An Open Letter for Those Trying to Understand Depression

If depression is creeping up and must be faced, learn something about
the nature of the beast: You may escape without a mauling. ~ Dr. R. W.

Recently, a good friend of mine had something of a breakdown that culminated with a week-long stay at a psychiatric facility. While she was in the hospital, some other friends and I did what we could to make sure nothing fell apart while she was recovering, and one of the tasks that fell to me was talking to her boss and keeping him updated about when she might be able to come back to work. In one of our conversations, he told me that he had never really known anyone who was depressed and he didn’t know how to handle it. In retrospect, I’m glad he said something and asked for advice; at the time, though, I was just totally flabbergasted. How is it possible to become an adult professional (in the health care industry, no less) and know nothing about depression? I gave him an idea about what to expect when she got back to work and some advice about how to talk to her, i.e. it’s better to say the wrong thing once than be forever walking on eggshells around her, she’ll know you are doing it and it will be stressful for both of you. As soon as I got off the phone with him, I called my aunt to vent for a while. She told me that it is entirely possible to grow to adulthood with no idea about how to treat a depressed person, she has seen it too many times. In the course of our conversation, she offered to write something up for him about depression in the workplace, based on research and her own personal experience. The result was, IMHO, excellent and so I am sharing it with you, on the off chance you are in a position where you need to explain depression to someone who just has no freakin’ clue, but is willing to learn.

Without any further ado, here are AuntieB’s pearls of wisdom:

I have lived with major depressive disorder for 40 years. It runs in the family and I got the worst of it. The first and last advice I give anyone suffering from depression is to get treatment from a medical provider (I am not one). Talk to your doctor if you or a loved one show signs of depression. A (preferably board-certified) family practitioner, internist, or psychiatrist can prescribe medications and often help you find a therapist. Insurance companies have virtually eliminated talk therapy from psychiatrists’ practices.

What is depression?

Depression is a serious illness caused (it is theorized) by an imbalance of neurotransmitters in the brain. A predisposition may be inherited and it may result from or worsen due to a traumatic event or extreme stress. Whatever the factors that cause it, the apparent imbalance is a physical change in the brain’s chemistry that frequently requires medical treatment.

Mental illness carries a stigma that prevents some sufferers from seeking treatment. That depression is common and information about it is readily available have increased awareness and the number of people treated for it. Some say that it is over-diagnosed and others that it’s not real. It’s real, and it can be deadly.

As the medical community has learned over those 40 years that I have been ill, depression manifests in nearly countless ways. It shares components with and treatment is similar for many other conditions — PTSDOCD, and anxiety disorder to name a few. Based on my personal experience, they are nearly all different flavors of the same underlying condition, albeit (particularly in the case of PTSD) with unique challenges. I have had numerous diagnoses and nearly all of the symptoms I will list.

Depression is more than a sad mood. It ranges in severity but none should be ignored. People with mild depression might go decades without treatment, which increases the risk of major depression and Alzheimer’s (also linked to cardiovascular health). Studies have shown that talk therapy alone can rebuild neural pathways in the brain and improve brain health. Early intervention can prevent later problems and the need for medication. Psychotherapy is a critical part of any treatment plan.

 What are the symptoms of depression?

Symptoms of depression vary from person to person. The behaviors typically apparent are forgetfulness, absenteeism or tardiness at work, fatigue, irritability, frustration, and/or poor job performance. A person suffering from depression may suddenly find their usual tasks tedious or difficult, take no interest in them, or fail to do them at all. He or she may be very negative. [Depression is a more common diagnosis in women than men but the statistics are still somewhat skewed. Historically doctors are quicker to recognize depression in women, and women are more likely to seek treatment.]

Other symptoms include low self-worth; negative self-talk; agitation; aggression; trouble falling or staying asleep (waking up one or more times during the night 2 to 5 hours after going to bed — at my worst I could sleep only 45 minutes at a time); mood swings; anxiety; difficulty concentrating; facial tics; eating disorders; chronic pain; difficulty swallowing; hiccupping or burping (from swallowing air); obsessive thoughts; repetitive behaviors; isolation and lack of interest in social events; a poorly kept home environment; and inability to deal with changes in routine or stress.

