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Depression
Diagnosis and Therapy
Causes of Depression
BY DISCOVERYHEALTH.COM WRITERS
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.
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.
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.
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.
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.
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