How Do You Know If You Have Depression? Hear This Woman Explain How She Found Out.

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How Do You Know If You Have Depression? Hear This Woman Explain How She Found Out.

Carina remembers the exact moment she hit rock bottom. She was looking at a knife in the kitchen, wondering if her blood from a cut to the vein would permanently stain the tiles she and her husband Dave had installed years ago, when they had just moved into the apartment as happy, hopeful newlyweds.

“I really did think about ending it,” she tells me. “Ironically, I was too lethargic and apathetic to figure out the easiest way of doing it. But in my head, I went through all the scenarios.”

That’s when she realized she still cared about something a long time ago. She had been happy in the past. Maybe, just maybe, she could be happy again.

Her depression first hit as she ate dinner. Dave was telling her about his work — some complicated Wall Street deal he had brokered. Then, the waiter interrupted to ask how the meal was going. Carina looked up and, suddenly, “It was as if the world was drained of a color,” she said. “I could feel some kind of switch in my brain being flipped off.”

When she turned back to Dave, for a moment, she didn’t recognize him. “Who is this man?” she wondered, staring at the strange mix of facial features in front of her. Other diners appeared freakish and odd, too — it was as if the human race had become lumps of flesh arranged by Salvador Dali himself. Shaken and unsettled, she went back to her dinner.

Carina didn’t realize it, but that incident was the beginnings of a depression that would plague her for years.

Only one thing gave her any sense of pleasure during her dark days — online shopping. But that habit might have plunged her into a deeper despair. Psychologists are exploring the ways the Internet can amplify the effect depression has on the psyche — even how it might cause the depression itself, and whether it might even help with the mysterious, engulfing condition.

Carina isn’t alone — an estimated one-in-ten of U.S. adults suffer from depression, according to the Center for Disease Control and Prevention. No one really knows what exactly triggers it, but experts believe it has roots in factors, such as life changes, family history, major stress events, changes in biochemistry like hormones, or past traumas like abuse. They all play a part, and for each person, isolating the causes is difficult.

Depression can show itself in several ways, such as disruptions in eating, sleeping and concentration patterns, a lack of interest in daily activities, or even consistent feelings of failure, lack of purpose and apathy. We all get the blues, but in depression, the fog never quite lifts, making it hard to keep a functional life. Sometimes, in cases of major depression, which recurs over several episodes during a lifetime, the feelings linger as an isolating darkness. Or, dysthymia disorder, a low-grade but persistent form of depression, simply saps the enjoyment out of life for an extended period. For the millions who suffer seasonal affective disorder, it often pops up in the dark of their winter.

For Carina, the hallmark trait was the sense of hopelessness, as well as an utter, absolute isolation and loneliness. “I could be in bed with Dave, surrounded by co-workers or hanging out with friends — but they felt eons away,” she said. “I couldn’t relate. I couldn’t connect. And I didn’t want to. It seemed like too much effort.”

Carina calls depression a vicious cycle, a self-perpetuating feedback mechanism. “Deep down, you believe that your actions don’t matter, that you have so little importance in the world. And you just can’t bring yourself to care, because you can’t feel anything,” she said. “You just cannot see. You are cut off from feeling, from love, from reality, from any sense of zest or vitality or pleasure.”

She found no pleasure in sailing or running, hobbies that had once meant so much to her. She couldn’t sleep, either. She became withdrawn, cold and distant, and one by one her friendships fell to the wayside. Instead, she threw herself in work, skipping dinners and bedtimes with Dave, who couldn’t understand what had happened to his engaging, funny, warm-hearted wife.

Hurt and lonely, Dave tried to talk to Carina, but she just pushed him away, refusing to acknowledge her problems, and convincing herself that she simply didn’t love him anymore. Dave began to withdraw as well, spending more time at the office. Their once bright, lively home became dark and quiet.

That’s when Carina began to take refuge in online shopping. She would spend after-hours at work, or at home, clicking on site after site, filling up shopping carts with anything that struck her fancy. “I’d start on Net-A-Porter. And then I’d look up from the screen, and hours had passed,” she said.