Work provides people with a sense of purpose and a depressed individual generally copes better in public settings (except for those that raise anxiety). If a person you know has depressive symptoms is weeping on the job, they are probably in crisis and need medical attention – definitely if they talk of harming themselves or others. An emotional breakdown in front of colleagues or at a low-stress social event can mean they are in real trouble.

 Understanding depression

People with mental illness often feel trapped in their own bodies. They know there is a healthy person in there somewhere and are frustrated that their illness prevents them from being who they really are. They obsess over their poor social skills. They have a hard time making small talk while dealing with the runaway and unwelcome activity in their head. This is keen in individuals with bipolar disorder (BPD). BPD is a severe condition that manifests as swings between mania or hypomania and depression that vary in length and amplitude by individual. Some medications are used in treatment of both depression and bipolar disorder but the medication regimens for the two are generally different.

Depression is hard to shake. Talk therapy, support groups, exercise, and healthy living can make a tremendous difference, even (or especially) in cases of severe depression.  Although a person may seem to cope well, what you see is only part of the story. Think of it this way. You have a sprained ankle. Everything you do on it hurts, but you must tend to some things in your life. So you rest when you can and endure the pain when you must. All day every day is painful for people with depression. The illness itself erodes their ability to make healthy choices, their judgment, and their hope. Your sprained ankle will get better more or less on its own. Depression feeds on itself and gets worse without intervention.

People who are depressed may harm themselves for the same reason that anyone in constant pain does: they can’t stand the suffering any longer. Once in an emergency room visit, I was asked what they could do for me (this is common). I replied, “Make me unconscious.” They didn’t go for that. I had my second breakdown after my son was born and told that doctor there was nothing they could do for me. I had been sick for a long while, rapidly deteriorating as the post-partum depression took me down, and I was ready to die. What saved me was ECT, which they started right away.


Seeking treatment for depression from a medical professional is vital; unfortunately the illness impedes that as well. Waiting for an appointment a week, or a month, or three months away; finding a doctor to call; making the call — all are obstacles. Intervene if you must — do not let a loved one with impaired judgment be defeated by steps that are simpler for you, or decide for themselves that they don’t need help.

The main purpose of hospitalization for patients in crisis is to reconnect them with reasons to live. Most of what happens there is talking — the staff will do whatever it takes to get the patient to talk. Life problems can’t always be solved, but there are social workers to help. Great hospitals go at it from every angle, looking for ways to reduce stress in the patient’s life and improve their coping skills. It’s a tall order on the budget most insurance companies allow, but these folks are good at what they do. They will insist upon and help arrange aftercare, and engage the family in outpatient planning as appropriate.

ECT is generally used only when there is an imminent threat to life and medications will take too long to kick in, or when they cannot be tolerated. ECT is swift and effective but not permanent; if medication is an option it is administered after the course of ECT is finished for long-term treatment. ECT is more humane than movies would have you think although I will allow as how my memory is not quite what it was after two series of treatments. Life is full of difficult choices and ECT literally saved my life.

The usual course of treatment is a combination of medication and talk therapy. Sometimes medication can be stopped after a while; a person with moderate to severe depression may require long-term administration. Symptoms can get noticeably worse at certain points in a woman’s menstrual cycle. Additional medications can be used during those times if the doctor knows about the difficulty.

 The way back

Successful management of depression is highly likely with commitment on the part of the patient, good doctors, and support from friends and family. If a patient does not improve under the care of a physician, it might be time to find a new one. Ongoing care and social interaction are critical as the patient unlearns how to be sick and relearns how to be well. Coping mechanisms that arise from the illness must be replaced by better ones.

The best way to help a person with depression is to behave normally. Listen when they talk, don’t press them if they don’t want to (that’s their therapist’s job), and be considerate of their feelings. Make a few allowances, especially in the beginning and after hospitalization, but expect of them what they know that well person they want to be can do. If they behave inappropriately, tell them (gently). Aside from not being forced into situations that are very stressful for them, they don’t need special treatment. They need what should be our policy with everyone; namely, courtesy, kindness, and constructive feedback.

