After his death, Foster's friends asked themselves whether there was anything they should have noticed about his behavior, anything they could have done. In retrospect, hints of trouble now horned large. Foster had seemed to be taking the pressures of his job hard. He had lost weight. His wife thought his smile seemed "forced, hollowed out." Later it was learned that Foster had asked an Arkansas doctor to send him an antidepressant.
They are the sorts of questions any of us might someday face: How do you know when a friend is in trouble? And what can you do to help? "Depression often strikes people who are particularly organized, efficient and responsible," says Dr. Frederick K. Goodwin, 57, director of the National Institute of Mental Health and an expert on depression, explaining why depression sometimes goes unnoticed. Correspondent Nina Burleigh talked with Dr. Goodwin about how to recognize signs of depression and what people can do to help the afflicted.
Are certain people more vulnerable to depression than others?
Yes. High achievers, people who are in control of things. When something happens that in their perception means they're no longer able to meet heavy demands, they can feel a helplessness that is a particularly dangerous precursor to depression.
How common is it?
Eleven million Americans a year suffer from clinical depression. It can occur at almost any point in life, although it most often appeal's in people in their 30s and 40s who are dealing with the stresses of adult life.
Are some people genetically predisposed to depression or do they develop it in response to certain experiences?
Both. Depression is believed to involve a biochemical imbalance, possibly genetic in origin. It can be triggered by a life event, either good or bad. One event commonly associated with depression is loss: loss of a person, of stature, of self-esteem, of reputation—even symbolic loss.
How can yon recognize depression in a friend or family member?
Be alert to its symptoms. These include insomnia or sleeping too much, fatigue, eating too much or too little and loss of interest in pleasure—including sex. Depression can also be accompanied by feelings of guilt, worthlessness or helplessness, difficulty concentrating or remembering, persistent sad or anxious moods, or thoughts of death or suicide.
Do colleagues and family sometimes ignore the obvious?
Sure. If they count on that person, they don't want cracks to appear. They may assume the person will be embarrassed. But the risk of ignoring someone far outweighs the risk of intruding.
What should a friend do then?
Avoid saying, "Look at all the good things in your life." To a depressed person, that sounds like criticism. More helpful is expressing concern, even asking if a person feels down. Often people who are depressed are befuddled. They may need to be actually guided toward help. You may need to make an appointment with a doctor and go with them.
What is the risk that a depressed person will kill himself?
Some 15 percent of Americans suffering severe, untreated depression over a lifetime will eventually commit suicide. One of the troubling paradoxes about suicide is that once people decide to kill themselves, they feel better. People will say later, "Gee, he looked like he was picking up."
Are antidepressant drags effective?
Yes, but often not for 10 days to two weeks. The initial phase of such a drug is the most dangerous because it may give the person energy to act on suicide before it improves his mood. You watch anyone on antidepressants closely for the first two weeks. If the suicide risk is high, you may hospitalize the person or put the spouse on a suicide watch.
If a person does commit suicide, how do family and friends avoid feeling responsible?
It's unavoidable that people close to a suicide victim will feel guilty—and angry. They'll say a person robbed his children of a father or interpret suicide as not caring enough about others to stay alive.
What we often don't take into account is the incredible power of depression. People describe depressive pain as quite anguishing. They lose their sense of time; they can only see the immediate present, filled with pain. Those who commit suicide are literally getting away from pain.
Families and friends have to recognize that depression is a serious illness beyond their control. They should let the afflicted person know they care, and then they should help that person get professional treatment.