Josie Miranda used to worry what people would think of her if they knew she took antidepressants. Now, she talks openly and even jokes about her medications-not to make light of depression, a sometimes fatal disease, but to help others around her feel more comfortable. "There's still a lot of shame, embarrassment, stigma" associated with emotional and mental illness, says Miranda, a UC Davis alumna and a seven-year campus employee who has battled depression since she was a teen. And that stigma, according to both depression sufferers like Miranda and mental-health professionals, often keeps people from seeking help. Here on campus, counselors and human-resource specialists say depression is common, especially this time of year. The sometimes-debilitating disease takes a toll on people's lives, often cuts into productivity and can disrupt the workplace. About one-quarter of the 400 to 500 people seeking help each year from the employee-assistance program describe themselves as depressed. How many actually have serious or clinical depression is unclear. "Often what people commonly refer to as depression is grief over a loss," says Sally Harvey, director of the campus Academic and Staff Assistance Program. However, "If somebody tells you they're depressed, you're going to start there." At the same time, Harvey says other people seek help for other reasons, such as problems on the job or at home, not recognizing that they are depressed. An overwhelmed feeling "When you're suffering from depression, everything feels hopeless," Harvey says. "You feel like there are weights dragging you down. Just getting yourself up and dressed can be a big job. Just making a choice about what to wear can be overwhelming." According to the National Institute of Mental Health, more than 19 million Americans-nearly one in 10-will suffer from depression this year. Depression is the second most common mental illness after anxiety disorders. However, only about one in three people with depression is likely to get help. "Depression is a very treatable disorder," says Carol Kirshnit, clinical director of the Academic and Staff Assistance Program. "But a lot of people walk around without seeking treatment for depression because they perceive it as representing a weakness of character rather than a real illness." Academic and Staff Assistance Program counselors typically see their caseload rise in the winter with a number of people suffering from the "holiday blues," as well as from seasonal affective disorder-a form of depression triggered by shorter periods of light in the winter. The program's five mental-health professionals offer short-term counseling and make referrals for people needing medication and longer-term treatment. The service is free and confidential. According to the American Psychiatric Association, treatment is effective in 80 percent to 90 percent of cases. Ricardo Freeman, a senior employee and labor relations consultant for the campus Human Resources and Risk Management Office, says managers, uncertain what to do when an employee's behavior suddenly changes, sometimes err by doing nothing. "If they're seeing behavioral changes-their performance, their attendance, their appearance-they need to be involved, sit down and ask them questions," Freeman says. "If you're in a spiral, a dark tunnel, to have people ask you [about it] is very helpful." Supervisors don't need to solve employees' problems but can refer them to other resources where they can get help. Handling it on their own At the same time, many employees try to handle stresses in their lives alone, when they could talk to their supervisors about taking time off or finding help, Freeman says. "Employees really need to help their managers understand what is going on," he says. In the darkest depths of her depression, Miranda found the simplest tasks overwhelming. She had trouble sleeping. Her weight dropped to less than 100 pounds. She lost enjoyment in her work and withdrew from her friends and co-workers. "It doesn't matter what's going on around you," she says. "It's gray no matter where you are, 24 hours a day. It affects your thinking pattern, how you perceive yourself. When you throw in sleeplessness, loss of appetite-those kind of things that drain you-it can be extremely debilitating." Depression first struck her when she was finishing high school. The ensuing years were marked by periods of despair, trips to hospital emergency rooms, brief stays in psychiatric wards and recurring thoughts of suicide. Once, she tried cutting her wrists with a razor blade. After starting counseling and antidepressants, she would begin feeling better. But thinking she was cured, she would stop taking her medication, only to cycle back into depression. During her last bout of depression about 2 1/2 years ago, Miranda, a program coordinator at the Women's Resources and Research Center, used up her sick leave and vacation time while she got help from a psychiatrist and tried to find the right combination of antidepressant drugs. Since then, Miranda says she has come to look at her illness much like diabetes-something she would have to manage the rest of her life. Depression runs on both sides of her family, she says. She approached Dateline about this story, she says, as part of coming to grips with her illness and in hopes of helping others. The campus has no estimates for lost productivity due to depression. However, the costs are real, according to counselors and human-resources specialists here. $43 billion cost to nation Nationwide, estimated costs in missed days of work, medical expenses and premature death from depression are $43 billion annually. Employees with depression may appear to be absent-minded, says Kirshnit of the Academic and Staff Assistance Program. "They can't do much of the work," she says. "Depressed people typically have trouble concentrating and remembering things. They make mistakes. It can create a lot of disruption in the workplace, including increased simple absenteeism and use of sick time, and other people carrying more of the workload." Supervisors and co-workers need to be aware of the symptoms and, if appropriate, recommend that the worker seek help, Kirshnit says. Depression and other mental and emotional illness are covered under the federal Americans with Disabilities Act, which requires employers to make "reasonable accommodations" for disabled workers. Of 449 campus employees who disclosed disabling conditions in 1998-99, 62 cited mental and emotional problems-four of those for depression, says Kathie McLean, a campus vocational rehabilitation counselor. The total does not include people who may be struggling with depression in addition to other disabling conditions, McLean says. Many cases are handled less formally between employees and their supervisors, McLean says. "A lot of times it doesn't rise to the level of the ADA." But many other employees struggle in silence, worrying about the stigma, she says. Miranda says she was fortunate to get the treatment she needed and the support of friends and co-workers. "This disease is impossible to control by yourself. If you don't reach out for help it will in the end claim your life, literally. "People who are depressed, dealing with clinical depression, need to know they're not alone, that they're not the only one," she says. "Those of us who are affected by mental illness shouldn't have to be ashamed," she says. "As long as the illness is managed, we can have wonderful lives, great jobs." Dateline UC Davis is the faculty and staff newspaper for the University of California, Davis.