Randy in such a short article you did a great job covering different ways the desease manifests itself differently in men than women, the shame that men feel and that they hide the depression.
I found it interesting that others use exercise to self medicate, it's something that I've never thought of before. I guess in my isolation I thought it was unique to me. Throughout my life I've pushed myself beyond exhaustion just to feel a different kind of pain. And yes, it is addictive and requires constantly pushing the envelope until you're exercising to a point that you can't walk.
You covered the difference between having the "blues" and being "clinically depressed" but in such a short article (you could write volumes of books on the subject ;-) ) it would have been impossible to go into detail about the possible pysiological reasons people have repeated depressive episodes, and that for many people there is no "real world trigger" that sets off depression. We all are conditioned to look for cause and effect - a stressor such as a percieved great failure or loss, but with many people it doesn't matter, they're getting depressed every year even if they win the lottery or become heavy weight champion of the world.
It was interesting to read about champions like Johnny Tapia who has been getting repeated depressive episodes throughout his life, I think that he would be an example of cyclical depression whereas Mike Tyson always struck me as a bipolar 1.
There is one point in the article that I have to give a differing opinion:
"Whether or not there is a ?cure?, depression is very treatable. Success rates exceed eighty percent. Therapy helps many people. A new generation of medications are very effective and have far fewer side effects than the early antidepressants. They are non-addictive and typically do not cause people to feel out of it, just ?normal?."
Although I know that your figures are backed up by medical and pharmacutical surveys, in my, long, experience with many depressed people "success" in treating depression is often not making people feel "just normal". For people with single episode depression a mild dose of an SSRI, SNRI or SSNRI will often help them to recover quicker but people with cyclical depression are often just drugged by large doses of often multiple medications. The feeling is anything but normal and they will never be cured.
One thing that I think is important to explain to healthy people is that depression is 24/7. The pain never goes away completely, even when self medicating with either exercise or drugs. Imagine staying up for 2 nights straight then getting in the car and having to drive at night with on comming traffics headlights in your eyes. You keep nodding off and snapping awake, all you can think of is sleep but you can't do it because you have to drive for 8 hours. This is a pain that most of us are familiar with.
Now take away the car and take away the time limit and, in your mind, you cannot sleep the rest of your life and depression has taken away your ability to perceive an ending to the pain. It is eternal. Any hope of your existance being anything but pain and dispair does not exist, you can remember some things you did while not depressed but have no memory of ever being without the pain and dispair.
That's as close an analogy to depression that I could give to a healthy person.
Great article, I hope everyone on the board reads it.
Well done Dr Borum.
(are you a psychiatrist?)