Be watchful for danger signs, respect what they are going through, and respect them as a person. They are ill, not feeble-minded. Interacting with them as you would (should) anyone else reinforces normal for them. And more than anything else, they desperately want normal.



Supplements I take

 [Talk to your doctor before adding any supplements, especially about SAMe, which can cause problems for patients prone to mania, hypomania, or are taking anti-depressants.]

Many of these were recommended by a doctor. Some are for cardiovascular health, linked to brain disorders. Depression also negatively affects the immune system.

  •  Multivitamin/mineral supplement 1/day
  • B-complex 2/week
  • Vitamin C 500mg 1/day
  • Vitamin D-3 400 IU 1/day
  • Vitamin E 400 IU 3/week
  • Garlic 1000 mg 3/week
  • Flaxseed oil 1200 mg 1/day
  • Fish oil 1200 mg 3/week
  • Nature Made SAM-e 200 mg 1/day



What it is: S-adenosylmethionine (SAMe), a naturally occurring compound that affects neurotransmitters, including serotonin and dopamine. In the United States, SAMe has been sold over-the-counter as a tablet since 1998.

The evidence: Lower levels of SAMe have been associated with depression. In studies, SAMe has been shown to be roughly as effective as tricyclic medications (an older generation of prescription antidepressants). But in many of those studies, the SAMe was injected, and it’s unclear whether orally ingested SAMe capsules have the same effect.

A 2002 review of the research on SAMe and depression conducted by the federal Agency for Healthcare Research and Quality concluded that SAMe was more effective than placebo at relieving the symptoms of depression and no better or worse than tricyclics. The report noted that more research on oral forms of the compound and research comparing SAMe to newer antidepressants (such as SSRIs) was needed.

The bottom line: SAMe has proven to be useful for the treatment of depression, but questions about its overall effectiveness and delivery methods remain. SAMe does have some side effects. Most notably, it can exacerbate mania or hypomania in people with bipolar disorder, so you should not take SAMe without consulting a physician.



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Glass artisan by day, blogger by night (and sometimes vice versa). SaraB has three kids, three pets, one husband and a bizarre sense of humor. Her glass pendants can be found at if you're interested in checking it out.

47 thoughts on “An Open Letter for Those Trying to Understand Depression”

  1. Thank you for writing this article and for speaking so candidly and eloquently about Depression.  I have had it for as long as I can remember.  I am on medication that seems to be helping.  I do not tolerate the meds well and I have tried over a dozen of them over the years.  It’s a shame there is still such a stigma attached to Depression.  I don’t tell many people that I have it for fear of judgement.  Depression is a chronic illness that can be managed with medication and therapy.  It runs on both sides of my family.  I wish that Depression could lose the “mental health” classification and be recognized a medical illness no different than high blood pressure and diabetes.  So many people have it and so few talk about it.

  2. Thank you for this, Auntie B. I won’t go into details here about my own condition but suffice to say I have struggled since early childhood with these issues. It’s very reassuring to read something like this and realize that it can be explained to those who do not have firsthand knowledge.

  3. Although a person may seem to cope well, what you see is only part of the story.

    When ever I let someone know I suffer from depression, they are shocked – “Really?!?  You seem so….?”  What people see is really only part of the story.  After a major breakdown that lead to years of intense therapy I came to understand I have suffered from anxiety disorder and depression for my entire life (from my earliest memories of childhood).  The thing that came to amaze me as I excavated my life in therapy sessions was that no one ever took my complaints of sadness, anxiety, insomnia, and fear seriously as a child and young adult.  So I learned to hide what was going on inside.  I read somewhere that people who suffer from anxiety disorders are the world’s greatest masters of disguise.  We grow up knowing something is different about us and learn to hide it.  I try now, every day, not to hide what’s going on inside so it doesn’t suck me down.  But my experiences have also made me very sensitive to those off hand comments people make (like I used to) that hint at something deeper than “Oh, I’m just having a bad day” or “Such and such is bothering me and I can’t stop thinking about it”.  You are right.  The best thing you can do is treat that person with friendliness and consideration, but most importantly, don’t blow off those passing comments as invalid or inconsequential.

