Some believe that depression may be related to an abnormality in the functioning of hormones in the brain. That's because people with severe depression tend to have higher levels of the stress hormone cortisol, and the size of their hippocampus actually decreases. Though different kinds of depression may be brought on by different triggers or may have different symptoms, depressed minds have similar qualities. Most of us tend to think that depressed people must have brains that are murkier than a muddy pondthat they can't think straight, that they're not able to put life's ups and downs in perspective. Yet the opposite is true. Depressed people see the world extremely clearly (and accurately for them); they have a very crisp perception of reality, which is why they often feel downbecause they see life's toughest moments so vividly. Because of their hypersensitivity, depressed people are often quite creative. Lots of beautiful people, artists (Hemingway, for example), and some very productive statesmen (Abe Lincoln) thrived between episodes of depression. Another silver lining in all this? There's actually a survival benefit to depression, in that it gives individuals the self-awareness to know their limitations and not take certain risksthe old idea of knowing when to hold 'em and when to fold 'em.
While some signs of depression are self-evident, many of us hesitate to call ourselves depressed. We'll write it off as being too tired or too stressed or justifiably sad because Boozer, our 18-year-old cat, couldn't hang on anymore. But here's the thing: Depression is actually one of the ways that your body sends a signal to you that something isn't working quite right--and that you should be thinking of coping strategies to get your mind and body on the right track. One under-the-radar symptom of depression is that early-morning awakening (we're talking 3:30 a.m., not 5:15 with a normal 5:35 alarm clock). While most of us would say that's simply a sign of stress, it's actually one of the more subtle signs of depression. If you experience it chronically, and not because you have to pee, it's something worth mentioning to your doc.
Depression is trickier than a David Blaine stunt because some of the symptoms are on the subtle side. Your doctor--trained to be a medical detective--can put together a good treatment plan, but only if she knows the whole picture. In an exam, shell ask you about medical problems that could be related to depression. But you also want to be up front about your recent history--the changes in your life that might not be medical but can certainly influence your mood. While it may sound as though you're going to confession, you should talk to your doc about major life events (such as deaths in the family or financial stresses, and, yes, changes in sexual pleasure or frequency), as well as changes in job and family situations (retirement, for example).