Her life was a dark wilderness, but online, her baubles and consumer fantasies were bright and colorful.

Humans have been grappling with depression for as long as history has been recorded. Ancient Greeks believed it was a result of a buildup of black bile in the body, an imbalance of “melas khole” — the Greek words for “dark” and “bile” that are the origin of our word “melancholy.”

According to Clark Lawlor, author of “From Melancholia to Prozac,” early Christian theology believed depression was a sign of man’s weakness against the sins of the flesh, and Renaissance medicine saw it as the disease of intellectuals. Theories of its causes have swung between physical and chemical explanations to mental and emotional ones, ranging from German physician Johann Christian Heinroth, who said depression was a moral and spiritual conflict in the soul, to current-day theories that say it comes from a lack of serotonin, among other mood-regulating neurochemicals, in the brain.

Treatments have shifted over the years, as well. According to Robert Burton, the 17th century author of “The Anatomy of Melancholy,” melancholy could be treated with a good diet, proper sleep, music and meaningful work, as well as confiding in friends.

But other treatments weren’t so benign. Those with chronic depression were often sequestered in sanitariums for “rest cures,” for example, and electroconvulsive therapy — where electric shocks induces seizures in the brain to give psychiatric relief — is selectively in use, even today, for catatonia and manic episodes of bipolar disorder.

Today, the treatment of choice is medication, such as Paxil and Prozac, which adjust levels of neurotransmitters in the brain. There is a growing criticism of the high levels of prescriptions, though, especially without more psychiatric treatment. Prozac was first approved in 1988; a decade later, anti-depressants became the third most prescribed medication in the U.S.

Successful treatments often focus on healing both body and mind with therapy and anti-depressants, often in combination with lifestyle changes, such as meditation, yoga or exercise.

One of the biggest challenges is actually getting a diagnosis in the first place. The CDC estimates that two-thirds of sufferers don’t realize they are depressed. The idea of having a mental illness is still a stigma, and victims often ignore persistent “blues” and refuse to seek help.

As a result, people self-medicate, filling the chasm of depression with distractions, such as sex, drugs or alcohol. They can indulge in overspending or over exercising, or develop obsessive interests in hobbies or sports. They have affairs and serial relationships, or do what Carina did, and go online.

While Carina has the money, she rarely buys anything. “Sometimes I’d think about it, but then I realized, ‘What’s the use?’ because I never went out or did anything,” she said. “Why buy that fancy lingerie when my husband and I stopped having sex months ago? Why get that dress, since we never go out?”

She found the act of browsing and clicking soothing, and it was convenient and easy. “I didn’t have time for real shopping — or any energy — but I could spend hours just browsing shopping sites, dreaming about all the clothes or stuff I could buy that would better my life,” she said. It required little real effort, and she could do it in secret.

Those habits show what psychologists have long suspected: the specific ways depressed people use the Internet can show their mental state. According to Time, heavy use of e-mail and chat often shows weak real-life social ties, which can correlate with a depressed mindset. Depressives who can’t feel emotions will often stimulate themselves by switching quickly between sites, and in the case of Carina, she sought it in glossy photographs of luxury goods.

According to Scientific American, some experts see a glimmer of hope in this data, and believe depression would be easier to diagnose if we track Internet use to show early cases of mental illness, even before people are aware of it.

Diagnosing depression is difficult because it relies on self-reporting, which is prone to distortions and selective information. The most vulnerable sufferers are also less likely to show any red flags. To combat this, clinicians have developed ways to diagnose with computer programs that measure reaction times to certain words indicating a higher susceptibility for suicide. Tracking Internet use might be a valuable addition to this toolkit.

Of course, there are privacy and logistical challenges, but for an illness that goes largely diagnosed, the data offers possibilities.

The Internet can show and even give a refuge during depression. But can the Internet actually help cause it — or at least push the most vulnerable over the edge in some way? This point is much more controversial, and difficult to prove, though some studies are beginning to notice some connection. According to Oxford University, teens already at risk for self-harm or suicide often spent more time online than normal teens. These teens often sought online communities for help, but they were also exposed to violent content, which correlated with higher levels of more violent self-harm.