    1. I love that, about how people with anxiety disorders are masters of disguise. I think it must be true. My first reaction to an anxiety attack was always to hide it – to do whatever I had to do to make people think I was normal. In the past few years, I have figured out that I don’t have to do that. In most circumstances, it’s OK to tell someone, and I have people in my life that I can safely tell. It doesn’t stop the attacks, but it stops me from making them worse by getting stuck in a loop, where trying to hide the anxiety gives me more anxiety, which I then have to try harder to hide, and so on.

  4. This is wonderful. I am one of those genetic predisposition and brought on my stress people, and my stress caught up to me when I was 22. I lived for 2 terrible years until I went to the dr for my exhaustion. When he asked about my job, I started word vomiting and crying, and got myself on Lexapro. I wish my insurance had covered therapy, but I’m not sure I would have been able to make myself go, even if it had. I’m recovered from that episode now and off the meds, but after being jobless for (what I consider) 5 months, I was on the brink again, and the days were getting really rough. As mentioned, work can help a depressed person feel a sense of purpose, which I guess is what got me out of bed for those two years, but without it, I started slipping, very quickly.

    It turns out that in a strange turn of events, the very stressful place that brought on my depression several years ago might be the thing that keeps me out of that mess now. Hopefully I’ll have two part time jobs going, with one being a possibility for a career.

    I have accepted the fact that I have depression and that for the rest of my life, another episode could be around the bend. And I feel like a lot of people are in the same situation, but they don’t talk about it. So I shared this on Facebook, because I think part of dealing with it is understanding it, and understanding it in others. Thank you so much for this.

  5. AuntieB here.  There are a few things I wanted to respond to.  First, I’m feeling much better.  I have very severe depression and I get to wake up well every day.  You would never know meeting me for the first time (unless you saw my MedicAlert pendant) that there was anything wrong with me.

    Obviously I’m not cured, but given that I can work and live on my own, and I am content, it’s as good as to me.  I take medications in addition to the supplements and I’m very stable.  Occasional tweaking required but given the suffering in the early decades I have no complaints.

    I am discreet about my illness for the most part, but I have to take pills multiple times a day and there’s no real hiding from it.  I’ve been maneuvered out of a couple of jobs due to setbacks in my illness and I know that employers can be real bastards.  I also know that filing a grievance can rain down on the person filing it.

    That said, you are not required to discuss personal issues with your manager, and they are not allowed to ask (unless you work for an employer with fewer than 50 — or whatever the number is — employees).  If you work for a largish company and can stand the backlash, speak up to your manager about their treatment of you and report them for harassment if necessary.  Human resources will work hardest to protect the company from liability, so take that under advisement.  But NO ONE should have to put up with a manager that’s an asshole.  Despite how it sometimes feels inside you, you are worthy of being treated with respect. You have done nothing wrong!  (I know, you don’t believe that always, but it’s true.)

    I work for a wonderful employer and I’m in good shape.  They’d walk away limping from any attempt to treat me differently, but more to the point they wouldn’t.  So it’s important to know your audience.  If you don’t trust your manager with the information, don’t tell them.  It’s a sad fact that people can be narrow-minded (I use more colorful wording usually).

    So it’s been my mission in life (sort of paying it forward) to be open about my illness when people ask.  After I’m certain that my manager can be trusted (actually this is the first one I’ve ever trusted, so take that under advisement as well), I am less circumspect to provide the opening.  And it happens that people seek me out for advice, somehow knowing I will be receptive and helpful.  People look at me and cannot believe that I’m sick. That’s the point — it can be managed and we are not freaks.

    Managers aren’t the only ones who can be indifferent at best.  If you aren’t feeling the way you want to feel, keep complaining to  your doctor until you do — or get a new one.  Therapy is critical, but you are not acting out, immature, a borderline personality, too controlling, manipulative, faking it, malingering, lazy, shiftless, drug-seeking, or anything else that they want to call what hasn’t gotten better.

    Therapy is for dealing with the damage from the illness, learning new coping skills, and yes, becoming a better person.  I spent nearly 30 years in therapy.  But you come at me with some perceived psychological problem of your imagining to explain a deficiency in medication, or claim that I’m malingering, you’ll be lucky to come away with only a limp.

