Despite lifelong periods of sadness, excessive drinking, and social withdrawal, Stephen Akinduro had little inkling that he was depressed and never connected his symptoms to his risky behavior. So Akinduro, a trained pharmacist, didn't seek therapy until his sexual promiscuity and pornography addiction began to confound his life and finances. I just wanted a quick fix for my behavior, a set of rules and guidelines on how to behave so I could feel normal, the 38-year-old Columbus, Georgia, resident recalls.
His therapist probed into his childhood and eventually revealed the root of Akinduro's depression. When he was 8, his mother committed suicide after enduring years of abuse from his father. Akinduro witnessed the abuse. I never cried at my mother's funeral. My father told me 'big boys don't cry' and I sucked it in.
For Akinduro, a depressive episode that would spiral into a catastrophe could be triggered by a relationship breakup or a challenge at work. But like many sufferers he had learned to mask his depression. One supervisor suspected his secret after a heated verbal exchange at work that followed a co-worker's racially insensitive remark. "I was shocked that he picked up on it but I didn't want to share my problems with a stranger, says Akinduro, who was eventually told he had bipolar disorder.
Akinduro is one of the roughly 14 million Americans who suffer from a form of depression each year. The disorder is characterized by mood fluctuations, low self-attitude, and five or more symptoms that persist for at least two weeks. These include mood disturbances, difficulty concentrating, psycho-motor retardation (slowing down of function), inexplicable crying, irritability, feelings of impending doom, lack of interest in leisure activities, decreased libido, and social withdrawal. Sufferers may also experience polar behavior such as lack of appetite or overeating and constant sleeping or sleeplessness. Bipolar individuals may engage in high-risk sexual activity. If symptoms persist, they can drive sufferers to commit suicide.
Depression is more intense than the normal feelings of sadness or loneliness that everyone experiences occasionally. It is also different from the grief experienced within two months of the loss of a loved one. Major depression, also called clinical depression and one of the most common forms, decreases quality of life, impairs mental acuity and occupational and emotional functioning, and robs sufferers of experiencing their full potential. Usually precipitated by a traumatic life event or other trigger, an episode of clinical depression may occur only once in a person's lifetime. But more often, it is a persistent, ongoing experience, with episodes that last for up to two years and that worsen without treatment. Women are more likely to suffer from depression, but men have a higher rate of completed suicide. Although whites experience major depression more than blacks over their lifetimes, it tends to be pervasive and more debilitating for blacks, according to a two-year joint study by Harvard, Wayne State University, and the University of Michigan. Successful treatment is challenging because of blacks' reluctance to take medication. What's more, while it's obvious that depressive conditions affect temperament and disposition, it's not widely known that these conditions directly impact hormonal functions including the regulation of blood pressure and glucose levels. Ignoring signs of depression could affect your health in ways you might have never imagined.
A Devastating Condition for Blacks
Chronic depression and bipolar disorder are two well-known forms of depression. Also called dysthymia, chronic depression is characterized by two years or more of a depressed mood. Less severe than major depression, it does not typically interfere with an individual's life. Bipolar disorder, or manic depression, is a complex mood disorder that alternates between periods of clinical depression and those of extreme elation or mania. With bipolar 1 disorder, sufferers have a history of at least one manic episode with or without major depressive episodes. With bipolar 2 disorder, sufferers have a history of at least one episode of major depression and at least one mildly elated episode.
Depression in Blacks is often masked by other issues and as a result may go unacknowledged and untreated for a long time. Stymied by fear of stigmatization, mistrust of health professionals, financial constraints, and the lack of access to appropriate healthcare, blacks tend to quietly carry the burden of depression. Causes of depression can be complex and multilayered-directly related to past personal challenges and/or compounded by collective experiences related to racially tinged slights and discriminatory acts. As a result, according to the National Institute of Mental Health, depressive disorders are less likely to be diagnosed in black people. The 2001-2003 Harvard, Wayne State, and Michigan study-one of the largest psychiatric epidemiological studies of blacks in the United States to date-indicates that of the 3,570 African Americans surveyed, 10.4% suffered from major depression over their lifetimes and 56.5% suffered from it for 12 months within their lifetimes. For the 1,621 Caribbean blacks surveyed, those numbers were 12.9% and 56%, respectively.
