Some types of depression
run in families, suggesting that a biological vulnerability can be inherited.
This seems to be the case with bipolar disorder. Studies of families in which
members of each generation develop bipolar disorder found that those with the
illness have a somewhat different genetic makeup than those who do not get ill.
However, the reverse is not true: Not everybody with the genetic makeup that
causes vulnerability to bipolar disorder will have the illness. Apparently
additional factors, possibly stresses at home, work, or school, are involved in
its onset.
In some families, major
depression also seems to occur generation after generation. However, it can also
occur in people who have no family history of depression. Whether inherited or
not, major depressive disorder is often associated with changes in brain
structures or brain function.
People who have low
self-esteem, who consistently view themselves and the world with pessimism or
who are readily overwhelmed by stress, are prone to depression. Whether this
represents a psychological predisposition or an early form of the illness is not
clear.
In recent years,
researchers have shown that physical changes in the body can be accompanied by
mental changes as well. Medical illnesses such as stroke, a heart attack,
cancer, Parkinson's disease, and hormonal disorders can cause depressive
illness, making the sick person apathetic and unwilling to care for his or her
physical needs, thus prolonging the recovery period. Also, a serious loss,
difficult relationship, financial problem, or any stressful (unwelcome or even
desired) change in life patterns can trigger a depressive episode. Very often, a
combination of genetic, psychological, and environmental factors is involved in
the onset of a depressive disorder. Later episodes of illness typically are
precipitated by only mild stresses, or none at all.
Depression in Women
Women experience
depression about twice as often as men.1
Many hormonal factors may contribute to the increased rate of depression in
women-particularly such factors as menstrual cycle changes, pregnancy,
miscarriage, postpartum period, pre-menopause, and menopause. Many women also
face additional stresses such as responsibilities both at work and home, single
parenthood, and caring for children and for aging parents.
A recent NIMH study showed
that in the case of severe premenstrual syndrome (PMS), women with a preexisting
vulnerability to PMS experienced relief from mood and physical symptoms when
their sex hormones were suppressed. Shortly after the hormones were
re-introduced, they again developed symptoms of PMS. Women without a history of
PMS reported no effects of the hormonal manipulation.6,7
Many women are also
particularly vulnerable after the birth of a baby. The hormonal and physical
changes, as well as the added responsibility of a new life, can be factors that
lead to postpartum depression in some women. While transient "blues" are common
in new mothers, a full-blown depressive episode is not a normal occurrence and
requires active intervention. Treatment by a sympathetic physician and the
family's emotional support for the new mother are prime considerations in aiding
her to recover her physical and mental well-being and her ability to care for
and enjoy the infant.
Depression in Men
Although men are less
likely to suffer from depression than women, three to four million men in the
United States are affected by the illness. Men are less likely to admit to
depression, and doctors are less likely to suspect it. The rate of suicide in
men is four times that of women, though more women attempt it. In fact, after
age 70, the rate of men's suicide rises, reaching a peak after age 85.
Depression can also affect
the physical health in men differently from women. A new study shows that,
although depression is associated with an increased risk of coronary heart
disease in both men and women, only men suffer a high death rate.2
Men's depression is often
masked by alcohol or drugs, or by the socially acceptable habit of working
excessively long hours. Depression typically shows up in men not as feeling
hopeless and helpless, but as being irritable, angry, and discouraged; hence,
depression may be difficult to recognize as such in men. Even if a man realizes
that he is depressed, he may be less willing than a woman to seek help.
Encouragement and support from concerned family members can make a difference.
In the workplace, employee assistance professionals or worksite mental health
programs can be of assistance in helping men understand and accept depression as
a real illness that needs treatment.
Depression in the
Elderly
Some people have the
mistaken idea that it is normal for the elderly to feel depressed. On the
contrary, most older people feel satisfied with their lives. Sometimes, though,
when depression develops, it may be dismissed as a normal part of aging.
Depression in the elderly, undiagnosed and untreated, causes needless suffering
for the family and for the individual who could otherwise live a fruitful life.
When he or she does go to the doctor, the symptoms described are usually
physical, for the older person is often reluctant to discuss feelings of
hopelessness, sadness, loss of interest in normally pleasurable activities, or
extremely prolonged grief after a loss.
Recognizing how depressive
symptoms in older people are often missed, many health care professionals are
learning to identify and treat the underlying depression. They recognize that
some symptoms may be side effects of medication the older person is taking for a
physical problem, or they may be caused by a co-occurring illness. If a
diagnosis of depression is made, treatment with medication and/or psychotherapy
will help the depressed person return to a happier, more fulfilling life. Recent
research suggests that brief psychotherapy (talk therapies that help a person in
day-to-day relationships or in learning to counter the distorted negative
thinking that commonly accompanies depression) is effective in reducing symptoms
in short-term depression in older persons who are medically ill. Psychotherapy
is also useful in older patients who cannot or will not take medication.
Efficacy studies show that late-life depression can be treated with
psychotherapy.4
Improved recognition and
treatment of depression in late life will make those years more enjoyable and
fulfilling for the depressed elderly person, the family, and caretakers.
Depression in Children
Only in the past two
decades has depression in children been taken very seriously. The depressed
child may pretend to be sick, refuse to go to school, cling to a parent, or
worry that the parent may die. Older children may sulk, get into trouble at
school, be negative, grouchy, and feel misunderstood. Because normal behaviors
vary from one childhood stage to another, it can be difficult to tell whether a
child is just going through a temporary "phase" or is suffering from depression.
Sometimes the parents become worried about how the child's behavior has changed,
or a teacher mentions that "your child doesn't seem to be himself." In such a
case, if a visit to the child's pediatrician rules out physical symptoms, the
doctor will probably suggest that the child be evaluated, preferably by a
psychiatrist who specializes in the treatment of children. If treatment is
needed, the doctor may suggest that another therapist, usually a social worker
or a psychologist, provide therapy while the psychiatrist will oversee
medication if it is needed. Parents should not be afraid to ask questions: What
are the therapist's qualifications? What kind of therapy will the child have?
Will the family as a whole participate in therapy? Will my child's therapy
include an antidepressant? If so, what might the side effects be?
The National Institute of
Mental Health (NIMH) has identified the use of medications for depression in
children as an important area for research. The NIMH-supported Research Units on
Pediatric Psychopharmacology (RUPPs) form a network of seven research sites
where clinical studies on the effects of medications for mental disorders can be
conducted in children and adolescents. Among the medications being studied are
antidepressants, some of which have been found to be effective in treating
children with depression, if properly monitored by the child's physician.8
Next:
DIAGNOSTIC
EVALUATION AND TREATMENT
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