Still, researchers are cautious about drawing a direct link between the Internet, depression and suicide. “We are not saying that all young people who go on the Internet increase their risk of suicide or self-harm,” Paul Montgomery, a professor at Oxford and a study co-author, said. “We are talking about vulnerable young people who are going online specifically to find out more about harming themselves or because they are considering suicide already. The question is whether the online content triggers a response so that they self-harm or take their own lives, and we have found that there is a link.”

The study’s authors suggest that doctors and counselors begin to ask teens — or other depressed people — about their online habits as part of their diagnosis routines, especially for a generation tightly connected to the Internet and social media.

For Carina, her online shopping addiction was mostly a way of avoiding her problem. “It was probably the most convenient, easiest way to mask my depression,” she said. “I kept working. On the surface, it looked okay. Being on a computer so much these days looks totally normal.”

She overworked during the day, and spend nights online. “Dave would come home, and I wouldn’t even look up,” she added. “He’d just go to the bedroom and go to sleep.”

This routine went on for months, until she got a wakeup call.

“Dave sat me down one day and told me he was having an affair,” Carina said. It was an ex-girlfriend, someone he reconnected with over Facebook. He said he wasn’t sure he wanted to be with his ex-girlfriend, but he was certain he wanted a divorce, unless Carina began to see a therapist.

That revelation broke through her apathy, but not in an entirely productive way. “I started buying things,” she said, going well beyond websites. Part of it was anger, and she charged expensive designer clothes and housewares to their shared credit cards — until he canceled them. Eventually, Dave moved out, leaving her alone in the expensive apartment.

Then, the downward spiral happened fast. The toll began to show at work, as she missed days and important meetings again and again. Her boss told her to take an unpaid leave until she got her act together. Depriving her of a major outlet, Carina spent days at home, lying in bed, staring at the walls or into her computer. But not even the Internet could divert her from her misery.

That’s when she thought about suicide. That’s when she hit rock bottom. That’s when she turned to the Internet — not to shop, but finally, to find the name and number of a therapist who could help pull her out of her slough of despondency.

Recovery hasn’t been easy, and generally isn’t when it comes to major depression. “It has taken years to feel somewhat normal,” Carina said. She went through a couple of psychiatrists until she found the right fit, with a specialist in cognitive behavioral therapy. Together, she and her therapist figured out Carina’s brain chemistry was a big part of why she was suddenly hit with depression, and they put her on medication.

“It took some time to get the right mix,” she said.

The right medication was a huge help, she said. “It gave me enough energy and balance to start making good lifestyle changes that had fallen by the wayside.” She exercised more, began going out again, and got back to work. Slowly, she rebuilt her life to a baseline of her former productivity, giving her equilibrium to look at the unaddressed deeper issues in her life.

“A large part of it was the chemicals in my brain,” she said, “but also a significant part was just looking at my life and choices, and realizing that my life didn’t really reflect me. I realized I was a stranger in my own life.”

With the guidance of her therapist, Carina is questioning everything: her work, her relationships, and her lifestyle. Sometimes, it overwhelms her, and she has bad days when she feels immobilized, guilty, embarrassed or ashamed. But one part of recovering is understanding that a few bad days are normal, and not reasons for concern.

She says her good days outnumber her bad days now.

Carina doesn’t know what life will be in a year, but she’s taking steps to rebuild her relationships. She reconnected with some friends, and most of all, she’s rebuilding her bond with Dave.

Though separated, they still see one another. They go out for dinners and coffee, and talk honestly and openly, even to see her therapist, together and separately. Carina knows that her relationship sustained a lot of damage, and it will take time to rebuild.

Carina carries a fragile hope that something will work out, and to her, that’s already a huge victory. “To feel hopeful is such a huge accomplishment after years of feeling numb and meaningless, of feeling worthless, of feeling there’s nothing good in life,” she said. It’s a small flicker of a light at the end of a long, dark tunnel — and it’s not coming from a computer screen.

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Modern Health

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