by Rima Thompson
Transitioning into high school is a difficult task within itself. Imagine trying to accomplish this transition with a constant unknown interference.
Freshmen Cassie Hoeffer entered her freshmen year of high school making mostly A’s. Although high school was hard at times, she was excited about it and looked forward to making new friends, until her sophomore year when everything plummeted.
At first, Hoeffer’s family contributed the downfall to a physical illness. She had been a long time sufferer of migraines and found herself suffering from trembling fits and occasional bouts of unconsciousness.
To find answers, she underwent a series of tests including an MRI. Sadly, none of the tests she took evaluated what was wrong with her.
“It seems like no one could figure out what was wrong with me,” Hoeffer said. “All the tests were coming back negative.”
Hoeffer’s dilemma continued throughout her sophomore year, and it was not until a few months before her 16th birthday that she was diagnosed with clinical depression.
For Hoeffer it was not the usual birthday wish, but it was an answer to the question that had long eluded her and her family. The answer brought relief, but it also brought great thought. There were questions of why and how.
Hoeffer believes that the antidepressant, serzone, she had been taking for her migraines was the contributing factor to her clinical depression.
“My doctor suddenly pulled me off it, (serzone), without weaning me off,” Hoeffer said. “He was supposed to wean me off it for at least two months because I had been on it for such a long time. He had me get off it in two days instead of reducing the dosage, so it kind of screwed up the chemical balance in my brain.”
Fortunately for Hoeffer, she is not alone. It is estimated that more than nine million Americans suffer from some form of depression in their lifetime.
Depression is a serious and treatable mental disorder that causes a person to have constant bouts of worthlessness and hopelessness.
“Depression is caused by biological or social factors,” said Carol Davis, clinical therapist for the County of San Bernardino Department of Behavioral Health. “Sometimes patients have a chemical imbalance in their neurotransmitters, making it difficult for signals to be transmitted properly between nerve cells in the brain. Additionally, problems in personal and professional relationships or stress can be contributing factors in causing depression.”
Depression consists of two major forms, unipolar and bipolar, with diagnoses ranging from milder to more severe, said Marta Bomortino, mental health clinic supervisor for the County of San Bernardino.
Under unipolar there are adjustment disorder, dysthymic disorder and major depression, which is also known as clinical depression.
Adjustment disorder with depressive features is a milder case. It is usually associated with a reaction to a particular adjustment situation in the individual’s life, which is not in the abnormal range. An example of this would be someone’s parents divorcing or relocating somewhere.
In the middle range is dysthymic disorder, which is a milder, but chronic type of depression. On the most severe end of the unipolar scale is major depression.
“A patient usually shows signs of sadness, feeling empty, being fearful, showing diminished interest or pleasure in all or almost all activities, significant weight loss, insomnia and lack of the ability to concentrate when they have major depression,” Bomortino said.
Hoeffer relates to this as she said her depression caused her to develop a phobia of school, which gradually led her to not care about her grades and have no motivation to do anything.
“When I get depressed, I tend to hide myself; I get very reclusive,” Hoeffer said. “I am also constantly overwhelmed by the decision making process.”
Due to the severity of the symptoms, major depression is associated with a high mortality rate. Fifteen percent of individuals affected with this illness commit suicide, Bomortino said.
Hoeffer admits to sometimes injuring herself with sharp objects almost unknowingly.
“Sometimes I’d be sitting and my wrists would be dripping with blood, and I wouldn’t even realize it until someone asked me what happened,” she said.
Major depression or clinical depression is also associated with other types of disorders such as substance related disorders, panic disorders, obsessive-compulsive disorder, anorexia and bulimia nervosa.
Hoeffer said that she was also diagnosed with panic disorder around the same time she was diagnosed with depression.
Studies show the rate of depression in women is twice as high as that in men, Bomortino said.
“It also appears to be unrelated to ethnicity, education, income or marital status,” Bomortino said.
Major depression may begin at any age, with an average onset age in a patient’s mid-twenties. It is twice as common in adolescent and adult females as in their male counterparts.
Dysthymic disorder can precede major depression. Individuals with this type of depression describe their mood as sad or “down in the dumps” for most of the day, Bomortino said.
They may show signs of poor concentration, low self-esteem and hypersomnia. Adults have these symptoms for at least a two-year period, while children and adolescents have them for at least a year.
