"I am now the most miserable man living. If what I feel were equally distributed to the whole human family, there would be not one cheerful face on earth. Whether I shall ever be better, I cannot tell. I awfully forebode I shall not. To remain as I am is impossible. I must die or be better it appears to me."

— Abraham Lincoln

Imagine attending a party with these prominent guests: Abraham Lincoln, Theodore Roosevelt, Robert Schumann, Ludwig von Beethoven, Edgar Allen Poe, Mark Twain, Vincent van Gogh, and Georgia O'Keefe. Maybe Schumann and Beethoven are at the dinner table intently discussing the crescendos in their most recent scores, while Twain sits on a couch telling Poe about the plot of his latest novel. O'Keefe and Van Gogh may be talking about their art, while Roosevelt and Lincoln discuss political endeavors.

But in fact, these historical figures also had a much more personal common experience: Each of them battled the debilitating illness of depression.

It is common for people to speak of how "depressed" they are. However, the occasional sadness everyone feels due to life's disappointments is very different from the serious illness caused by a brain disorder. Depression profoundly impairs the ability to function in everyday situations by affecting moods, thoughts, behaviors, and physical well-being.

Twenty-seven-year-old Anne (not her real name) has suffered from depression for more than 10 years. "For me it's feelings of worthlessness," she explains. "Feeling like I haven't accomplished the things that I want to or feel I should have and yet I don't have the energy to do them. It's feeling disconnected from people in my life, even friends and family who care about me. It's not wanting to get out of bed some mornings and losing hope that life will ever get better."

Depression strikes about 17 million American adults each year — more than cancer, AIDS, or coronary heart disease — according to the National Institute of Mental Health (NIMH). An estimated 15 percent of chronic depression cases end in suicide. Women are twice as likely as men to be affected.

Many people simply don't know what depression is. "A lot of people still believe that depression is a character flaw or caused by bad parenting," says Mary Rappaport, a spokeswoman for the National Alliance for the Mentally Ill. She explains that depression cannot be overcome by willpower, but requires medical attention.

Fortunately, depression is treatable, says Thomas Laughren, M.D., team leader for psychiatric drug products in FDA's division of neuropharmacological drug products.

In the past 13 years, the Food and Drug Administration has approved several new antidepressants, including Wellbutrin (bupropion), Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine), Effexor (venlafaxine), Serzone (nefazodone), and Remeron (mirtazapine).

According to the American Psychiatric Association (APA), 80 to 90 percent of all cases can be treated effectively. However, two-thirds of the people suffering from depression don't get the help they need, according to NIMH. Many fail to identify their symptoms or attribute them to lack of sleep or a poor diet, the APA says, while others are just too fatigued or ashamed to seek help.

Left untreated, depression can result in years of needless pain for both the depressed person and his or her family. And depression costs the United States an estimated $43 billion a year, due in large part to absenteeism from work, lost productivity, and medical costs, according to the National Depressive and Manic Depressive Association.

Three Types

The three main categories of depression are major depression, dysthymia, and bipolar depression (sometimes referred to as manic depression).

Major depression affects 15 percent of Americans at one point during their lives, according to the U.S. Department of Health and Human Services. Its effects can be so intense that things like eating, sleeping, or just getting out of bed become almost impossible.

Major depression "tends to be a chronic, recurring illness," Laughren explains. Although an individual episode may be treatable, "the majority of people who meet criteria for major depression end up having additional episodes in their lifetime."

Unlike major depression, dysthymia doesn't strike in episodes, but is instead characterized by milder, persistent symptoms that may last for years. Although it usually doesn't interfere with everyday tasks, victims rarely feel like they are functioning at their full capacity. According to the National Alliance for the Mentally Ill, almost 10 million Americans may experience dysthymia each year.

Finally, bipolar disorder cycles between episodes of major depression and highs known as mania. Bipolar disorder is much less common than the other types, afflicting about 1 percent of the U.S. population. Symptoms of mania include irritability, an abnormally elevated mood with a decreased need for sleep, an exaggerated belief in one's own ability, excessive talking, and impulsive and often dangerous behavior.

Genes and Environment

Study after study suggests biochemical and genetic links to depression. A considerable amount of evidence supports the view that depressed people have imbalances in the brain's neurotransmitters, the chemicals that allow communication between nerve cells. Serotonin and norepinephrine are two neurotransmitters whose low levels are thought to play an especially important role. The fact that women have naturally lower serotonin levels than men may contribute to women's greater tendency to depression.

Family histories show a recurrence of depression from generation to generation. Studies of identical twins confirm that depression and genes are related, finding that if one twin of an identical pair suffers from depression, the other has a 70 percent chance of developing the disease. For fraternal twins or siblings, the rate is just 25 percent.

Tags: Depression

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