Until last year, when Deborah saw a checklist of the symptoms of depression in a newspaper story, she thought depression meant feeling so bad you couldn't function and so low you were suicidal.
But she was going to work every day, although every project seemed nearly insurmountable, and she wasn't considering killing herself. She simply had no energy, no interest in trying anything new, no desire to socialize.
Perhaps, she thought, she was exhausted. Or overly stressed. She just had to "snap out of it."
But when Deborah answered "yes" to almost all of the questions in the checklist, she decided to get some help. She got it in a relatively new way -- she attended a free screening for depression at a Boston hospital.
Tomorrow, thousands of others are expected to get help, too, in the third annual National Depression Screening Day, a project begun and directed by a psychiatrist at McLean Hospital in Belmont, Mass.
Mental health professionals at 1,300 hospitals, churches, shopping malls and medical offices will give talks on how to recognize depression, hand out booklets describing the disorder and administer questionnaires anonymously to ferret out signs of depressive illness. Each person who goes to a screening will then be interviewed individually, and those who need help will, if they wish, be referred to professionals for evaluation, medication, therapy or perhaps all three.
Last year, with 400 screening sites nationwide, 20,000 people sought help, and three-quarters of them showed signs of depression. More than half had never been treated.
Most were mildly or moderately depressed, but about 200 people were so desperately ill that they needed immediate hospitalization, says Dr. Douglas G. Jacobs, the project's founder and director and a psychiatrist at McLean.
One young man, a Boston-area college student, attended the session at McLean Hospital and told his interviewer that he had been putting plastic bags over his head in suicide attempts each of the three preceding nights. Within half an hour, the student was admitted to the hospital. He later was able to return to school and finish the year.
"For me, it made the whole project worthwhile," says Dr. Jacobs.
Deborah asked that her last name not be published because some of her company's customers may not realize that depression is an illness. On the screening day last year, she went to Massachusetts General Hospital, where a psychiatrist said she seemed severely depressed.
Deborah ultimately enrolled in a drug-treatment study and took Prozac, an anti-depressant medication, for five months. Each day, she says, she could feel the depression lifting. When the research project called for her to, she stopped taking the medication; the depression did not return.
Diana, who lives in Arlington, Mass., had a different experience; she attended the screening at McLean Hospital last year after deciding it couldn't hurt to find out more about why she felt so bad so much of the time. Diana, who also didn't want her last name published, said the screening was "relaxed and unthreatening," and she was referred to a therapist, whom she still is seeing.
The talking has at times been painful, stirring up upsetting feelings, but it has helped. She has not taken medication, Diana says, but the therapy has improved her self-confidence and helped her gain perspective on herself and relate better to others.
"Last year, I turned 40 -- I had the whole midlife crisis," she says. The screening "was the best thing I could have done for myself."
This year, Dr. Jacobs hopes as many as 50,000 Americans will take advantage of the screening opportunity. Depression can be treated successfully in most patients by medication, talking therapy or, usually,both, he says. The illness is equally treatable in the elderly, who may mistakenly believe that their depression is an unavoidable part of growing old.
The National Institute of Mental Health estimates that 15 million Americans experience depression each year, and only 1 in 4 seeks treatment. The rest, says Dr. Jacobs, watch their physical health, careers, relationships and families deteriorate. Some commit suicide. Most suicides are committed by people who are depressed.
His goal is not only to reach thousands who otherwise would go untreated, but to reduce the stigma and secrecy surrounding illnesses of the mind and emotions.
"Traditionally, mental illness has been something that has always been put in the back room, and psychiatry has been practiced behind closed doors," says Dr. Jacobs. "This is a statement on the part of psychiatrists that we're coming out from our offices to talk with patients openly about a disorder that's an illness, and that we have very specific treatments for."
Health organizations sponsoring the screening include the American Psychiatric Association, the National Institute of Mental Health and the National Mental Health Association.
DEPRESSION SCREENING DAY
The following is a sampling of local programs being held tomorrow:
* Stouffer Inner Harbor Hotel. Noon to 5 p.m. Gibson Room. Sponsored by Maryland Psychiatric Society. (410) 938-3000.
* Good Samaritan Hospital. 10 a.m. to noon and 5 p.m. to 6 p.m. Call for appointment. (410) 532-3838.
* Maryland General Hospital's Professional Center. Suite 405, 821 N. Eutaw St. 8 a.m. to 10 a.m. and 1 p.m. to 6:30 p.m. (410) 225-8395.
* Sinai Hospital.1 p.m. to 3 p.m. Rymland Building. Sponsored by hospital's department of psychiatry. Includes lecture, videotape on depression with question and answer period, followed by screening. (410) 578-5457.
* Howard County. 9 a.m. to 9 p.m. Programs include brief talks, a video, discussion with a mental health professional. Sponsored by private and public health care organizations in Howard County. For screening schedule, call (410) 730-3773.
* Fallston General Hospital. 7:30 p.m. Hospital's dining room. Lecture: Caring for care-giver. (410) 893-9140.
To find a screening site close to you, or anywhere in the country, call (800) 433-1400.