By Susan Levine
Washington Post Staff Writer
Friday, June 23, 2006

Nearly one in 10 adult Americans deals with depression every year, struggling through a range of often debilitating symptoms, seeking help if they are smart or fortunate, and trying to carry on with life.

Few do so during a run for political office.

"A campaign is an extreme, all-or-nothing intense period, and treatment for depression is an intense period," said psychiatrist Frederick Goodwin, a professor at George Washington University and former director of the National Institute of Mental Health. "If they coincide, that's not good. . . . You can't take sick leave in the middle of a campaign."

In withdrawing from the Maryland gubernatorial race yesterday, Montgomery County Executive Douglas M. Duncan acknowledged that reality. A doctor had diagnosed his depression Monday after hearing him describe such warning signs as a sudden loss of appetite, flagging energy and difficulty sleeping. Two days later, he realized he had only one option.

"It's time for me to focus on my health," Duncan (D) said.

His decision and public disclosure elicited praise from mental health experts and advocates. Far too frequently, they said, people grappling with depression hide their problems, especially if they work in professions where disclosure could put their job or career at risk.

"There is an enormous amount of stress to keep quiet, and you just aren't able to get the same amount of support," said Johns Hopkins University professor Kay Redfield Jamison. As a psychologist who has battled bipolar disorder, she empathizes greatly with Duncan.

"Just having this kind of illness is difficult enough," she said. "It's so incredibly painful and hard to cope with, even though it's treatable."

Although people may understand depression better than they did a decade ago, Goodwin and Jamison said, many misconceptions remain about the illness, which affects more than 20 million American adults.

Depression commonly surfaces first during the late teens to mid-twenties -- influenced at times by such factors as biochemistry or genetics -- but it does not discriminate by age, gender, race or economics. In recent years, people as varied as journalist Mike Wallace, Rep. Patrick J. Kennedy (D-R.I.) and professional basketball star Chamique Holdsclaw have found themselves in its grip.

Clinical depression differs from the sadness that follows a family death or medical crisis in the severity, duration and disabling nature of its symptoms. The symptoms Duncan is dealing with are among an array of emotional changes sufferers experience, including feelings of worthlessness or helplessness, pronounced irritability and difficulty concentrating or making decisions. An individual's mood may not be sad as much as completely flat.

At its most extreme, depression can lead to suicide. Publisher and former diplomat Philip Merrill was apparently suffering from depression when he took his life this month while sailing alone on the Chesapeake Bay.

Duncan's family has battled mental illness in the past; his father and a sister received bipolar disorder diagnoses. How much that history conspired with what had been the most difficult campaign of Duncan's career is unclear. People with depression often set high standards for themselves, and when they fail to meet those standards, "they can be very harsh on themselves," Goodwin said.

"It may be that he began to doubt himself," the psychiatrist said of Duncan. And on the slippery slopes of politics and mental illness, that may have made him more vulnerable.

Other officials have disclosed mental problems with little harm to their careers. Yet there is no certainty. "Once you go public with this kind of thing," Jamison said, "you don't know what the consequences are. Hopefully he'll be struck by the public's kindness and understanding."

Duncan's announcement may ripple far beyond Maryland political circles.

"We should applaud Mr. Duncan for what he's doing," not just in recognizing his symptoms and need for help but in publicly discussing them, said Oscar Morgan, a spokesman for the National Mental Health Association. "It's not only a bold statement for him, but for others."