhere else an individual can still suffer from major depression even when the sun is shining as mental health challenges do not disappear with the clouds.