These percentages are compounded by the fact that black people manifest specific symptoms that are often misunderstood, ignored, or misdiagnosed, suggests Dr. Patricia Newton, medical director of Baltimore-based Newton & Associates, which specializes in behavioral medicine. Blacks are more likely to be socially withdrawn, and experience guilt and paranoia and internalize blame for whatever went wrong, explains Newton, who is also president-elect of Black Psychiatrists Of America. Workplace and personal conflicts can also fuel dramatic events and reactions, which often manifest in the form of anger and/or addiction.
The Problem with Being the 'Problem Solver'
This was a reality for Jennifer Jones, 45, who was fired from her position as director of community relations at a New York cooperative development in December 2006. Refusing the company's settlement changed her status to a voluntary resignation, which prevented her from collecting unemployment.
I was angry and humiliated, says the married mother of two, who was told she had clinical depression. After eight years, all my efforts and programs I'd created all went down the tubes. Over the course of nearly two years, the formerly two-income family went into a financial tailspin. The couple depleted their savings and took their daughters, one in college, out of private schools. They traded in two cars for one and moved from their Princeton, New Jersey, home to a relatively small apartment in the New York City area to be closer to family. Feelings of disgrace because of the lack of viable employment opportunities and the stress of her family's upheaval took a toll on Jones. She became a virtual recluse, sleeping constantly, overeating, and eventually ceasing most of the functions of daily living, including the care of her younger daughter. Her husband helped pick up the slack. With no history of mental illness, Jones was convinced the low feelings would recede over time. I was told to pick myself up and count my blessings," she recalls. I've always been the go-to problem solver for my family. It was impossible to believe I couldn't help myself.
Like Jones, some sufferers believe that they're imagining the severity of symptoms and that eventually they will be able to pray or will the sadness or behavior away. Donna Holland Barnes Ph.D., president and co-founder of National Organization of People of Color Against Suicide, says, Lack of communication helps to deepen depression, because symptoms are misunderstood and therefore go untreated. Black men are less likely than women to seek help, Barnes adds. They are less likely to comply with treatment and less likely to stay in treatment if they start it.
Medication can both manage a depressive condition and cause other challenges, such as weight gain or impotence, explains Newton, who does not oppose the use of medication. Understandably, patients are reluctant to take [their medicine], which perpetuates the cycle. Akinduro is on medication, but it took three or four tries to find one that worked for him without side effects. Jones is reluctant to try it and prefers sessions with a therapist, which has worked for her, but in some cases psychotherapy is not enough.
The Physical Toll
Although many suffer in silence, the effects of depression are never felt in isolation. Aside from the variety of burdens it may place on the family of a sufferer, depression cost the U.S. about $83 billion because of decreased productivity and workplace absenteeism in 2000, the latest year for which numbers are available. There are other health costs as well. Depression has been linked to heart disease and stroke, which are major health concerns for African Americans. Changes in appetite and sleep patterns, root symptoms of depression, are linked to the hypothalamus, a small structure located at the base of the brain responsible for many basic functions such as sex drive and stress reaction. The hypothalamus also supports the function of the pituitary gland, which in turn regulates key hormones. Abnormalities of pituitary function are related to increased levels of the hormone cortisol, which is related to blood sugar imbalances, and to the hormone catecholamine, which is related to blood pressure changes. Depression causes impaired cognitive performance, lowered immunity, and inflammatory responses in the body.
The Process of Healing
Depression is treatable with the help of a qualified healthcare professional. Treatment includes talk therapy and the incorporation of antidepressants, depending on the severity of the condition. Akinduro, who is a board member of National Organization for People of Color Against Suicide, credits therapy, medication, and finally confronting his father with putting him on the road to recovery. It was very liberating to confront my past. In therapy I learned that it's not a moral failing or scar on your character. Jones' healing began when she saw a television interview with author Terrie Williams about her book, Black Pain: It Just Looks Like We're Not Hurting (Simon & Schuster; $25). Today, Jones is executive director of the Stay Strong Foundation, a New York-based nonprofit that Williams co-founded offering mental health and mentoring programs. As we treat depressed individuals, we also have to treat the community in order to address the larger issues that are affecting our environment, advises Newton. Anything less is a Band-Aid.
Getting Help for Depression
Every year about 14 million Americans suffer from some type of depressive illness and according to several reports, blacks are particularly at risk. Here's a list of resources for those at risk or battling a depressive disorder.
National Organization of People of Color Against Suicide works to increase suicide awareness within minority communities and seeks to educate individuals about prevention and intervention, as well as provide support services to families and communities impacted by depression and suicide.
The National Institute of Mental Health works to broaden understanding and treatment of mental illnesses through research and thereby facilitate prevention, recovery, and a cure.