Part I

It’s 8 a.m. Eric wakes up, hits the alarm clock and resets it for a few more minutes of sleep. The alarm goes off again; he gets up. He shuffles to the bathroom and takes a shower. He throws his clothes on, and he’s out the door. He takes one last moment to check his backpack and is on his way to class on Monday morning.

Just like you.

But the difference is that under the surface, Eric is living with depression. His day may well go just like yours — class, lunch, more class, homework, maybe some down time. But Eric lives with the constant possibility that the day might take a turn for what he calls “the bottom of the roller coaster.”

“I think it’s probably different for everyone, but you know, I guess it’s a general feeling of lifelessness,” Eric says. “You kind of feel like you’re sinking lower into yourself. It’s a very strange feeling….when it’s really acute, it’s really hard to make even basic decisions. The thought of doing anything at that point stresses you out so much that you kind of become incapable of doing those things.

Going to his Monday morning lecture, Eric knows that he has to be 100 percent prepared to understand the material for the day – feeling unsure about class can set off anxiety that leads to a depressed state.

“I’m very hard on myself,” he says. “If I don’t understand something in a class, then I start to panic and I blow it out of proportion that I’m falling behind, and that kind of spirals into feeling depressed.” Eric says he tries to avoid that spiral by minimizing situations that might make him anxious.

“You have to do what the teachers always say, really having read the book and everything before you go to lecture — I mean every time, you have to do that. So that you don’t get into a situation where you feel like, ‘I don’t understand this.’ At least for me. And it’s not just education or academics, it’s really anything. You have to have your i’s dotted and your t’s crossed.”

Eric, 21, is one of the 350 million people globally who suffer from clinical depression, one of the most pervasive mental diseases in the world. Though generally physically undetectable to other people, it can wreak a whole host of problems: difficulty concentrating or making decisions, loss of energy, insomnia, overeating or appetite loss, physical aches, excessive feelings of guilt, loss of self-esteem, persistent anxiousness, feelings of emptiness, unusual feelings of panic and recurring thoughts of death and suicide. And while not everyone with depression will face all of those symptoms, any number of them can assail an otherwise calm person who appears to be just fine.

After his first class, Eric takes some time to sit and talk about stressors in his life. He grew up with constant pressure from his parents to succeed. “I felt like I constantly had to be, had to be perfect…which carries over into other things.”

“I have a very big commitment to being fair in decisions,” he continues. “I get so paralyzed in decision-making that I don’t seem to get anything done.” He has to be meticulous to minimize the possibility of feeling wrong or not good enough; self-worth is an important factor in depression, he explains.

On days like Monday, Eric goes without much interaction, studying and going to classes until around 6 p.m. Usually he gets through the day without issue, but being alone can make bouts of depression more likely, he tells me as we sit down again after his evening class. “It’s usually not very acute when I’m around other people. Having to save face or go do your daily things helps stave it off. But when you go back and you’re alone with your own thoughts, that’s when it gets pretty bad.”

“I think a lot of people really feel the isolation… it’ll turn in on itself and kind of feed off of whatever bad things are going on.” But despite the exacerbating effects of feeling isolated, being alone is what he sometimes prefers. He feels that talking about what’s on his mind “burdens others with [his] problems and really doesn’t get anything done.”

“I don’t want them to waste their emotional energy on me,” he adds.

Eric says that having depression has made him a less open, less committed friend. “It seems like I’m massively closed off…I try to deal with it on my own, and that’s not healthy.” A close childhood friend said, “‘You never tell me anything; I always tell you everything.’ That really hit home.”

Eric says depression has damaged how he sees himself and his ability to do well in many areas of his life. “I suspect that it’s also damaged a lot of my relationships with my friends and even deeper personal relationships.

“[Depression] has definitely done a lot of damage in my life. Most of which, like I said, I more look at as my fault than perhaps depression’s fault.” Because of his upbringing, his high standards contribute to blaming himself for depression-related complications in his life. “I feel like blaming it on depression is a cop-out. I’m not very accepting of it.”

“I think I was technically diagnosed when I was 16. I don’t think I ever really had a concept of depression before that…that’s really the first time I became aware of it, or that term was put toward me in any way.” He came from a family focused on success and progress, one that “wasn’t really very emotionally deep in a lot of senses.”

