Physician Focus: Understanding depression
Commonly misunderstood, somewhat mysterious, and often stigmatizing, depression is a widespread chronic medical illness. According to the National Association of Mental Illness, 25 million Americans experience an episode of major depression annually. The illness also has a sizable impact on patients and health care: it is a leading cause of disability for those 15-44 years of age, and costs the nation upwards of $80 billion in lost productivity and medical care every year.
Depression doesn’t discriminate. It affects all ages and all racial, ethnic, social, and economic groups. It reaches anywhere from 2 to 5 percent of children and adolescents. The condition strikes women at twice the rate of men, a gap experts attribute to a combination of biological, genetic, psychological, and social factors. It touches more than 6.5 million seniors 65 and older, and while it becomes more common as people get older, it is not a normal part of aging as some believe. Veterans diagnosed with the illness account for 14 percent of total cases, with younger veterans most at risk. In the workplace, depression ranks as the third most prevalent problem for employee assistance professionals, topped only by family crises and stress.
Given its reach and the burdens it imposes, we should recognize depression as a serious medical illness that can be extremely debilitating and even life threatening.
Depression is characterized as a prolonged period of feeling extremely sad and irritable, severely limiting a person’s ability to enjoy the things one normally enjoys. The illness makes it hard to function in one’s normal role, be it at home, at work, in school, or in other venues. Depressed patients will experience pronounced changes in sleep, appetite, and energy; difficulty concentrating and making decisions; and feelings of guilt and hopelessness. Thoughts of suicide may also be present.
Contributing to depression are the experiences of major losses, such as the death of a loved one or the loss of a job or home. Genetic and environmental factors, along with a family history of the condition, can also raise a person’s predisposition to the condition, and other chronic medical conditions, like heart disease, diabetes, chronic pain, cancer or other life-threatening illnesses, can increase the risk of depression for patients as well.
The effects of depression may include physical problems, such as alcohol or drug abuse, deterioration of eating and sleeping habits, and nonspecific aches and pains like stomach aches or headaches. Relationships between spouses, parents and children, other family members and friends, may also be disrupted. Clearly, depression is not just having a bad day, but rather an illness that can be described as "taking the life out of life," sometimes literally. In the worst cases, suicide - a major risk of untreated depression - may result, and studies have shown that more than 15 percent of depressed people take their own lives.
The good news is that depression is very treatable, and recognizing the signs of the illness is the first step to treatment. Various therapies are available, including counseling and medication, and in some cases, advanced treatments such as electro convulsive therapy may be appropriate. Seeking treatment is very important, because depression need not be a lifelong condition.
And here’s more good news: there are preventive steps to take to boost mental health. It is important to be proactive about your mental health, and you can be guided by the idea that what’s good for your body is good for your mind. Having a healthy body helps to decrease your anxiety level and your risk of depression. A healthy diet and especially physical activity can have huge benefits.
For families with someone who may have depression, it is vitally important to have an understanding of this illness and how it can be treated. For more information, visit the National Institute of Mental Health at www.nami.org. For a video discussion, visit www.physicianfocus.org/depression.
Marie Hobart, M.D. is a psychiatrist and chief medical officer of Community Healthlink in Worcester, part of UMass Memorial Health Care that provides psychiatric, mental health, and substance abuse services for families and individual patients. Physician Focus is a public service of the Massachusetts Medical Society. Readers should use their own judgment when seeking medical care and consult with their physician for treatment. Send comments to PhysicianFocus@mms.org.
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