I’m Depressed and Afraid of People Finding Out

Reader’s Question

I am a 41-year-old female. I have never been diagnosed or treated for depression, but I believe I suffered through an episode about 14 years ago. I kept my unhappiness to myself and no one ever seemed to know the difference. Currently I have five children; one is in college, three are in high school and one is three years old. I homeschool and recently went back to school online. I have a great husband, but we are currently a commuter couple; he lives 400 miles away, so we only get to see him once or twice a month.

I just cannot seem to pull myself together. I do not even want to do any of my school work, which I had been enjoying. I feel lonely all the time. I have not got dressed in three days and I lie and tell the kids that I am in my room studying. From the moment I wake up my mind races. I am not suicidal, but I think about what it would be like if my husband died or one of our children. I do not want to eat — not because I am not hungry, but because it is one of the few things I feel like I can control.

Everyone thinks that I am some super woman, but I am actually falling apart. I have lots of acquaintances, but only one close friend. I do not want to burden her, as she has a family of her own to take care of. I cannot tell my husband because there is nothing he can do. I do not want him worrying about me. He has to live there and I have to live here, at least until the end of the school year.

I am afraid of people finding out how I feel. I sit on the board of directors for a nonprofit, and I am a recent Mrs. (State) titleholder. I do not understand what is wrong with me. I am usually optimistic and outgoing. I understand on a cognitive level that none of this is normal, but I cannot seem to make myself care about anything.

Psychologist’s Reply

Everything you describe fits a classic presentation of depression. The fact that you experienced an episode of major depression 14 years ago further validates the tentative, unofficial diagnosis. With that earlier bout of depression, it sounds like your high-achieving personality prompted you to put on your best face and push ahead with life’s demands until the depression apparently resolved itself. Being the same person 14 years later, it sounds as though you’ve been taking the same approach.

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(Please read our important explanation below.)

As you noted, one of the cruelest symptoms of depression is the apathy and negative shadow the disorder casts over life generally. As a result, many people find it difficult to seek treatment for depression — their energy and initiative is low, and there’s a general feeling that it won’t help anyway. Fortunately, we live in an era of history in which we have more effective and safe treatment options than ever before. Between medication and cognitive-behavior counseling, there is no reason anyone should have to suffer with major depression.

You also raised two other important issues people often face with depression: the stigma sometimes associated with psychological disorders, and the nagging question of why someone would be depressed when that person “has so much to be thankful for.” In a way, the two issues are related. There remains some stigma attached to depression and other psychiatric illnesses because some people still think of them as character flaws or personal weaknesses. These same people then assume that depression is not legitimate when there is no obvious “reason” to feel depressed (such as a major loss).

In reality, some of us are more prone to depression or anxiety or other particular disorders because of the way the genes came together to form our unique genetic makeup. More specifically, people vary genetically with regard to brain chemistry and functioning, and although we know more about our brains than ever before, our understanding of those differences is still fairly crude. Then there is the effect of stressors. Our neurotransmitters and brain functioning are affected by stress, whether it’s one major loss or an accumulation of lots of smaller stressful events. Given enough stress, virtually everyone would qualify as having a depressive and/or anxiety disorder. Multiple demands on your time, attention, and energy, along with being socially and romantically isolated, sound like a potent recipe for depression.

So, it’s likely that your brain chemistry has strayed too far from it’s typical functioning. Family physicians are used to prescribing antidepressant medication, and do so much more frequently than you probably imagine. Many people first seek treatment there, because they already have relationships with their physicians and because there is less social stigma than seeing a psychiatrist. That said, a psychiatrist is a specialist in treating problems caused by neurotransmitter dysregulation, so the ideal is to start there (or at least seek treatment from a psychiatrist if initial prescriptions from a family physician do not seem to help).

The bottom line is to seek treatment, making a cognitive decision to do so rather than relying on feeling motivated to do so. The sooner you start treatment, the sooner you’ll be feeling like yourself. Take advantage of the knowledge and tools we possess at this point in history, and join the millions of people who have been successfully treated for depression and/or anxiety.