My friend sat across from me in the car. Her face was a frozen mask of anguish. "If I ever feel like that again," she said, "I think I'll kill myself." And in fact, that last time she almost had. Letters had been written to her children; the place and time determined. My friend is smart, attractive, and financially secure. She looks terrific in a mini-skirt. But she is tormented by depression.

Winston Churchill called depression his "black dog." Journalist Tracy Thompson called it "the beast." Therapists identify those seriously depressed by a characteristic look called an "omega face."

Depression (or MDD--major depressive disorder in clinical parlance) sabotages work and relationships. It paralyzes the sufferer with guilt, despair, and feelings of worthlessness. It can make life unspeakably difficult. For the estimated fifteen percent of depressed people who commit suicide, life literally became unlivable.

"I understand why depressed people kill themselves. They need the rest," writes Parker Palmer (in Let Your Life Speak), a well-known educator and speaker who has endured his own depressions.

. . . and counting. The cost of an epidemic

Not all depression is as severe as my friend's, but it is always more than a "blue mood." It's not something you snap out of. It's not something you take a walk or go to bed early to cure. And it is staggeringly common. The World Health Organization has recently named depression the fourth leading cause of "lost years of healthy life," ahead of all those Third World diseases that kill with such blithe efficiency. It is the first time a psychiatric malady has made the list.

Michael Norlen was an attorney in the rough-and-tumble world of criminal law. But for years he also walked along the fine edge of depression. In the late 1980s he lost his law practice during a bad patch. But he went on antidepressants and managed to pull things back together. He even rebuilt his practice. He might have a few bad days now and then when he would avoid the office and hang out in a library or coffee shop, using avoidance as escape, but there were more good days than bad--until the winter of 1998.

Even those of us who are basically happy are at risk for depression. One in five of us will become depressed sometime in our lives. More than 17 million American adults are depressed right now. The disorder doesn't discriminate between race and class, but it is blatantly sexist, targeting women twice as often as men. (We told you we were stressed.) And first episodes increasingly affect younger adults between the ages of 25 and 44.

Numbers like these have profound economic reverberations. Depressed workers are less productive (by about twenty percent according to one research team). They are absent more (by up to four extra days per month according to a study by Eli Lilly, the pharmaceutical company, and reported in the July 1999 issue of the Journal of Occupational and Environmental Medicine). Depression can also have a demoralizing effect on fellow workers, who may find it hard to accommodate their colleague's mood.

The total cost of depression, which includes the cost of treatment as well as absenteeism and low productivity, was conservatively estimated in a highly regarded 1993 study to be about $44 billion per year. No one seems to have revisited the numbers since.

The cost of absenteeism and lower productivity alone amounts to $3000 per year per depressed employee. "When these data are shown to employers, they take notice," said Reginald Williams, Ph.D. and associate professor of nursing at the University of Michigan, whose research has focused on depression.

Indeed, employers pay either way--in absenteeism and lower productivity or in the cost of treatment. Some companies, such as Bank One, Motorola, and Black and Decker, that have experimented with providing services like mental health care coverage and onsite counseling, say that their overall health care costs for "physical" ailments have declined, that productivity is better, and that absenteeism has decreased.

"I tell employers that their depressed employees are a good investment," said Dr. Richard O'Connor, psychiatrist and author of Undoing Depression: What therapy doesn't teach you and medication can't give you, "because people who are prone to depression typically have high standards and are dutiful and loyal. If you aren't like that, you don't get depressed."

In February 1998 Michael Norlen lost two cases. ("I don't think it was the depression, they were just doggy cases.") He began to slip. He stopped going into the office. Mail languished in unopened piles; unreturned voicemails grew indignant. He slept 16 hours a day. "Sleep was my only solace. I was tired constantly." In early autumn he closed his practice. In October he took a night job delivering newspapers to gas stations and vending machines. Rather than being a humiliation, it was a finger in the dike.

The physiology of depression

The brain is not an organ to be trifled with. It consists of about 10 billion neurons, give or take a few, all firing impulses at 1/5000th of a second and governing our every thought, emotion, and movement. There are more possible connections in our brains than there are atoms on the earth.