 

 

Eric didn’t have a real idea of what depression was before his diagnosis, and he is certainly not alone there. Throughout his life, he’s heard the ways people can stigmatize depression. “I think a lot of people see it as a weakness. They think, ‘Well I don’t have that, so I’m better.’ It’s a classic example of people being ignorant.”

“You know, you hear it a lot: ‘Just be happy,’ or ‘Happiness is a choice,’ or ‘You should be so grateful…because you’re not starving in Africa’ or whatever,” he says. “You can try and trivialize people’s problems away and say that they’re not as big as other peoples’ problems, and maybe that’s true, but each and every person has their own life and has their own problems and they are just as important to those people as others. Maybe that’s the biggest misconception — people wonder, ‘Why are you unhappy?’ or, ‘Why do you have [depression] when you have all this other stuff going on in your life?’”

As Eric explains, there is no set reason for having depression. “It’s not like [when] you lean on your wrist too hard, you’re gonna break it, it’s this many pounds of force; there’s no concrete formula for it, and there doesn’t seem to be a concrete formula for solving it, either.”

After the conversation, Eric goes back to his dorm room to resume his normal routine. At the end of the day, he’ll “do homework or get in bed early and go on Reddit. Or I’ll read a book; I’ve been really trying to get myself to read a little bit more.”

Eric’s advice to other people with depression is to “try to do something every day, no matter how minor it is. If you can do something every day — and when I say ‘something,’ I mean even reading one page of a book, or eating one piece of fruit or one piece of food — I mean just do something every day.”

Part II

On Thursday, on a northbound bus in the fall-flushed, sunny, peaceful-looking afternoon, Eric is on his way to see his psychiatrist for a therapy session. Up Broadway into the outskirts of Boulder, there are small, unfinished-feeling streets and large-lot houses. One of them is Dr. Leland Johnston’s, a private practicing psychiatrist who has worked in the psychiatric field since 1978. Dr. Johnston helps treat Eric’s depression by prescribing medication and talking to him in therapy sessions.

Around the back of the house, the door is open and a small office opens to the right. This is where Dr. Johnston talks to patients. The couches, lighting and colors in the room create a calming atmosphere.

 

 

“Lifetime prevalence is 20 percent,” Dr. Johnston says of depression. “So one out of five people you run into will have had a clinical depression in their lifetime – huge number. It varies, of course, by the intensity of depression. But the criteria for clinical depression are mild, moderate and severe.” The amount and severity of the symptoms a person experiences determine which level of depression they have.

Suicide is much more likely when someone has depression, Dr. Johnston says. “The numbers just go skyrocketing. Suicidality is a subject that often gets most closely associated with depression.” While depression isn’t the only factor, about two out of every three people who commit suicide suffer from depression, and people who have depression are 20 times more likely to commit suicide than the general population. Suicide is especially prevalent in Colorado – our state’s suicide rate consistently ranks within the top 10 in the nation.

Dr. Emily McCort, lead physician and psychiatrist of the Psychological Health and Psychiatry department at CU’s Wardenburg Health Center, explains that there are many different factors that cause depression.

“Depression is a bio-psycho-social issue,” she says. Genetics make it more likely for certain people to develop depression, and psychological trauma, abuse and negative life experiences play a role. On the social side, making the transition to adulthood adds to the risk: “Forging an identity can be stressful.” She also points to substance abuse as a biological factor, saying it’s a “chicken-or-the-egg thing; people may turn to substance abuse in response to feelings of depression, or people who are in college and are having more chances to drink may put themselves more at risk for depression because alcohol is a depressant.”

Depression is treatable, but the social stigma surrounding it makes it difficult for people to discuss it openly. Simply typing in the words “Is depression…” into a Google search bar brings up suggestions like “Is depression an excuse?” and “Is depression a choice?”

“Many cases go undiagnosed – there is a stigma for young people,” Dr. McCort says. “People are afraid of what they don’t understand. In the past, people with mental illnesses were put in asylums and mental health institutes, separated from the population.” Today, the prejudice isn’t so severe, but there’s still a social barrier for people who want to open up or seek treatment for depression. The idea that depression is just a mood, or a result of not trying hard enough to be happy, still persists.

“Depression is real,” says Robyn Loup, consulting director for Equitas, a foundation that advocates for better mental health care in the criminal justice system. “It isn’t something where you can just pick yourself up by the bootstraps and be better…It can be a paralyzing disease where you can’t get out of bed, or you can’t function.”

