[Editor's Note: Depression can occur as a reaction to being told that one has a chronic illness, or it can be a symptom of the disease process itself. It can also occur at the same time as a medical condition and be entirely unrelated. Many people diagnosed with sarcoidosis report being depressed. Therefore, I believe it is vital for our carers to understand depression and what may cause it. It is important to know that your loved one can little control the emotional pain of a depressive episode. It is quite likely that medication will be needed to put the body's chemical balance back into "sync" and restore the person's sense of wellbeing. Be sure to seek medical advice if your loved one is ill and becomes depressed.]

Editor's Note: The source of this article is the NIMH Depression Awareness, Recognition, and Treatment Program (DART).

For free brochures on depression and its treatment:

• Review and complete the order form.
• Call: 1-(800)421-4211
• Mail request to: DART, 5600 Fischer Lane, Rockville, MD 20857.]

The misery of depression extends beyond those suffering it to their families and friends.

Depressed people often frustrate and alienate those around them. "Try not to take it personally," says San Francisco psychiatrist Michael Freeman, M.D. "They have an illness. They can't help it." Of course, that's often easier said than done. It's very difficult to control your temper when a close relative or friend never returns your calls, hardly gets out of bed, answers you in monosyllables, acts completely self-absorbed, seems to have no interest in you or doing anything you liked to do together, and doesn't keep dates or follow through on commitments. Get mad if you must, but then, get over it. Keep reminding yourself that the person is ill, and not responsible for his or her many failings.

Depressed people often engender tremendous guilt in those around them. "You think: 'Nothing I do seems to help, so there must be something wrong with me,'" Dr. Freeman says. There's nothing wrong with you, nothing to feel guilty about. You can't relieve clinical depression with love alone any more than you can cure heart disease or cancer with just love. People who are depressed need professional help. Many require medication.

Reassure the children of depressed parents that the illness is not their fault, says Eda Spielman, PsyD, a Boston area psychotherapist. "Otherwise," she says, "children may blame themselves for the parent's condition, feel guilty, and become more vulnerable to depression themselves." Also reassure the parents of depressed children in the same way. The illness is not their fault, and they can't "fix" it. The depressed person has to get professional treatment.

On the other hand, social support improves treatment results in many serious illnesses, such as heart disease and -- according to some studies -- breast and skin cancer. Many experts believe that social support also helps treat depression. Keep reaching out to your depressed loved one, just to reinforce the fact that you care. Call. Send affectionate notes. Invite the person to movies, concerts, ball games, parties, and other events. But keep your expectations low -- as close to zero as possible. Chances are that the depressed person won't respond to you, or that if you get a response, it won't be that of a normal individual. But depressed people notice outreach efforts and appreciate them, even with their illness renders them incapable of acknowledging your love and devotion.

If the person responds to you after a long period of silence and neglect, work hard not to be sarcastic: "So, after 121 phone calls, you finally call me back. Thanks a lot." Try to accept the contact as matter-of-factly as possible: "Oh, hello, Marcy. It's nice to hear from you. How are you feeling?"

Don't feel that you have to apologize to others for your depressed loved one's lack of sociability or responsibility. When mutual friends remark that the person never RSVPed for their anniversary party, simply explain that he or she has been seriously depressed, and that the illness has crippled the person's social skills.

Guard against falling victim to depression yourself. Don't get dragged into the emotional whirlpool that has sucked your loved one into an emotional abyss. "Stay involved with other people," Dr. Spielman urges. "Work at not becoming isolated." Solidify other family and social connections. Pursue hobbies and other interests. Have fun. Consider getting some counseling yourself.

How can you help a depressed loved one through depression? Here's what you can, and should, do:

Urge your depressed loved one to get professional help. That's what the person needs. If necessary, offer to make an appointment with the person's doctor, or therapist, or psychiatrist, and drive the person there, or arrange for a cab.

Learn more about the condition yourself. The National Institute of Mental Health's Depression Awareness, Recognition, and Treatment (DART) Program offers a free booklet, "Helping the Depressed Person Get Treatment."

Editor's Note: The following three articles are from the National Institute of Mental Health and are part of a series of articles about depression co-occurring with other illnesses.]

The Unrecognized Link--Depression Co-occurring with Medical Conditions

Having a physical illness can cause you to feel "down" or sad. But if the sadness is severe or long-lasting, there may be an unrecognized link: clinical depression co-occurring with a medical condition.

Clinical depression is a serious but treatable illness; its symptoms have been estimated to occur in as many as one third of persons with any medical condition, and the rates in some specific conditions may be even higher. Depression can cause changes in eating and sleeping patterns, problems with memory and concentration, decreased energy, and feelings of hopelessness, worthlessness, and negative or pessimistic thinking. Discussing such symptoms with your doctor is important for several reasons.

First, if the depressive symptoms are part of the medical illness or side effects of medications, treatment may be adjusted or changed. Second, if clinical depression is an additional problem, it can be treated. And treatment is effective and can start to work within a few weeks.

Your doctor must first find out whether you have one diagnosis or two. This requires careful evaluation, especially in illnesses with similar symptoms.

Weight loss, sleep disturbance, and low energy occur in depression and also in diabetes, cardiovascular disease, vitamin or mineral imbalances, and endocrine disorders. Symptoms of apathy, poor concentration, and memory loss are found in depression and in Parkinson's and Alzheimer's diseases. Depressive symptoms may also include achiness or fatigue which are present in many other conditions.

