Some firefighters have noticed that another member hasn't been acting like himself for a couple of weeks. When they asked him if anything was wrong, the firefighter replied, “Oh, nothing.” This firefighter may be suffering from depression and not even know it — and it may be affecting his ability to do his job.

Emergency service exposes firefighters and EMTs to depression. The very nature of the job can easily lead to depression, without even considering that emergency services personnel are people too and can fall victim to depression in their everyday experiences as well. Fire chiefs, officers and EMS leaders need to understand depression, its signs and symptoms, its effects on the job, and what to do when a person under their command exhibits those signs.

Many Americans suffer from depression. According to the National Foundation for Depressive Illness Inc., 35 to 40 million Americans living today will suffer from a major depressive illness during their lives. In fact, Dr. William C. Shiel Jr., medical editor for MedicineNet.com, has called depression, “the common cold of mental illness.” And for each person directly suffering, three or four of their relatives, employees, associates and friends also will be adversely affected.

Research shows that depression results from biochemical imbalances in the brain. It's a physical illness that affects behavior. It's imperative to know that depression can be treated successfully. According to the NFDI, more than 80% of those suffering from a depressive illness can be treated with non — habit-forming medications and counseling.

There isn't just one way a person can fall victim to depression. According to allaboutdepression.com, the causes of clinical depression are likely to be different for different people. Depression can appear to come out of nowhere when everything seems to be going fine. Other times, depression may be directly related to a significant event, such as losing a loved one, experiencing trauma or battling a chronic illness.

Untreated depression can be fatal. MedicineNet.com states that one in 10 cases of depression is fatal, resulting in suicide. But that isn't the only effect that should concern department leaders. “In terms of human suffering, the consequences of untreated depression are beyond measure,” according to the NFDI. “They include loss of self-esteem, ‘self-medication’ with alcohol and drugs, family and career disruption, and chronic disability.”

Depression affects not only emotion, but economics as well. The NFDI estimates that the cost of depression ranges from $15- to $35 billion a year and encompasses the loss of time and productivity, personnel replacement, medical care, and loss of life. These costs are shared not only by the affected individuals, but their families, friends, employers, colleagues and the community-at-large.

Before I continue with showing how a victim of depression can effect the department they work or volunteer in, I must make myself very clear. I'm not trying to instill a fear of the person who is depressed, or to suggest ostracizing that person. On the contrary, I hope to promote an understanding and an awareness of the silent illness of depression.

So how can a person who is a victim of depression affect the department in which he or she works or volunteers? Janet Savia, a doctoral student in clinical psychology at Regent University who is trained in CISM and married to a volunteer firefighter for 28 years, said: “Depressed individuals may move and think more slowly and have trouble making quick and quality decisions. As those in emergency services well know, this can be devastating at a fire or accident scene. Clinical depression can significantly increase the risk of on- and off-duty accidents. Depression can also result in mistakes that may leave a department open to criticism or legal liability.”

This statement has many implications. Fire and EMS work is dangerous enough when a person is mentally alert and in top condition. It's essential that emergency services leaders become more aware of the signs and symptoms of depression and know what to do to help so a possible tragedy can be avoided.

Let's look at the signs and symptoms of clinical depression. The Diagnostic and Statistical Manual of Mental Disorders, fourth edition, commonly referred to as the DSM-IV, provides the official list of necessary signs and symptoms of clinical depression:

• Changes in sleep patterns, either a problem sleeping or sleeping much more than usual.
• Changes in appetite, shown by a significant loss or gain of weight.
• Changes in energy level, typically lower, but not always.
• Loss of interest in hobbies and things once enjoyed.
• Increase in mistakes or inability to make decisions when this hasn't been a prior problem.
• Comments implying thoughts of suicide or unreasonable guilt.

“Clinical depression affects all aspects of a person's life,” according to allaboutdepression.com. “It impairs our ability to sleep, eat, work, and get along with others. It damages our self-esteem and our ability to accomplish everyday tasks. People who are depressed find daily tasks to be a significant struggle. They tire easily, yet cannot get a good night's sleep. They have no motivation and lose interest in activities that were once enjoyable. Depression puts a dark, gloomy cloud over how we see ourselves, the world and our future. This cloud can't be willed away, nor can we ignore it and have it magically disappear.” This statement also may help one to recognize depression.

Some of these signs and symptoms could be readily recognized in the workplace, while others would be difficult to observe. A chief officer of a paid department would have an advantage over a chief officer of a volunteer or combination department because of more routine contact with firefighters and EMTs. Chief officers of volunteer and combination departments should make an extra effort to observe changes in behavior because of the serious nature of clinical depression.

Once these signs and symptoms are observed, Savia suggests that “paid and volunteer chiefs can identify mental health professionals (counselors, social workers, marriage and family therapists, or psychologists) in their community (or nearby if a small or rural department) who have participated in CISM training. CISM is not what is needed with a depressed firefighter or EMT. However, the mental health professional needs to know something about the unique work environments of emergency services personnel. If a mental professional has taken the time and spent the money to receive CISM training, they have shown and interest in the emergency services.

“It would be a good idea for the chief to have a short list (no less than two) of CISM- trained mental health professionals within driving distance of the service area. The firefighter or EMT of concern can then be given specific names and telephone numbers of available and knowledgeable mental health professionals. There is no guarantee the firefighter or EMT will follow through, but few departments have even tried to provide this level of support for their firefighters and EMTs.”

If this type of mental health professional is unavailable in your area, it is important to get the depressed person to a competent mental health professional for appropriate diagnosis and treatment. It is also imperative to offer that person emotional support. This support involves patience and understanding.

“I started missing days from work, and a friend noticed that something wasn't right,” recalled one person's account of her depression on allaboutdepression.com. “She talked to me about the time she had been really depressed and had gotten help from her doctor. I called my doctor and talked about how I was feeling. Now, I'm seeing the psychiatrist once a month and taking medicine for depression. I'm also seeing someone else for ‘talk’ therapy, which helps me learn ways to deal with this illness in my everyday life. Everything didn't get better overnight, but I find myself more able to enjoy life and my children.” This is not an unusual case. It reinforces the fact that clinical depression is a very treatable disease.

In the interest of firefighter and EMT health and safety, I urge you to be more aware of the signs and symptoms of depression. Have a plan in place. Serve those who serve and do all that you can to encourage anyone who exhibits these signs and symptoms to seek professional help.

If you wish to learn more about depression, please go to the Web sites mentioned or contact The National Foundation for Depressive Illness Inc., P.O. Box 2257, New York, N.Y. 10116; 800-239-1265.

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Chief Mike Chiaramonte is a 35-year member of the Lynbrook (N.Y.) Fire Department and a past chief of the department. He's currently the chief fire inspector, where he's responsible for code enforcement and prevention education. Chiaramonte was a past chairman and board member of the IAFC Volunteer and Combination Officers Section Board and New York State Director to the IAFC Eastern Division. He's also a National Fire Academy Instructor and an adviser to the National Fallen Firefighters Foundation. Chiaramonte is a state EMT-CC and an instructor at the Nassau County EMS Academy. He has a bachelor's degree from the University of Houston and a master's degree from Hofstra University, both in communications education.