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She was 10 minutes late
for work. Normally this 39-year-old female, seemingly happily married
wife and mother of two was always on time. She prided her ability
to arise early every morning, and seemed to enjoy her 9-to-5 job.
She was late picking up the
kids from school that afternoon. Her tardiness in picking up her
children that day resulted in conflict and arguments in the car.
On returning home, she was not focused on any of the tasks at hand
that evening, and the arguments extended into the evening. She refused
to apologize for her behavior and instead became very defensive.
What her husband and children didn’t know is that she would
lock herself in the bathroom, sobbing for 10-15 minutes every afternoon
on returning home. Her husband began picking up some of the household
chores she would normally do herself. When he voiced his concern
regarding her change in behavior, she would take on a defensive
posture and quickly state that everything was fine. There had been
no recent traumas in her life, no loss of loved ones. In fact, she
had recently received a promotion approximately 6 months prior to
these symptoms beginning. Her sleep was restless. She would pretend
to fall asleep in the beginning hours in bed with her husband, and
then sneak out of bed and watch television, or attempt to read.
She would frequently pace the halls. To take her own life had crossed
her mind. However these thoughts were fleeting and not well thought
out. She could not conceive of leaving her children or her husband
in that manner. She was clearly distraught, and her symptoms seemed
to progress. Denying or fighting her symptoms seemed to exacerbate
the situation. She remembered her mother feeling the same way years
before, but was unable to remember exactly when, although she seemed
to remember her mother may have been in her 30’s or 40’s,
and she remembered it was a very stressful time for her. Her husband
began to show anger, although initially not verbalized. It would
be displayed in passive-aggressive forms around the house. The children
became more needy. One would cry and act out, vying for mom’s
attention. The other was much more clingy, following her around
wherever she went, which only exacerbated her irritation.
The above is a brief example of a familial major depression. Although
there are many variants, this is a classic scenario that is seen
quite often.
Two of the most common types of depression are reactive and endogenous
depression. Endogenous depression is depression which is frequently
inherited, and may or may not need an environmental trigger, and
can occur at any point in one’s life. Reactive depression
usually is secondary to some life event, and is usually much more
transient.
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