Loup has been an activist fighting for better mental health care in Colorado and in the nation since the early 1990s; she saw the effects of depression firsthand in her family as a child, and she’s been an advocate for mental illness awareness ever since. Working with the Mental Health America organization and the MHA of Colorado, Loup pushed to pass mental parity laws in Colorado in the late 1990s and at the federal level in 2008. Parity laws require health insurance providers to give the same benefits to mental health patients as they would to patients with other disabilities. Loup also helped establish Rocky Mountain Crisis Partners, which runs a statewide 24/7 mental health crisis hotline for people dealing with stress, depression and suicidal thoughts.

Throughout her years of fighting for mental health care, Loup has combatted social stigmas against depression. She says it is “strictly a lack of education and poor information getting disseminated” that leads to negative views of mental illness.

“People should learn about depression.. so that they can have empathy for someone who has it, and learn to relate better, and be an assistant and help. The point is, if your goal is to have a healthy society, to have a healthy family, to have healthy friendships, then you should have the knowledge about it.”

Part III

There was a time when I, like Eric and like a lot of people, didn’t know what depression was. It wasn’t until my freshman year of high school that I met one of my soon-to-be best friends who was struggling every single day with severe depression – the anxiety, the breakdowns, the panic attacks. The tears that I couldn’t fully wipe away. It was something I had never seen before.

In the years following, I made several more friends who sooner or later revealed that they, too, were suffering from depression. I learned that some of my old friends had been dealing with it, and I didn’t even know. Seeing it affect so many people that you love and care about is a difficult thing. You want to push hard enough, wish hard enough, and will depression to go away and let people live – but it isn’t that simple.

Hannah Ho, a freshman international affairs major at CU, was diagnosed with depression at a young age. “I feel like I was robbed of my childhood,” she says, “because instead of playing tag, instead of all these playground games and the swings, I actually grew up wanting to kill myself. Not wanting to be alive when I was only eight.”

Hannah struggled with depression for years before building the courage to speak up and seek help, despite the pressures within her own family toward not accepting depression as a valid illness. For Hannah, understanding and accepting her condition was the most important step to getting past the stigma and making progress. “You can’t grow out of something you were traumatized with, you can’t grow out of your genetics or who you are,” Hannah says. “It’s not some teenage-angst cry for help. It’s a scary condition for people. You need to understand that it’s a serious thing.”

“Everybody feels sad or blue sometimes, but if you’re staying down for weeks and can’t shake it, that’s when you have depression,” Dr. McCort says. Depression often goes undiagnosed because people don’t understand the full scope of the symptoms. “Some people with depression aren’t sad or crying, but are irritable, can’t have a normal sleep schedule or don’t have regular eating patterns.”

Many people with depression have a “tendency to isolate themselves,” Dr. McCort says. “Don’t be afraid to ask.” People can be hesitant to ask someone if they’re feeling depressed because they aren’t used to talking about such personal things. Even more difficult is asking someone if they’re thinking about suicide – Dr. McCort says not to be afraid, because asking isn’t going to “give them the idea of suicide.”

Dr. McCort stresses that it’s important not to leave people to face depression alone — and “don’t feel like they ‘need to try harder’ to get out of their depression,” she says. Eric’s advice to friends and family of those with depression: “Do be there for them. Do try and listen. Don’t try and preach to them. Don’t try and trivialize whatever issues they’re having…let them know that you’re their friend, and that you’re there if they wanna talk, and kind of leave it at that and let them do the rest of it.”

Depression has probably been around as long as the human brain has. Studies in the psychological field differ on whether depression rates are staying constant, or whether they have increased dramatically in the last 80 years, especially since the 1990s (and there is convincing evidence to the latter). What is indisputably true is that 350 million people are suffering from depression, and it’s become the leading cause of disability worldwide.

Eric on the hardest part about depression, what he wishes people knew about it and advice to those who have it:

For more information:

• Colorado Crisis Hotline: call (844) 493-TALK (8255)
• World statistics on depression
• Information on types of depression and symptoms
• Mental illness support and screenings at CU
• Locate depression and other mental illness resources in Colorado
• Locate resources anywhere in the U.S.

Contact CUIndependent Assistant Opinion Editor Ellis Arnold at ellis.arnold@colorado.edu.