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ST. PAUL, Minn. - A new mother suffering from postpartum depression is accused of fatally slitting the throat of her 6-month-old daughter.
A single mother of four with a history of depression faces charges of throwing her 14-month-old twins off a bridge - one to his death - into the Mississippi River.
Those violent acts in St. Paul, Minn., in recent weeks have thrust depression into the headlines. But depression is anything but new or extraordinary. For growing numbers of Americans, it is part of everyday life.
At least 6.6 percent of Americans, or 13 million to 14 million people, seek treatment for depression each year, according to a National Institutes of Health study released this year.
"Even Tony Soprano takes Prozac," says Pete Feigal, a St. Paul-based national speaker on the subject who has battled the disease most of his life. "Depression is everywhere."
National studies stop short of asking, "Why?" But experts on the subject say we can't blame Sept. 11, threats of terrorism or the poor economy. Triggers for depression hit much closer to home. They often come with personal losses, lack of a shoulder to cry on and an elevated standard of beauty and materialism that's too high to climb.
"Many people are chasing the impossible dream," says Jean Twenge, a research psychologist at San Diego State University who studies anxiety, an accepted precursor to depression.
Rising numbers of people getting treatment are fueled by a new generation of antidepressants that promise a quick fix, experts say. Many more family doctors are diagnosing and treating depression than in the past, driven by changes in the health-care system and education of physicians on its front line. And celebrities' stories have helped push depression out of the closet.
The shift shows up in participation that has increased fivefold in as many years - from 30 to 150 participants - in support groups for depression Feigal directs for Hennepin County, Minn., NAMI (the National Association of the Mentally Ill). That is just one of many organizations that provides resources.
"On `Entertainment Tonight' last year, about every other story was about somebody like Christina Aguilera or a band member from (ASTERISK)NSYNC struggling with depression," Feigal says. "People are hearing these stories and realizing maybe there's help out there."
They seek help when they can't sleep or sleep too much, doctors say. They seek help when the joys of life don't call to them anymore. They seek help when facing a new day seems an impossible task.
Psychiatrists in recent years have redefined depression and bipolar disease, paying attention to relatively mild cases that would have been dismissed a decade or two ago.
More than three in 20 people will experience serious depression in their lifetime, according to the NIH study. More women than men seek treatment for depression, but the number of men asking for help gradually has climbed.
Depression rarely leads people to violence, according to the American Psychiatric Association, which considers only a small subgroup of people with serious mental illnesses at risk of violence.
While triggers for depression usually are personal, many causes are visible in cultural trends. We live in an "age of anxiety," says Twenge, the California researcher. It is largely driven by crime, AIDS, unemployment, divorce, lack of trust, materialism, debt, road rage, fast-paced lifestyles and loneliness.
More people are living alone than ever before, according to 2000 U.S. Census numbers. People are marrying later and nearly half of them are divorcing. Many people don't know their neighbors. And when asked to get involved, many say no.
"From PTA to Kiwanis, people don't belong to community organizations as much as they used to," Twenge says. "People don't connect."
Even those who live with others may feel isolated, says Gerald Metalsky, an associate professor of psychology at Lawrence University in Appleton, Wis., and director of the school's Anxiety, Stress and Depression Center. In most marriages, both partners work outside the home. Many work more than 40 hours a week. When they get home, there's more work to do. And TVs and computers compete with human interaction.
A hectic home life is hard on both men and women, he says. But it may be harder on men from a psychological standpoint because many rely solely on their partners for an emotional outlet.
"Men don't have as much emotional support in the environment as women do," says Metalsky, a clinical psychologist. "For men, there's sort of a pressure-cooker building. In some cases, it's just a question of how it will come out - as anger and irritability, marital problems, drug or alcohol abuse, or depression."
Even high points in life can lead to depression. Because the body can't separate "good" and "bad" stress, both can change the body's physiology in ways that trigger brain dysfunction, explains Dr. Ron Groat, a Twin Cities psychiatrist. In the case of postpartum depression, hormonal changes after childbirth may contribute, too.
"Some people welcome the new baby, the new marriage, the new job," Groat says. "But it can also be stressful. Some people are sitting in my office apologizing. They're saying, `Everything's wonderful, but I can't sleep at night.' "
Effects of negative stress also are unpredictable, says Dr. David Mrazek, who heads the psychiatry and psychology department at Mayo Clinic.
"Some people seem to be made of stainless steel," he says. "They go through all kinds of crisis and just keep going. But for most of us, if the environment gets tough enough, we're very vulnerable. It may not take very much."
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Losses - of a loved one or of good health - have long been recognized as triggers for depression. Other losses may be harder to admit.
"One is a loss of self-esteem," Mrazek says. "It can happen when someone gets fired or loses the sense of who they are. It can happen with retirement; all of a sudden, you see how people can get along without you very well."
Some people who buy into media images of celebrity, beauty and materialism as a norm may have to let go of the impossible dream.
Depression is confusing because almost everyone knows the sadness of loss and the low energy that comes with feeling "down." It's harder for people who haven't been there to identify with a lingering depression that deepens and makes ripples around it.
"When you add up all that impact on people's ability to work, to have relationships and kids' ability to go to school, it's hard to find any other medical problem that affects more people and has a bigger impact," Mrazek says.
For people with depression, the ideal treatment is medication combined with talk therapy, at least for a time, psychiatrists say. Some also find hope in growing support groups, such as those Feigal leads each month in Minneapolis.
Feigal calls the push to break the stigma of depression and mental illness "the civil-rights movement of the 21st century." The word is getting out, he says.
"People are finding the courage to go out and say, `I have depression,' " Feigal says. "They're figuring out it's not that they've done something wrong. It's becoming OK."
(c) 2003, Saint Paul Pioneer Press (St. Paul, Minn.). Distributed by Knight Ridder/Tribune News Service.