Jack's family tried everything. Even though Jack seemed to have his alcoholism under control -- he'd been sober since going through treatment a year ago -- he remained depressed. His family gave him support to stay sober and find a new job. They encouraged him to take time off and tried to cheer him up. They thought a new hobby would help, so they bought him a beautiful bicycle. But instead of sending Jack off to serenity on a bike path, he needed help in identifying depression.

Depression can be a devastating illness for both the individual and family. As with Jack's family, many well-meaning families operate on the misguided notion that changing externals will change the depression. The real key to relief from depression is early identification and treatment.

It's important to know what depression is and is not. Depression is a psychiatric disorder that affects appetite, sleep and energy. It is not just sadness, or feeling blue. Sadness is a normal feeling that everyone has, but it is intensified in those with clinical depression. In addition to feeling sad, other signs of depression include:

• Apathy and fatigue.
• Changes in eating, including loss of appetite or a significant increase in appetite.
• Changes in sleep, such as insomnia or marked increases in time spent sleeping.
• Changes in personal tempo, which can speed up (restlessness) or slow down (lethargy).
• Trouble concentrating.
• Feelings of worthlessness, including thoughts of suicide.

Some types of depression include major depression, which is characterized by symptoms such as apathy and changes in physical functioning, and bipolar disorder, which is characterized by states of depression and euphoria. Seasonal affective disorder (SAD) occurs with the seasons and is related to what appears to be a biological requirement for natural light.

Symptoms of depression are often confused with those for other problems, and one disorder may exacerbate the other if both are not identified and treated. For example, anxiety and depression frequently overlap. If someone with anxiety self medicates with minor tranquilizers or alcohol, the depression will increase. If an alcoholic drinks to relieve depression, the sedative effects of alcohol will intensify depression. It takes an experienced health care professional to separate one condition from another and recommend appropriate treatment for each condition.

Tremendous overlap exists between addiction and depression, according to Patricia Owen, PhD, a licensed psychologist. People treated for addiction are two to three times more likely to experience depression in their lifetimes than people without addiction. For people dependent on both alcohol and other drugs, the rate is higher yet. And well over half of the people with manic-depressive illness have an alcohol or drug problem.

In her book, I Can See Tomorrow: A Guide for Living with Depression (Second Edition), Owen cites recent advances in understanding depression that have led to effective treatment for both depression and addiction. We understand more about the relationship between stress and trauma and depression, how lifestyle and other factors affect depression, and effective therapy and medications."

Other advances in the treatment of depression include use of light boxes to alleviate seasonal affective disorder. The relationship between physical activity and depression relief was recently underscored in a study at Duke University that showed that a brisk 30-minute walk or jog three times a week produced the same effect as an antidepressant. In many cases, lifestyle changes alone won't cure the depression, but research shows that aspects of lifestyle cant be ignored.

Effective treatment exists for those with both addiction and depression. "The general wisdom now is that the earlier and more vigorously depression is treated, the less likely it is to be a relapse factor in recovery from addiction," said Owen. "And people in late recovery from addiction, even when they are working their program well, are not immune to depression."

Depression is a problem with a solution. Early identification and treatment is key. Treatment for major depression can include psychotherapy alone or in combination with antidepressant medications. Cognitive-behavioral therapy can be particularly effective, and the Twelve Steps can provide a framework for treating both depression and addiction.

--Published July 17, 2000