“These problems are less severe than in major depression, and the person may still be able to function at home and work,” Bomortino said. “In children and adolescents they are usually irritable and cranky as well as depressed. They may show impairment in school performance and social interactions, have low self-esteem and are overly pessimistic.”
For adults, women are three times more likely to develop dysthymic disorder than men. It is also more common among immediate relatives of people with any type of depressive disorder. The likelihood of developing this type of disorder is six percent.
“A number of individuals first diagnosed with dysthymia are likely to develop a major depression episode if not treated,” Bomortino said.
The most severe form of depression is bipolar disorder or manic-depressive disease, which causes a patient to have severe mood swings. It is referred to as “bipolar” because a patient goes from being overly happy to overly sad with normal mood swings in the middle. “Manic” refers to the periods when a patient is overly joyful.
Because the symptoms of bipolar disorder and major depression are so similar, patients are often misdiagnosed with major depression.
“A person with manic-depressive disease can be overly hopeful and excited, talk rapidly, become easily distracted, abuse alcohol and have a lack of poor judgments,” said Heather Granger, public health registered nurse for the County of San Bernardino. “They also may feel sad, empty, attempt suicide, have a gain or loss in weight, feel worthless and a loss of interest in things they would normally enjoy.”
The onset of bipolar usually appears in a patient’s adulthood. Women experience more severe mood swings than men but the disorder occurs equally in both. People with anxiety disorders tend to have a greater risk of having bipolar.
Treatment for depression depends on the type a person has and usually consists of a through assessment by a qualified mental health specialist.
“The specialist takes into account precipitating events, symptoms, mental and health history as well as any history of substance abuse,” Bomortino said. “A consultation with a psychiatrist for medication intervention is warranted if symptoms are severe and do not abate after the first two months of therapy.”
Most individuals treated with medications respond positively, although it may take several trials of various medications before the right one or dosage is found.
Hoeffer said that when she was first prescribed medications, she received one that would make her wake up at night, while another one would make her sleepy during the daytime.
“It took several tries before they finally figured out the right dosage and medications for me,” she said.
Patients taking medications need to take them on a regular basis as prescribed, and they must take them consistently for at least six weeks before effects are felt, Bomortino said.
A patient with mild depression can also receive psychotherapy, which involves talking to a licensed mental health specialist.
Hoeffer started seeing a counselor immediately after being diagnosed with clinical depression.
After not having much success with the counselor, Hoeffer started to see a psychologist.
“I eventually switched to another psychologist that was better suited for adults,” she said.
“The first one I had was for children, and I did not like him because he would treat me like a child,” she said.
Besides medications and psychotherapy, electroconvulsive therapy and alternative treatments are also available.
Electroconvulsive therapy is a last resort when other therapies fail to help someone with severe depression.
It involves electrical shocks to release chemicals in the brain to sustain messages between brain waves.
Alternative medicines include acupuncture, hypnosis, aromatherapy and herbal medicines.
Most alternative medicines have not been proven to be safe, but can provide a sense of relief that some modern medicines cannot.
Once diagnosed with depression, adjusting and coping with it can be hard on the patient and his or her family.
When Hoeffer was diagnosed with clinical depression, she said her mom and dad did not take it well.
“(My dad) was like, ‘Just get over it. If you really try, it will go away,'” she said.
“My mom was upset, and she blamed the doctor, but she was very supportive of me,” she said.
For the most part, Hoeffer’s friends initially reacted positively upon learning about her depression.
It was not until she transferred back to her high school from an independent work school that Hoeffer realized who her true friends were.
“While most people received me well when I got back, I was still whispered about in the halls as the crazy girl,” Hoeffer said.
She said that people are also less likely to trust her, and that she lost a lot of friends.
“It hurts a lot, and there isn’t really anything you can do about it except cope. I cope with sarcasm. Everyone has his or her own little method. If I have to cry, I cry, and it actually does make you feel better.”
Despite all this, Hoeffer said her depression has made her less naïve and gives her a different perspective.
“I can see people’s true feelings and intentions by their responses towards me when I tell them that I have depression,” she said.
She advises anyone thinking they might have depression to take action.
“Seek help, immediately,” Hoeffer advised. “Seek a second opinion, immediately.”
“If you notice that all you want to do is sleep, seek help immediately because there is either something emotionally or physically wrong with you.”
“Depression, like cancer or diabetes, is an illness. It’s not a sign that a person is weak and it isn’t something to be ashamed of,” Davis added.