Depression

Exceptional Parent, The, July, 2008 by Robert Cancro

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War is traumatic, not only in terms of physical injuries but psychological ones as well. The veterans presently returning from Iraq and Afghanistan have experienced hand-to-hand combat, blast injuries, traumatic brain injury, etc. In addition, they have experienced severe stress, loss of comrades, family separation and breakup, loneliness, etc. It is not a surprise that we face a near epidemic of depressive disorders with our returning troops. Hopefully, a better understanding on our part can be of help in their recovery. We owe them no less!

The following was written as a primer article on depression. Subsequent articles will provide details about depression specific to the experience of military servicemembers.

Depression--An Under-Recognized Health Crisis

Mental illnesses are an under-recognized public health crisis. They are the last of the medical illnesses, hidden because of the unrelenting stigma associated with them. People frequently are ashamed to admit the presence of a mental illness and tend to deny its existence in themselves and/or their family members. This is particularly unfortunate because of the tendency of mental illnesses to run in families. This tendency is most true for the more severe forms of mental illness, which have a significant genetic component.

Depression and Genetics

Concerning the genetic component, it is important to realize that it is frequently misunderstood that genes have an inevitable outcome in an almost Calvinistic sense. People believe that if you have the gene you must have the consequence of that gene. Though this is usually true for simple traits such as hair color, it is not true for complex traits such as mental illnesses. The genes represent a potential or a tendency. They are necessary but not sufficient to produce an illness in most cases. A common example is Type II diabetes. If the individual gains weight, they may develop the illness, but if they remain slender, they may well go through life without ever knowing that they have the tendency.

The cumulative and acute stressors of living act as the precipitating events for most mental disorders. Obviously, there are certain periods of life in which the individual is at increased vulnerability. Yet, it must be emphasized that having the potential is not the same as becoming sick.

This article will focus on the mental illness of depression. Depression is a genetically loaded disorder that runs in families but does not necessarily affect every member. Again, while genes play a role in predisposing an individual to depression, they do not preclude either successful treatment or avoidance of illness.

Symptoms and Associations

Depression is a disease that must be distinguished from unhappiness or an appropriate response to a loss or injury. Sadness in the face of unhappy events is not an illness. Depression, furthermore, is not just a disease of mood. It is characterized by a loss of energy, by fatigue, social withdrawal, confusion, cognitive dulling, a loss of ability to enjoy the activities that normally please the individual, and changes in sleep, libido, and appetite. Much more than mood is involved.

Depression is the leading cause of disability/sick days in the United States workforce and soon will be the second leading cause in the world. About half of the individuals who are challenged with depression have a recurrent form of the illness. While depression is more frequent in women, it is an equal opportunity disease, striking all socioeconomic classes, races, and age groups. It appears to be on the increase in frequency, but this may reflect greater public awareness of depression as an illness and not just as a condition of life that must be borne. Furthermore, family doctors and pediatricians are more alert to depression than they were in the past, so we cannot say if it is more frequent or simply better recognized. On the other hand, the stresses of contemporary life are such that it would not be a surprise if depression were actually on the increase.

Depression, unfortunately, is frequently associated with suicide. Suicide is on the increase in the United States, and this supports the hypothesis that depressive illnesses are on the increase. Presently, suicide is the eighth-leading cause of death in the United States and is the second leading cause of death in the college-age population.

The criterion of an official psychiatric diagnosis is a major depressive episode. The diagnosis requires that several symptoms must be present during the same two-week period and represent a change from a previous level of functioning. Depressed mood, most of the day and practically every day, is the leading subjective criterion. But the official diagnostic system recognizes that loss of interest or loss of pleasure in activities that are normally pleasurable to the individual is an extremely important criterion as well. Classical depressions are associated with weight loss and loss of appetite. We do, nevertheless, see certain depressions that are associated with increased appetite and weight gain. Insomnia, particularly waking up early in the morning, is the classical finding in depression, but again, there are cases where the person overeats and/or oversleeps. Fatigue or loss of energy is an extremely important finding. Impaired ability to think clearly, to concentrate, and to make decisions are very important diagnostic findings in this syndrome.