Now 50, he's been dealing with depression since his mid-30s. After his brother's suicide in 1999, it got worse. He was profoundly sad, and the depression also settled into his body. His chest constantly ached. Sometimes it seemed like his body was going into panic mode. At the same time, as a politician, he had a public image to maintain. "I'm supposed to be out and about, smiling," he says now. "I just wasn't able to. I'd go into withdrawal."
He now has a comprehensive strategy; Antonioni goes for regular therapy and takes an antidepressant. But other physical interventions are equally important. He doesn't drink anymore, except on rare occasions—not that he ever had a drinking problem, but the depressant effects of alcohol worsened his symptoms.
Sleep is his number one secret weapon. "Sleep makes all the difference in the world to me," he says. It's not always easy to explain to his aides and colleagues why he won't arrange early-morning meetings. So be it. "The adjustments come," he adds. "People are a lot more willing to be flexible than I might originally have given them credit for."
Mood and sleep share basic biological mechanisms, and, according to Yapko, the single most common symptom of depression is some form of sleep disturbance. Getting lots of sleep is crucial. The challenge is in admitting that you just may not be able to do as much as you want to—and then sticking to your guns, even when life throws drama or excitement your way.
Getting Through Despair
"I've found that I have to be careful or I crash," says Kathryn Goetzke, a 37-year-old entrepreneur who battles major depression. "You have to be pretty disciplined about it." Goetzke has her own business, Mood-Lites, which develops decorative lighting. She also founded a nonprofit, the International Foundation for Research and Education on Depression (iFred). Then her husband ran for Congress in 2006. Of course, she got involved in the campaign. "I thought I had it all under control," she says now. "I just took on way, way, way too much."
He lost, and for maybe six months afterward she struggled to do anything at all. The marriage ended, and sometimes money was very tight—two other major sources of stress. "I learned the hard way," she says. "I have to listen to my body. I can't be ashamed. The consequences are much worse, in the long run, if I ignore it."
Goetzke reached out to her mother and brothers, who "moved mountains" to help her through the worst times. When she was closest to the brink, they pulled her back. She found a good therapist and, when she couldn't afford therapy, she turned to support groups, augmented by long walks outside.
Now, she says, she feels pretty good. "I'm happy to be around," is how she puts it. But it still takes a lot of work. She quit drinking entirely, avoids eating too much sugar, gets plenty of sleep, and hikes, plays tennis, does yoga, or bikes almost every day. She relies on her dogs, and the encouragement of a weekly women's support group. She, too, takes medication.
What might have made the biggest difference, though, was inside her own head— a major psychological shift. Before she started grappling with depression, Goetzke was an escapist. Her father, also depressed, committed suicide when she was in college, and she was eventually diagnosed with posttraumatic stress disorder. She drank, and she had an eating disorder, two ways of blunting the bleakness that only made things worse.
Finally, in her 30s, she began to confront how bad she felt and actually learned to live with her feelings of despair. "I sit through my feelings of awfulness," she says. "I let myself fully experience the bad feelings, and then move it toward something positive." Mindfulness meditation, which derails the obsessive thinking that typically intensifies negative feelings, is also useful. In these ways, she has learned to accept herself—and that includes accepting the sorrow.
Being able to withstand feeling lousy has been important to her success. As a businesswoman, she has to endure constant rejection. Once, the head of product development for a major lighting company told her that she would never get her product into a store. Her Mood-Lites are now on the shelves of hundreds of Wal-Marts, as well as in spas and chiropractors' offices across the country.
Cognitive tricks and techniques may seem insubstantial against such a formidable foe as depression, but they work. Cognitive behavioral therapy and interpersonal therapy both focus on the future, teaching mental and emotional skills that challenge negative thought patterns and counteract feelings of helplessness and self-loathing.
"Psychotherapy gives you a toolbox of approaches to handle stress, which can elicit depression," says noted mood disorder researcher Dennis Charney, dean of the Mt. Sinai School of Medicine in New York. "Part of it is getting the right treatment, the right doctor, the right psychotherapist." The important question to ask a therapist, says Charney, is whether she or he is experienced in teaching techniques that work.
Learning how to step away from your own thoughts and see them objectively is a technique that can short-circuit the downward spiral of despair. In her 20s, Gina Barreca was drowning in sadness and emotional turmoil. Small setbacks and difficulties regularly turned into huge cataclysms that took over her life. She cried constantly, for just about any reason. "I really think of myself in those early days as somebody blindfolded, walking underneath an emotional piñata with a bat," she says now.
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