Thomas said that when he is depressed, darkness rules. “It is like I’ve slipped into a dark, dark bubble. I can’t feel. I can’t care. All enjoyment of life is gone. I find myself disappearing into an unknown place, a place without love, feeling, laughter.

“I feel guilty but I don’t know what for. I can’t sleep. I can’t remember simple little things. I try to solve the situation with alcohol, but it only makes it worse.” Thomas has made several suicide attempts in the past, although he feels they were “half-hearted.”

His condition has cost him many jobs. It has cost him his family.

Thomas suffers from clinical depression. He asked that his real name not be used. He has suffered periodic episodes of depression since he was 12 years old. For years, Thomas felt that he was suffering alone, that he was going crazy. And then he sought the advice of a physican and learned he had a serious medical illness.

Thomas is being treated for this condition and says, “I feel a part of my own life again. There is hope that I can be happy and at peace.”

Clinical depression affects more than 11 million people in the United States each year. It is much, much more than just feeling “blue.”

It is a serious medical illness that causes changes in a person’s mood, behavior and feelings. If not treated, the episodes of depression can last nine months to a year and will probably recur throughout a person’s lifetime.

“Depression can be disabling. It can be dangerous. It is a pretty complex illness. It is like a normal reaction to life situations that has sort of gone haywire,” said Dr. Robert S. Croswell, medical director of pyschiatry at Mid-Maine Medical Center in Waterville.

In simple terms, clinical depression results from complex interactions among brain chemicals and hormones that influence a person’s energy level, feelings, sleeping and eating habits. Medical research has discovered that people who suffer from clinical depression have changes in important brain chemicals, such as serotonin and norepinephrine.

But Croswell said there are new medications available that restore these brain chemicals to their proper balance and relieve the symptoms.

Clinical depression, said Croswell, has a fairly specific set of symptoms. They include, but are not restricted to: a “blue” or unhappy feeling that persists for more than two weeks; a diminished interest or pleasure in familiar or favorite activities; a significant change in appetite or weight; sleep disturbances.

“Patients often say they feel like they are walking through cement,” said Croswell. “Or the opposite feeling is true. They can’t sit still. They have difficulty concentrating. They seem very preoccupied with thoughts of death, with thoughts of life coming to an end.”

There is a world of difference between clinical depression and what is commonly called “the blues.” Croswell said “the blues” are a normal reaction to a life situation, such as a death, divorce or other loss. It is a temporary mood and rarely produces suicidal thoughts. “The blues,” said Croswell, “requires a good listener and time to heal.”

Clinical depression, however, is an illness that overtakes one for no apparent reason. It has multiple symptoms and persists for more than several weeks. There is a potential of suicide. Clinical depression requires specific medical and pschiatric treatment.

“Without treatment,” said Croswell, “depression can last six months to two years. With treatment, you can feel better within a month.”

The causes of depression are complex and interesting, he said. Life experiences, genetics, personality factors and other medical illnesses may all play a contributing role.

“There are theories that some people may have a genetic value that is touched off by life experiences or illness,” he said. The average number of episodes in a lifetime are seven, but can be more. There are a number of risk factors which affect depression. They include prior episodes of depression, a family history, being female and the post-partum state.

Croswell said that twice as many women than men suffer from clinical depression. He said it was particularly interesting that “three times as many women as men experience depression, while three times as many men as women go to jail.” He said the link between feelings and actions is an interesting one to study. “We will see, in the same dysfunctional family, that the women will experience depression. The men will exhibit anti-social behavior and alcoholism.”

Croswell said 25 percent of women and 10 percent of men will suffer one or more episodes of clinical depression during their lifetimes. Age does not seem to be a factor — it strikes all ages — but most often people are in the prime of their lives, ages 24 to 44, when they are diagnosed as clinically depressed. High school- and college-age populations suffer high rates of depression. Senior citizens, often isolated, also frequently suffer from clinical depression.

Croswell said recovery from depression involves proper treatment, support and education. The most important steps to a person’s recovery are to see a doctor and stick to a treatment plan of medication and therapy. Participation in a patient-support group is also very helpful during the recovery process, as well as educating oneself about clinical depression and its treatments.

Philip Monaco, a social worker at Mid-Maine Medical Center, oversees the psychiatric recovery program. Monaco said it is important for the victims of depression to know “you do get better. Depression is an illness, and it is treatable.”

“Just 15 years ago, if someone was stricken, we had a very limiting and intrusive treatment as well as moral judgments attributed to mental illness,” he said. “Today, there is a tremendous range, a menu of options. You can be treated at home, during the day, after work. Years ago, you went to the hospital and sometimes were there for months.”

Monaco said today’s “miracle” medications, such as Prozac, can replace six months in a hospital. Although he recognizes that Prozac has been controversial, he said it was because physicians, and patients, believed it to be a “cure-all.”

Just like other medications, he stressed, Prozac can be an absolute miracle for some and not for others. “These medications, however, are major technological advances,” Monaco said. “These are really quite profound.”

When someone is suffering from clinical depression, said Croswell, they need to talk to someone — someone who will suggest they get help and use honesty in assessing their situation. “Surround them with love and kindness, but still express your concern. There is a vast wealth of resources for those suffering depression.”