Kara Davis has had a rocky life.
At 14, Davis was institutionalized for the first time, setting the standard for the next nearly quarter-century of her life. From that point on, when overwhelmed or in the throes of a breakdown, Davis would return to psychiatric hospitals until, some semblance of stability achieved, she would be released. Now 39, the Harrisburg resident was diagnosed with major depressive disorder at 16, along with attention deficit disorder. She skipped school frequently, was disruptive and often in trouble when she did make it to class and regularly ran away from home, sometimes disappearing for a week or more.
A survivor of domestic abuse, Davis spent years cutting herself; her thighs and hips still bear the scars of this self-harm, an attempt, she says, “to handle what was going on in my head” or perhaps “a form of punishment for feeling.” In 2006, she slashed her wrist deeply enough to require a trip to the ER, where she was bandaged up and then sent on her way. A week later, Davis checked herself into a psychiatric ward.
“As far back as I can remember, I’ve been depressed, like melancholy, with periods of really dark, black depression mixed with anxiety – they tend to go hand in hand,” Davis describes. “And I think as I got older, it affected the people around me because they knew I was suffering, and there was nothing they could do to change it. I didn’t know where I fit, or what to do with myself. I was just so unhappy with everything.”
After a pause, Davis adds, “The worst depression was just blackness. I could not even feel myself…it was like there was an eternal void. No future, no past. And I sobbed constantly. That’s all I did. I wanted to not exist, but I didn’t want to have to kill myself, so I was in limbo. I didn’t want to actually die. I wanted to be a normal person. I wanted to live. But I didn’t want to be in pain the way I was in pain. At that time, the only thing I could think of that would take away the pain was if I was just dead. Because I couldn’t see anything else, there was nothing except my pain.”
Davis is not alone in her despair, though that is no doubt cold comfort to her and the millions like her who suffer from depression, an illness far more widespread than is commonly believed. According to the World Health Organization, about one in five women and one in 10 men are affected by depression – that’s about 350 million people of all ages across the planet – and it is now regarded as the leading cause of disability worldwide and a major contributor to the overall global burden of disease. More than 800,000 people commit suicide each year, most of them depressed; the act is the second-leading cause of death in people ages 15 to 29. In the United States, in 2014, it was estimated that 15.7 million adults aged 18 or older had at least one major depressive episode in the previous year, which represented 6.7 percent of all adults.
But what qualifies as depression? What separates a case of the blues from someone who is grappling with this serious mood disorder?
According to Dr. Erika Saunders, chair of psychiatry at Penn State Health, Milton S. Hershey Medical Center, “While everyone feels down or sad at times, individuals with a clinical illness of depression, also called a depressive episode, have low moods that get ‘stuck’ and interfere with everyday activities. A depressive episode is a syndrome of low mood, energy and cognition that can cause changes in appetite, sleep and memory that lasts for at least two weeks. Sadness, frequent crying, severe anxiety and withdrawal from social activity can be present. Often these symptoms are so severe that people feel hopeless, losing the will to live. Depression is an illness of the brain that can come in times of stress, but also often comes out of the blue with no known stressor.”
Depression can take on various forms, ranging from major depressive disorder, which can be confined to a one-time occurrence or may manifest itself repeatedly, to dysthymia, which affects individuals for at least two years consecutively. Bipolar affective disorder is characterized by bouts of depression alternating with mania and periods of normal mood. Seasonal affective disorder is related to decreased sunlight in winter months and tends to occur every year, with symptoms lessening come springtime. Postpartum depression affects women after childbirth, while perinatal depression occurs during pregnancy. Both are serious conditions and require immediate treatment.
South Central Pennsylvania resident Patrick M., who asked to remain anonymous, knows firsthand how debilitating the effects of depression can be – and how severely they can impact not only those grappling with the illness but also their families. M., 44, has been diagnosed with what he calls “panic and anxiety – and depression has always been underlying it.” He has coped with therapy, occasional use of antidepressants such as Lexapro and Zoloft, and the anti-anxiety medication Xanax.
After falling into a depression a few years ago, M. saw his second marriage break up, an event he believes was due largely to his illness.
“I think the depression led to her leaving because I just kind of shut down for six months,” M. says. “When you’re depressed, you go in a hole. It’s a daily battle.”
Depression has also impacted M.’s ability to sleep. “I only average about three or four hours of sleep a night. The worst is when you wake up in the middle of night with your mind racing, and you can’t shut it off,” he adds.
After his wife left, the father of two found himself consequently suicidal, going so far as to begin to ponder the logistics of his own death. “There was one point, I was in the shower crying, and I was thinking how exactly I’d do it,” M. recalls. “And then my daughter came into the bathroom and said, ‘Hey Daddy, I love you.’ And I realized there was no way I could do it. I couldn’t leave my little girl and my son. It was a turning point. Now, no matter how bad I feel, I would never consider it.”
After a pause, M. adds, “I am a gun owner, and at that point in time, I did call one of my friends and tell them to come and get my guns.”
Although hard to believe when in the midst of a depressive episode, there is hope – plenty of it, as a matter of fact – for people who suffer from what author William Styron famously called the “black dog.”
Lifestyle changes can help alleviate depression, too, says Saunders, including sticking to “a healthy diet, regular exercise, a regular sleep schedule and eliminating recreational drug use and limiting alcohol use,” which “can improve sleep, appetite and energy.”
Meanwhile, Davis recommends coping mechanisms such as journaling, meditation and art therapy, all of which she utilizes.
Along with enduring the symptoms of depression, people with the illness additionally suffer needlessly thanks to widespread misconceptions about it.
Licensed Psychologist Melissa Brown, Psy.D., of PinnacleHealth Psychological Associates, says, “Some of the most difficult aspects of depression are that others do not understand what a person with depression is experiencing,” Brown explains. “Many people will make disparaging comments like, ‘It is all in your head,’ ‘Just pull yourself up by your bootstraps’ and ‘Just get over it already.’ Most people just think depression is feeling down and are not aware at the level that it impacts one’s overall functioning.”
This misunderstanding of the disease and its often devastating effects has led to the stigmatization of depression, according to Sue Walther, executive director of the Mental Health Association in Pennsylvania.
“I think there are still people who view depression as a weakness or a character deficit,” she notes. “Stigma, or the fear of stigma, causes individuals to isolate themselves and, in some cases, not reach out for support from family, friends and professionals. Stigma also results in discrimination. I think people are still very hesitant to disclose a mental illness at work for fear of losing the job, or perhaps not getting the next promotion or being isolated. Of course, losing your job simply because you have a mental illness is a violation of the ADA. When you tell your employer and colleagues you have cancer, generally speaking, people are supportive, but people with self-disclosed depression do not always experience the same level of support. Unemployment and underemployment are much higher for individuals with mental illness, and that would obviously include depression.”
For Davis, speaking out about her battle with depression is her way of helping stop the stigmatization of it and showing others with the illness that they are not alone and that there is hope.
Davis is healthy and currently attending HACC, where she is working toward a master’s degree in social work.
Of those dark days when she struggled just to survive, Davis now says, “At the time, I didn’t understand how wonderful my life was going to be. That’s the problem with depression – you don’t see your way out of it. I honestly can say I’ve never been happier in my life.”
Davis is optimistic but realistic. She knows that she will likely experience depression again but offers, “It doesn’t have to be this way forever.”
For more information about depression or to find help for yourself or someone else, visit ppimhs.org/contact or mhapa.org/programs/behavioral-health-navigators.