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Dr. Saltzman,

I have read your testimonials, and although I am usually very pessimistic about the validity of testimonials in general, I have a good feeling about yours.

I spotted one of your articles on the web and followed a link to the Aetna Health quiz that I took to determine my CESD score, which is a 43. The website says this is a high score and depression is likely.

I don't want to take any medication, but I am willing to take vitamins that you think may work for me. Any counseling for me would have to be anonymous and through the web. I fear that I may lose my security clearance if the truth is known that I think I might have a mental health condition. I am a rational person, and I don't believe that depression is a good reason to void my clearance, although I don't make the rules so I must remain anonymous.

I fear that if I do, in fact, have a "condition" it is worsening. In recent months I have been verbally exposing too many thoughts and weaknesses that I usually keep to myself, and finding myself angry over many things I have no control over. I try not to drink alcohol because it doesn't solve any of my problems, although it does calm my racing mind and make me feel a sense of euphoria I very rarely have when sober. I have gained 15-20 pounds in the past year and I've never been this heavyset in my whole life. I am a 27 yr old female, married (never divorced), no kids.

I try not to communicate with my husband over these issues I have because I don't want to bring him down. He has his own problems to deal with and doesn't need to be dealing with mine. My sister is 25 yrs old and has taken medication to treat depression (her condition in general is much worse than my own), and my mother recently started in the past two months to cope with my father's alcohol addiction. My aunt has had mental illness for quite some time and my parents shielded me from her and I haven't seen her since I was two years old.

I refuse to believe that I am a product of genetic misfortune, and I want to find my own ways to cope with my problems and not resort to drugs that will remain on my medical records for life.

Do you have or know of any reputable, informal, volunteer websites that contain an online chat forum that I may be able to participate in? I spend a lot of time on the internet looking for answers, and rarely find any that I am satisfied with. I know there has to be some answers out there for me. Any advice you can give me would be appreciated.

Thank you for your time,


Dear A.C.--

Thanks for your confidence in me. I am grateful for the testimonials of old patients and colleagues who contributed them when I launched this website in 2004.

Depression is not an attitude which one can change by force of will or by just "snapping" out of it; depression is a disease, and needs to be seen as such and treated as such. In other words, depression is not just feeling sad, "being in the pits," or experiencing pain and grief after a loss. Depression is a medical disorder--in the same way that high blood pressure, or heart disease are medical disorders--which affects behavior, thoughts, feelings, and can destroy physical health even to the extent of producing brain damage, dangerous loss of bone density, damage to the adrenal glands, damage to the heart, etc. In fact, the physical effects of depression can be so serious and profound, that, in my view, anyone who seems to be depressed must seek evaluation and treatment immediately.

Although the cause or causes of depression still are not known, the condition is familiar to all psychologists who are taught to screen new patients for depression as a matter of course. Part of this screening may involve asking the patient if he or she has any of the following symptoms:

If some of these symptoms are present, and if they have lasted for more than a few weeks, the psychologist must begin to assume that depression is present, and must begin to treat it. Even without a symptom checklist, an experienced therapist often recognizes depression immediately through intuition of some of the deeper, non-spoken signs of depression, but these subtler signs cannot easily be listed. And listing the symptoms of depression, does not even begin to suggest what being depressed feels like. Here are the words of one person (author Elizabeth Wurtzel) which aim at sketching out how it feels to be actively in the throes of that illness:

"I start to feel like I can't maintain the facade any longer, that I may just start to show through. And I wish I knew what was wrong. Maybe something about how stupid my whole life is. I don't know. Why does the rest of the world put up with the hypocrisy, the need to put a happy face on sorrow, the need to keep on keeping on? . . . . I don't know the answer, I know only that I can't. I don't want any more vicissitudes, I don't want any more of this try, try again stuff. I just want out. I've had it. I am so tired. I am twenty and I am already exhausted."

Of course depression takes many forms, and this is just one of them, but her words do give an idea of the depth of this mood disorder.

Now, because the causes of depression still are not known (at present I am interested in the theory holds that depression is a disorder of chronic improper response to stress), treatment of serious depression is complicated, but the best approach--in my own experience, and as demonstrated in studies--is a combination of psychotherapy with antidepressant medication. Sometimes psychotherapy alone can do the job, and then the antidepressant will not be needed, but, in my opinion, the reverse is not true: medication should never be used unless the patient is being cared for in an ongoing psychotherapeutic relationship at the same time.

Although I have not met you, and so cannot offer a diagnosis with full confidence, judging from the results of the depression evaluation quiz you completed, along with your own subjective report of your mental condition and weight gain, I assume that you are suffering from depression. Since it is probable that depression has a genetic basis, your report of the family history of depression is suggestive too. And, reading your statement that you do not want to trouble your husband by telling him about your feelings and fears leaves me wondering if your marriage really does lack the possibility of such communication, or, if instead, depression might be distorting your view of the marriage.

In other words, it seems likely that you are suffering from the disease called "depression," and that you may require expert advice and expert treatment in order to deal with that disease. The idea that you can deal with this dangerous disease by yourself, or by finding a chat group for support is a bad idea. In fact, it is not an idea at all, but a form of denial. As for vitamin therapy, which you asked about, I do encourage to you follow my advice on diet for physical, mental, and emotional stability. Right diet, particularly addition of sufficent omega-3 fatty acids may help, but life-style changes are not enough. I understand that you would like to believe that your "condition" is somehow just a point of view which can be changed just by wanting it to change, or by eating right and taking the right supplements, but I have not seen this. True, it sometimes happens that depression simply descends, stays for a while, and then just leaves again of its own accord, but this is rare. Almost always, in my experience, active therapeutic intervention, very often including medication, is required, and usually helps a lot.

You asked for my advice, so here it is: You should establish a relationship with a therapist experienced in treating depression, and you should do this without waiting any longer. You may think this an alarmist position, but those of us who work with depression will know better. Depression can be a killer, either suddenly through suicide, or slowly by its debilitating effects on the physical body. To repeat: Depression requires immediate treatment.

I understand that you believe that your position will be compromised if your bosses learn that you have sought help for depression, and that you believe that you must avoid obtaining expert help in order to keep your problem secret. I do not practice in the US, but here in Todos Santos, Mexico, so I am not up on the latest wrinkles in USA privacy laws, but is it really the case that the full details of medical treatment are so readily available? I always thought that in the US the physician-patient privilege allowed psychotherapists to keep secret all patient information except in cases in which the therapist learned that someone known to the patient was in imminent danger from the patient. Perhaps I am mistaken, and if so, I hope that someone will write to me to straighten me out.

In any case, you must find a doctor who can treat you and protect your private information. I agree with you that being treated for depression is not a valid reason for lifting your security clearance, and I imagine that at least some of my colleagues in your city would agree and find a way to get you the help you need without compromising your situation.

To answer your specific question: I do not know of any online depression chat groups, but I feel certain that you can find one--perhaps by dropping in on some of them to check them out--if you think it will help. But a chat group or any other self-help solution is not enough. The important point, which I will reiterate, is this: If you are depressed, your brain and other organs, including even your bones, are in a disease mode, and may be suffering serious damage.* In addition, depression untreated usually deepens, becoming more and more resistant to treatment. Please get help now.

Be well.


* See Against Depression, by Peter D. Kramer, Viking Penguin, 2005.

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