Marcel is what mental health workers call a "survivor."The grey-haired, 55-year-old Gananoque-area resident, a member of the depression recovery support group at the Leeds and Grenville Rehabilitation and Counselling Services, speaks with difficulty, slowly and with frequent pauses. His eyes are lowered, his hands shake and he works nervously with his pen on the plastic cap of his open pop bottle as he recounts some of the horrific incidents that caused his illness.Other members of the group take fewer than five minutes to outline some of the experiences that triggered their depressions. Marcel, whose every sentence feels like a crippled runner's heroic attempt to complete a full mile, takes more than an hour.The other members of the small depression group, which meets at the former Brockville Friendship Centre, are riveted by Marcel's story. It's easy to understand why someone in his shoes would prefer silence.Both his parents drank and frequently beat him. On one occasion, after an act of boyish mischief, he ended up naked in a snowbank outside his home and had to be taken in by a neighbour.At age four, his mother left him standing alone on a railway platform in Chicoutimi, Quebec. Later in his youth, he ran away from home, hitchhiking in the snow until his feet froze. Still later, after he reunited with his father, the cycle of violence resumed. In his life, Marcel has endured beatings so severe he could only crawl away from them.This is one of the triggers of depression - experiences so traumatic they are literally painful to remember. The body and mind shut down under such a barrage.A younger member of the group, which used to meet at the Brockville Psychiatric Hospital (BPH) Elmgrove Unit, has similar outward symptoms. He speaks in a quiet voice, eyes down, head swaying back and forth.The man, whose sister is also in depression recovery, said his depression dates back to childhood, when his father suffered multiple health problems. The man's depression so debilitated him that teachers at the time believed he had a learning disability.Now in adulthood, he takes antidepressants but often finds he needs sunlight to stay emotionally balanced.With help from the medication, Elmgrove and the support group, he is now able to live independently where before he lived in a group home.The local rehabilitation and counselling agency looks after people known in the profession as "SMIs," or "severely mentally ill." Cases such as theirs are clearly identifiable as much more serious than what we commonly associate with the word "depressed."But depression has many faces and many triggers, some not as visible as the outward suffering of Marcel and his colleague. In fact, the Canadian Mental Health Association estimates a tenth of the population suffers from mood disorders, either depression or manic depression.Depression, in which a person "feels low" and loses interest in life, is the more common of the two mood disorders, the CMHA notes.In many cases, it's also easier to overlook or pass off as "a case of the blues."The first barrier to treatment is often shame, notes BPH's interim chief psychiatrist, Dr. Pushpakumara Malaviarachchi, who abbreviates his Sri Lankan name to "Dr. Malavi."In reality, depression is not just a mood problem; it's an illness, and it's treatable."It's as real as pneumonia or appendicitis or whatever," Dr. Malavi said. "It's a medical problem. It's not a weakness."And the good news is a majority of people who suffer from depression get better, he said.Dr. Pushpakumara Malaviarachchi, interim chief psychiatrist at Brockville Psychiatric Hospital, says the first step in fighting depression is coming forward and seeking help.Depression can happen to anyone who undergoes an event that is traumatic enough, like losing a loved one, losing a job or suffering the kind of abuse that poisoned Marcel's childhood.It can also happen on its own, the result of a chemical imbalance in the brain - a problem with a strictly physical cause such as, say, diabetes.Often, both a difficult life situation and psychochemical issues are at work in a depression sufferer, Dr. Malavi said.In some cases, people with a biochemical tendency to depression just need something to trigger it."Stress or an event can unmask the depression," he said.Suicide becomes a major risk in people with severe depressions, he noted.Depression sufferers know they have more than a case of the blahs if they notice some common symptoms.The most obvious is a low mood. An early warning sign is a lack of interest in things that usually give one pleasure."Generally speaking, people get preoccupied about negative things in life," Dr. Malavi said. "They feel guilty about mistakes they have made. They start ruminating about morbid aspects of life."Such morbid ruminations can lead people to assume the worst about their own health or dwell on human tragedy. For instance, a depressed person may feel he doesn't deserve to eat because there are too many starving people in the world.At some point, this can become a delusion. For example, someone who thinks he has a heart condition may actually start feeling chest pains.Depression impedes a person's concentration and saps one's energy and appetite. It can even alter some sensory perceptions. Depressed people have been known to give up sweets because they taste like ash, Dr. Malavi said.While depression robs one of energy, it also causes insomnia. Dr. Malavi notes that people with chemically caused depression tend to wake up late in their sleep periods, while people whose depression is more situation-related have trouble falling asleep right after going to bed.The two forms of depression also vary in what he calls the diurnal variations of mood. Clinically depressed people feel worse in the mornings than in the evenings, while people whose depression is situational will tend to be all right in the morning but worse in the evening, after a day spent dwelling on problems.Because these symptoms are so varied, depression can overlap into other mental illnesses, such as phobias, panic disorders or obsessive-compulsive disorders (OCDs), Dr. Malavi noted. A depressed person may be afraid to leave home because he believes he smells bad, a behaviour that also occurs in OCD.But these classic symptoms do not always show up in children, making it harder to diagnose a depression, he said."More often than not, you get children with behavioural problems or learning difficulties, but the underlying problem could be a depression."At the heart of the chemical problems that make up clinical depression is a communications breakdown at the centre of the brain.The limbic system, located in the mid-brain, deals with basic emotions, Dr. Malavi explained. Nerve cells, known as neurons, transmit messages to each other through specialized chemicals, known as neurotransmitters. Neurons have "receptors" to receive those messages.Research has shown the brains of depression patients do not produce enough of one such neurotransmitter, serotonin. As a result, some of the messages don't get through.Hence the success of medications, such as Prozac, known as selective serotonin reuptake inhibitors (SSRIs). Put simply, what they do is prevent neurons' receptors from ditching the serotonin they do receive.Medical science is still sketchy about how all this works, Dr. Malavi said. He prefers the term "clinical observations" rather than "causes."What doctors observe is that the brains of depressed people have serotonin deficiencies, SSRIs increase the amount of available serotonin and the people get better."More than that, we don't know," he said.Research is ongoing, with psychiatrists battling the illness both with behaviour therapy, counselling patients on how to handle their feelings, and medication, trying to rewire the faulty mechanisms of the mind."The majority of people (in the profession) believe one would not exclude the other," Dr. Malavi said. "It's a combination of approaches that helps the person rather than one or the other."But the key is coming forward and seeking help. Many people can get their depressions treated by their family doctors, he said.In the case of the people soldiering on at the former Friendship Centre, that combination of approaches includes a pat on the back from fellow sufferers.That's what helps Marcel after he sinks into tears for the second time during his long, rambling narrative of pain.As his story draws to an end, the group learns that Marcel is now on a very specific mission. It turns out "Marcel" is not his name at all. He was adopted, and is now searching for his biological family.For the moment, the people at this table are the best family he has known.