    Yes, we all have psychological problems.  But when I have a setback, I can tell you the instant I return to normal after the medication adjustment.  I can literally feel myself walking back through the door to wellness.  And not a damn thing about my personality changed in that moment.  Get the medication you need and don’t give up, never give up, until you can feel happiness again.

      1. As I read the comments, I am reminded again of how painful depression can be, and how insensitive others can be (and have been to me).  Overall I’m grateful for the great care I have received, but there were tough times when I resented being made to feel that my illness was my fault.  I hope it’s not too scary and that it doesn’t make anyone feel they should do this or that.  Dealing with depression is a personal, day by day journey; sometimes minute by minute.

        It took me years in therapy to believe it wasn’t all my fault.  Those thoughts haunt me even now when stress is high and the medications are struggling to keep up.  I still have a hard time trusting people and still live a quiet life.  I moved closer to family a few years ago to reduce the isolation.

        But I was ill for a long time; acutely ill for years.  It doesn’t have to turn out that way.  Forty years ago there were fewer treatment options and the disease was less well understood.  When a family member had a bout with anxiety disorder, he asked me how I survived it for so long without drugs.  I don’t know.

        So I’ve been a difficult patient and sometimes a difficult employee. .It might not be in someone else’s nature to be difficult (some in my past would use a less flattering term about me) and I am not now. Still, no regrets.  I am alive and I have a happy life.  Everyone deserves the opportunity to make a joyful noise and that includes me (repeat as necessary).  Thanks for the kind thoughts.  AB

  6. This is a wonderful, wonderful post. I’ve been dealing with bipolar disorder since I was about 16, and a lot of people don’t understand how bad the depression that comes with it can be. I’m especially glad you included information on ECT. I was in the hospital over the fall, and I saw it work wonders for a couple of my fellow patients. It’s important to get the word out that ECT isn’t what you see in the movies. It’s not for everyone, but in severe cases? Yeah, it can help. Thanks for sharing this, Sara. Your aunt rocks.

  7. Thank you so much for this. My first 3 months at my first real job after graduating from undergrad happened to coincide with some of the worst depressive episodes of my life. I haven’t yet explained to my employer what is happening with me, though he does know that I am seeking therapy and has been very understanding of my weekly appointments in the middle of the day.

    My therapist also told me about SAMeand I will definitely check it out. Thank you for the information! All the best to your friend.

  8. Thank you for sharing this with us! I think depression is probably one of the most well known but hardest to understand mental illness. It takes so many shapes and forms. What you know about one person’s depression may not apply to the next. My best friend and I both have major depression, but her’s is more anxiety based, where as mine makes me want to be a hermit. The first time I really understood that I was depressed was watching Girl, Interrupted, and I was envious that Winona Ryder’s character got to “take a break”. I’m glad that I’m getting better at recognizing when I’m depressed, but I haven’t yet worked out how to deal with it. Like AuntieB said, taking the steps to get help is an obstacle in and of itself.

  9. This is brilliant. Please give AuntB a hug for me!

    People with mental illness often feel trapped in their own bodies. They know there is a healthy person in there somewhere and are frustrated that their illness prevents them from being who they really are. They obsess over their poor social skills. They have a hard time making small talk while dealing with the runaway and unwelcome activity in their head. This is keen in individuals with bipolar disorder (BPD). BPD is a severe condition that manifests as swings between mania or hypomania and depression that vary in length and amplitude by individual. Some medications are used in treatment of both depression and bipolar disorder but the medication regimens for the two are generally different.

    Definitely related to this part the most. I have OCD and I am probably hypomanic, but I’ve felt like this most of my life, even as a little kid. My last major depressive episode was 3 years ago, and this feeling was the one that haunted me the most during that episode. I felt so trapped.

    Since then I’ve done (free!) talk therapy through my schools counseling program and in the last year I’ve been fortunate to get the best job of my life so far (as a library clerk! seriously perfect for someone with OCD) and make a lot of great friends and have a really tough (but good) counselor. I take B complex and D, and have had access to better food (now to work on the whole mindful eating thing more).

