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.
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, 3 to 4 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.