There are also hundreds of chemical substances that leap the tiny synapses (gaps) between those billions of neurons to pass along their electric impulses. An imbalance in three of those chemicals, called neurotransmitters, is linked to depression.

Although the brain is highly plastic--fluid and changeable in its biochemistry--once the chemical pattern of depression is imprinted on its neurons, that pattern is likely to recur. This is called a "kindling" effect. "Depression is like an assault to the brain," said Williams. About 50 percent of those who have had one depressive episode will have another.

"Depression is like a threshold," said O'Connor. "Once you step over it, you can't get back without really taking yourself in hand and working very hard at some of the things depression has magnified."

Antidepressants play a critical role in the treatment of depression, but they don't cure it. "Meds can keep you from sinking into the deepest depths. They can help you sleep better and give you more energy," says Connor, "but medication doesn't really work on the self-defeating habits that got you into trouble."

Delivering newspapers engaged Michael Norlen's body without distressing his mind. (Physical exercise helps relieve depression.) It gave him a reason to get out of bed. There were the other "night dwellers" to converse with. And it was a safe space for introspection. "Driving around at three in the morning I was able to put some pieces together that might make the rest of my life happier," he said.

For one thing, Norlen saw how the practice of criminal law had done violence to his character. "Criminal and plaintiff litigation required me to be very confrontational. That wasn't my personality and never has been."

And he identified ways in which he had allowed himself to be pushed around. "I grew up in an alcoholic home, so that was probably part of it--wanting to please everybody. But that buried anger and resentment might have contributed to the depression. In therapy I joke that I need to learn to be an SOB sometimes."

Depression through another window

The big question, of course, is why? Why are more people becoming depressed and at younger ages? Why are Zoloft, Paxil, and Prozac among the six top-selling prescription drugs, ahead of penicillin and insulin? Are we trying to be better than well? Has a marketing juggernaut by drug companies engendered its own epidemic? Has a competitive, lonely, fragmented culture created a people with "a hole in their souls," as one medical doctor described the most common illness he sees?

"We now have, as average Americans, doubled real income and double what money buys," writes David Myers in The American Paradox: Spiritual Hunger in an Age of Plenty. "And we have less happiness, more depression, more fragile relationships, less communal commitment . . . and more demoralized children." Depression, then, might be an appropriate response to a toxic culture. "We have lots to be depressed about," said Palmer.

Or maybe we've forgotten Buddhism's first Noble Truth, that life is suffering. That no one has a birthright to long life, health, and well being. Maybe we've become so insulated from unnecessary pain, such as starvation and disease, that the suffering that remains, psychic or physical, is much harder to bear.

But in the end, no one really knows. Like any suffering, depression has an element of paradox. It has the potential to cleanse as well as kill, to instruct as well as destroy. Having endured depression's very caustic cleansing, some emerge with a deep awareness of who they are--and aren't. It demands a brutal honesty and self-awareness that most of us have the luxury of ignoring.

"It's a mystery," said Palmer. "Try to understand what it's trying to tell you about who you are and try to embrace that knowledge."

Vigilance is also part of the work of depression. It takes consistent effort to avoid what O'Connor calls the "habits of depression" --the irrational thinking and self-defeating coping mechanisms that those struggling with depression repeatedly stumble over.

In therapeutic circles, the work of cultivating rational thought patterns is called cognitive therapy, but it has its counterpart in several religious traditions as well. (". . . whatever is true, whatever is honorable, whatever is just, whatever is pure, whatever is lovely, whatever is gracious, if there is any excellence and if there is anything worthy of praise, think about those things." Philippians 4:8)

Michael Norlen now works for a search firm, writing resumes and helping people find jobs. He keeps a journal and monitors his thoughts and emotions to short-circuit the most irrational and damaging. And he has this to say to those who struggle with depression: "It's not a character flaw; it's an illness you can find help for. You are not alone, and it's nothing to be ashamed of. A lot of other people have been through it."

KATE CONVISSOR (happily) writes for Juggle and a handful of other publications from her home office in West Michigan. While she only has maybe one of the four traits of happy people, work on this article has motivated her to think nice thoughts.