Depression and medical illnesses may occur together for different reasons. For example:

• Medical disorders may contribute biologically to depression, as with an underactive thyroid or Cushing's disease.
• Medically ill people may become depressed as a psychological reaction to the prognosis, pain, and incapacity caused by the illness or its treatment, as in cancer.
• Though occurring together, depression and a general medical disorder may be unrelated.

Major depression is particularly common in persons diagnosed with cancer, stroke, and diabetes. A doctor can best make the diagnosis and prescribe the right treatment.

Treatment of co-occurring depression can have a positive effect on the course of the medical illness, particularly when it improves a person's ability to properly manage chronic illnesses such as diabetes and heart disease. In addition, it can significantly enhance an individual's quality of life.

Recognize the Link. Don't ignore mental health as a part of overall health. Get professional treatment for depression.

Depression Co-occurring with General Medical Disorders

Clinical depression commonly co-occurs with general medical illnesses, though it often goes undetected and untreated. In fact, while the rate of major depression among persons in the community is estimated to be between two to four percent, among primary care patients it is between five and ten percent and among medical inpatients it is between ten and fourteen percent. And an additional two to three times as many persons in these groups experience depressive symptoms. Research suggests that recognition and treatment of co-occurring depression may improve the outcome of the medical condition, enhance quality of life, and reduce the degree of pain and disability experienced by the medical patient.

What is depression?

Clinical depression is a common and highly treatable illness affecting over 19 million American adults-- with or without a co-occurring condition-- this year. Unfortunately, nearly two thirds of them do not get treatment, in part, because the effects of depression are not understood to be symptoms of an illness. With proper treatment, however, nearly 80% of those with depressive illness can feel better, and most within a matter of weeks.

Depression: A Whole Body Illness

Depression affects mood, thought, body, and behavior. For some, it occurs in one or more relatively severe episodes, known as major depression. Others have ongoing, less severe but also debilitating symptoms, known as dysthymia.

Symptoms of Depression:

• Persistent, sad or "empty" mood
• Loss of interest or pleasure in ordinary activities, including sex
• Decreased energy, fatigue, being "slowed down"
• Sleep disturbances (insomnia, early-morning waking or oversleeping)
• Eating disturbances (loss of appetite and weight, or weight gain)
• Difficult concentrating, remembering, making decisions
• Feelings of guilt, worthlessness, helplessness
• Thoughts of death or suicide; suicide attempts
• Irritability
• Excessive crying
• Chronic aches and pains that don't respond to treatment

If a person has five or more of these symptoms for more than two weeks, it is important that these symptoms be brought to the attention of the individual's health care provider.

Accurate Diagnosis is Important

Since some symptoms are common to both depression and certain medical disorders, accurate diagnosis is critical to developing an effective plan for treatment. For example, symptoms of depression such as weight loss, sleep disturbances, and low energy, may also occur in diabetes, thyroid disorders, some neurologic disorders, heart disease, cancer, and stroke. Other depressive symptoms, such as loss of interest or memory, also occur early in the course of disorders such as Parkinson's and Alzheimer's disease. In addition, achiness or fatigue may be present in many other conditions. In such cases, careful assessment of an individual's emotional state, and personal and family histories can help determine if one or two illnesses are present.

Other Diagnostic Concerns

The relationship of clinical depression to a medical illness can be varied. Depression can occur as the biological result of a condition such as an underactive thyroid, or can be the side effect of one or a combination of medications, including over-the-counter medications. In such cases, the depression may be relieved by a change in dosage or type of treatment(s). On the other hand, it is not unusual for a traumatic diagnosis, such as cancer, to trigger a period of depressive symptomatology including sadness, poor concentration, anxiety, or withdrawal. Careful monitoring of the length and severity of depressive symptoms can determine if clinical depression is an additional diagnosis.

A Message of Hope: Depression is Treatable

When depressive illness is a co-occurring condition, it should be treated. With treatment, up to 80% of those with depression can show improvement, usually in a matter of weeks. Common interventions include a range of antidepressant medications, focused short-term psychotherapy, or a combination of the two. In addition, in special circumstances, electro-convulsive therapy (ECT), a safe and effective treatment, may be considered as an option. Which treatment is recommended depends on the severity of the depression, the type of co-occurring illness and its treatment, and, to some degree, on individual preference. In addition, maximizing the treatment of the medical disorder may also help to diminish the depressive symptoms.

Treatment of Depression has Added Benefits

Treatment of depression can improve a patient's overall quality of life in several ways. It may enhance the ability to follow the treatment regimen for the co-occurring medical condition, decreasing complications and improving the eventual outcome. In addition, effective management of depression can lessen the degree to which the patient is irritable, demanding, or experiences overall problems in functioning, any of which may contribute to slower or more difficult recovery, and greater stress and disability from the medical condition. Finally, controlling the depression will often improve the cognitive symptoms that are a part of some illnesses.

The Path to Healing

Whether or not it co-occurs with medical illness, overcoming depression requires recognition of symptoms, and evaluation and treatment by a qualified health or mental health professional. Success involves a partnership with a health care provider so that an individual's concerns can be addressed. Negative thinking is a part of the depression that will fade as symptoms resolve. Family and friends can help by encouraging the depressed person to seek or remain in treatment, and by offering emotional support. In addition, the following may be helpful adjuncts to treatment: support groups, mild exercise or hobbies, reading self-help materials.

Depression: Treat it. Defeat it.

Awareness and Treatment Can Improve Overall Health and Reduce Suffering.

For additional information about depression, write to: DEPRESSION, 6001 Executive Boulevard, Rm. 8184, MSC 9663, Bethesda, MD 20892-9663.

For free brochures on depression and its treatment, call: 1-800-421-4211.

Use the order form on the NIMH website to order a copy of most brochures.