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Depression Most Prevalent Mental Disorder in America

By Karyn Lu

This article is the first in a series regarding depression and mental health issues. It presents a general description of depression and its symptoms; future articles will discuss topics such as mental health and support services at MIT.

Clinical depression is far more menacing than just the passing “blues” that everyone experiences at some time or another in their lives. Depression is not a sign of personal weakness, and people suffering from depression cannot simply “pull themselves together.”

In actuality, depression is the most common serious brain disease in the U.S. today. Major (also called unipolar) depression, a physical illness whose principal manifestations are psychological, involves frequent episodes of intense hopelessness and lowered self-esteem. It can effect an individual's mood, body, behavior, and mind; when left untreated, depression may eventually lead to suicide.

Major depression is recognized as the most prevalent type of mood disorder today. It is estimated that 17 percent of the U.S. population (between 5-12 percent of men and 10-20 percent of women) will suffer from a major depressive episode at least once in their lifetime.

According to the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) of the American Psychiatric Association, the most widely accepted guide for classifying psychiatric and psychological disorders today, a major depressive episode is diagnosed by the presence of at least five of these nine symptoms during the same two-week period:

1. Depressed mood

2. Reduced interest in almost all

activities

3. Unintended significant weight gain or weight loss

4. Insomnia, or sleeping too much

5. Increased or decreased motor activity

6. Fatigue or loss of energy

7. Feelings of worthlessness or guilt

8. Reduced ability to concentrate or think

9. Recurrent thoughts of death

Depression has many causes

Many factors can contribute to major depression. Depression is often triggered by traumatic life events, such as the death of a loved one, divorce, financial problems, or some other significant loss. An episode of depression may be an appropriate response to some of these crises. Such depression, however, is usually time-limited.

Depression is also more likely to co-occur with certain medical illnesses (including stroke, heart disease, cancer, and diabetes), psychiatric disorders (such as anxiety and eating disorders), and substance abuse disorders. In addition, some medications may actually cause clinical depression.

Although it can occur in people who have no family history of depression, those who do have a history can inherit a biological vulnerability for depression. Rates of depression are also especially high among persons suffering from post-traumatic stress disorder.

A person’s psychological makeup plays a vital role in determining susceptibility to depression. People who tend to be pessimistic, have low self-esteem, worry too much, or feel they have little control over life events are at a higher risk for developing depression. Very often, though, it is a combination of biological, cognitive, genetic, psychological, and environmental factors that triggers the onset of a depressive episode.

Gender differences in the prevalence of depression is surprisingly large. In North America, women are 1.7 to 3.0 times more likely than men to experience depression during their lifetime, and one in every four women is likely to experience severe depression.

The causes of depression in women are not primarily biological (as was once believed), but are of a variety of biological, social, and psychological origins. For example, infertility, miscarriages, and surgical menopause can all cause depressive symptoms in women. Mothers of young children tend to be very vulnerable to depression; in fact, the more children a woman has, the more likely it is that she will be depressed.

Abuse is another key factor in triggering depression: in the U.S., at least 37 percent of women have been sexually or physically abused by the age of 21 (some experts believe the rate is actually closer to 50 percent).

The poor and members of minority groups are also extremely vulnerable to depression: women (along with children) make up 75 percent of the population living in poverty in the U.S.

Poor or minority women also often lack access to basic mental health care. Finally, women are more likely to become depressed if their personality styles tend to be passive, dependent, pessimistic, or negative in attitude. Furthermore, their tendency to brood and dwell on their depression, a process called rumination, contributes to the perpetuation of their depressive episodes.

Many treatment options available

Depending on the severity of the case, depression can be very often be successfully treated with a variety of antidepressant medications, psychotherapies, or some combination of both. Appropriate treatment can help over 80 percent of those who suffer from depression. In a combination treatment, the antidepressant medication is often employed for direct symptom relief, while psychotherapy is employed to teach the individual how to deal with life’s problems more effectively.

It is important to note that for many people, depression can be successfully treated on an outpatient basis. On rare occasions, however, particularly for those individuals whose depression is life-threatening or who cannot take antidepressant medication, Electroconvulsive Therapy may be useful.

Drug therapy can be useful, sometimes even necessary, for treating people suffering from depression. Three groups of antidepressants are used to treat depressive illnesses: trycyclics, monoamine oxidase inhibitors (MAOIs), and lithium.

Depression often makes a person feel overwhelmingly exhausted, helpless, and worthless. The most important thing a person suffering from depression can do for himself is to seek and adhere to treatment. It is important to realize that the negative thinking one experiences during depression typically does not accurately reflect one’s situation. Postponing important decisions, and participating in social activities may help improve one’s mood. Mild exercise is also recommended. For women, the successful integration of multiple roles (such as mother, worker, volunteer) has been proven to alleviate depression.

In order to help someone who is depressed, the most important thing anyone can do is to help him seek appropriate diagnosis and treatment. This may involve encouraging the individual to seek help, accompanying the individual to the doctor, and making sure that he stays with treatment until symptoms begin to abate. It is important to offer emotional support and to encourage the individual to engage in conversation or social activities. Keep reassuring the individual that in time and with treatment, he will feel better.