    Last year I was dealing with mild depression and dating a guy who was completely ignorant to depression/OCD and who was really good at derailing me every time I tried to explain it. Aside from the physical violence I want to inflict on him, I’d I also like to show him this.

    Thank you for sharing.

  10. Thank you for this post.  I have struggled with depression and anxiety since I was a child and after one particularly difficult time I ended up in the psychiatric ward at a hospital when I was in my late teens.  I think the worst feeling about it all was that I felt like no one understood what I was going through; even the doctors that I dealt with and my family.  I still have nightmares about that time in my life (almost ten years later) and only began to seek some kind of therapy that has been helpful in the last year due to a massive distrust in doctors following the hospital stay.  I wish that more people understood how isolating it can be to have these mental issues, and that there wasn’t such a stigma attached to them.  I have struggled in my career finding a way to explain to my boss why my productivity drops during my most painful episodes, but I still haven’t found any way to express that to him without feeling even worse about myself.

  11. Thank you for such a wonderful article, SaraB. I had a depressive period and breakdown in December because of stress, and I wish I could staple this to the forehead of my awful manager. I had to take a month off work, and when I was feeling better after Christmas and went back to see about my shifts she yelled at me, guilted me for taking time off during the holidays (which I would have done so I could go home and see my family at Christmas, since they’re not in my city) and claimed I wasn’t “being fair to the other cashiers”. She’s a real piece of work and I doubt she’s open to learning anything about depression, but I plan on showing her this if she starts guilting me again.

  12. Though this is an excellent article and well-worth passing along to everyone I know…I just wish bosses would understand that this does not go away just because a pill was administered, just like cancer doesn’t disappear after one round of chemo.

    And honestly, after my personal experience of letting my boss know why I was in the hospital, I will never EVER make that mistake again. By letting him know that a mental illness was affecting me it gave him an open door to start making my life a living hell at work to push me out that much quicker.

    I don’t trust that any boss would be as good as your friend’s in dealing with this, not in my life. The less detail given about any time I’m at the doctor or hospital the better off I’ll probably be.

    (sorry, I try not to be bitter about that situation, but I am and probably will be for a long time to come)

      1. Yep. That was alleged to have happened in Ireland very recently. A young woman wrote an anonymous column for a major newspaper detailing her hospitalisation, depression, and the behaviour of her employers afterwards. By the time the column was published she’d committed suicide; her parents revealed her identity; and her employers threatened legal action against the paper. Details here:

        and her original letter (now with her name added) here:

    1. My manager has been awful about my depression (I posted a comment about her above). I also don’t plan on telling any of my coworkers about my mental illness, because there will be lots of gossip and people generally being mean. I just tell them that I’ve been sick, and they usually ask no further questions.

    2. I’m sorry your boss was an ass, and I think it is true that not every boss needs to know. In this case, I made a judgement call based on an earlier conversation and it worked out. And I figure that if someone cares enough to learn, then they deserve good resources.

  13. Thank you for this, and thank you to your aunt.

    I’ve heard of ECT being used before, but the only firsthand talk I’ve heard about it came from my grandma, who underwent it back in the day where husbands could admit their wives to mental hospitals and other places at their whim and leisure; suffice it to say that my grandmother did NOT need ECT, and I’ve always had a sense of fear whenever it has been mentioned in regards to depression and other illnesses. I’m really relieved to know that it is actually beneficial to some people. I think I’ll  have to read up more on it.

    1. It’s how it’s used that matters. ECT was often used for treating illnesses like schizophrenia and many people suffered horribly as a result – there has been a lot of negative talk of ECT in that respect, with very good reason. ECT for use with depression, however, does seem to be a treatment with the potential for good results.

      1. Great point. My grandma’s then-husband wanted her to forget certain people so she could focus on him all of the time, basically. Definitely not a legit use for ECT, and even though I realized that, it still scared me.

        It’s amazing how just a little bit of information can help change my perspective some; like SaraB’s comment above, it’ll probably always be a little scary for me to think about, but at least I can be more informed and appreciate the positive effect that it has for some people when used correctly.

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