But while symptoms of depression can manifest on their own, people suffering from other illnesses, including Parkinson’s disease, stroke, multiple sclerosis, and chronic pain, can also become depressed, often to the point of making these conditions far worse than they need to be. Also, older adults who are depressed often develop symptoms that are similar to Alzheimer’s disease, at least in the very early stages. This can make early diagnosis very difficult in many cases and may also lead to older patients being afraid to see their doctors about their symptoms.
As we can see, depression can take a variety of different forms depending on how the symptoms reveal themselves. Whatever form these symptoms take, it is essential to see a professional as soon as possible to ensure that the right diagnosis is made and the appropriate treatment is begun.
2. Are there different types of depression?
Some of the confusion that comes from talking about depression is that there are a number of different diagnoses that can be applied depending on the kind of symptoms someone is experiencing, how severe those symptoms are, and the pattern those symptoms follow.
Though these conditions may seem similar in many ways, it is important to leave it up to a qualified mental health professional to make the diagnosis rather than trying to diagnose ourselves or someone we know based on what we might have looked up online. An incorrect diagnosis can mean significant delays in getting the right kind of treatment and lead to unnecessary suffering.
Among the different diagnoses that can be made for someone reporting symptoms of depression is whether the symptoms are related to true depression or due to bipolar disorder. While we all experience mood swings as we go from highs to lows, these changes in mood tend not to be that severe. With people experiencing bipolar disorder, however, their symptoms often swing from feeling extremely depressed to feeling manic (i.e., superenergized or on top of the world).
Though most manic highs tend not to be that severe (and they are often referred to as hypomanic episodes), people in manic states can often make grandiose plans for the future, talk a mile a minute, and experience an inability to sleep because they are so excited about what is happening to them. They may also be prone to impaired judgment resulting in risky behavior or unwise financial decisions. These manic highs rarely last long though, and as soon as they run their course, the depressive phase sets in.
Since people rarely go to their doctors when they are having a manic episode (and why would they when they feel great?), they are usually only diagnosed after getting in trouble with the law or when family members force them to get help. The depressive phase, however, can often be impossible to distinguish from true depression. As a result, proper treatment can often be delayed, which is why a correct diagnosis is so important, especially in the early stages.
Even when depression is properly diagnosed, there are still different diagnoses that can be given depending on how long the depression lasts and how severe the symptoms are. For people with depression, the most common symptom is major depressive disorder. To receive this diagnosis, someone needs to be experiencing episodes of depression that last for two weeks or more, and depending on how disruptive it is to normal life, it can be classified as severe, moderate, or mild.
There are also different subtypes of major depressive disorder depending on the symptoms and who gets them. For example, postpartum depression is often experienced by women who have recently given birth. Postpartum depression affects an estimated 10 to 15 percent of new mothers and can last for months in many cases, often subsiding thereafter only to recur with a new pregnancy. Another well-known form of depression is seasonal affective disorder (SAD), which seems to be linked to the time of the year when the symptoms develop. People typically develop SAD during autumn or winter, though their mood often improves in springtime. Research suggests that SAD may be due to the reduced sunlight during winter months. We will be talking more about postpartum depression and SAD later in the book.
For people with milder symptoms who don’t quite meet the DSM criteria for major depression, there is another diagnosis that can be given: dysthymic disorder, or persistent depressive disorder. While not as severe as major depressive disorder, dysthymic disorder can still be serious, with symptoms lasting for years before finally being recognized. These depressive symptoms can also cycle with periods of hypomanic moods (a condition referred to as cyclothymic disorder) or else lead to more severe depressive episodes (also known as double depression).
Whatever symptoms may develop, it is essential that sufferers seek medical help immediately to ensure that they receive the right treatment as soon as possible. Contrary to popular belief, depression doesn’t just go away on its own.
3. What is the difference between being depressed and being unhappy?
Everyone experiences unhappiness at some point or the other in their lives and, as a result, people may think that they know what people with depression are going through. But anyone who has experienced both has no problem recognizing how different unhappiness and depression really are.
For people who are unhappy because of some problem or a recent setback or even when grieving the death of a loved one, it is still possible to find comfort in friends and family to ease the pain. In fact, there are a number of ways to cope with unhappiness, whether through the sympathy of people in our lives or simply by telling ourselves that “this too shall pass.” And, sooner or later, the unhappiness does pass.
But for people suffering from depression, there are no easy fixes. Even though family and friends may offer emotional support, these symptoms don’t disappear the way that unhappiness does. Because of what some researchers have termed the prison of depression, experiencing these symptoms often means feeling isolated from the rest of the world because other people simply can’t understand what is happening. This sense of isolation makes depressed people feel as if an invisible wall is preventing them from experiencing any kind of relief.
And this wall often seems impossible to overcome. Not only do people who are depressed have difficulty describing what they are feeling to others but it can also prevent them from getting the help they need. Along with the sadness are a bevy of other emotions that also seem overwhelming: guilt, shame, and apathy, to name just a few—guilt, because depressed individuals can see how worried friends and family members are about them; shame, because they aren’t able to handle life as well as everybody else (that other people have similar pains rarely makes a difference); and apathy, because of the belief that nothing they say or do can possibly change things for the better.
It’s certainly possible for unhappiness to become depression if it goes on long enough or if the people experiencing it don’t get the emotional support they need. For that matter, what we call unhappiness can vary widely across different cultures due to the kind of emotions that might be regarded as acceptable. This means that unhappiness may be regarded as more acceptable than depression since there is still a strong stigma against many mental disorders, which can often lead to individuals trying to keep their unhappiness hidden—something that can have major consequences for them in terms of their mental and physical health.
As we can see, while people can become unhappy for a variety of reasons, depression is much more severe and long lasting. For individuals who are particularly vulnerable to developing depression, whether due to problems in early childhood, heredity, or because of their life circumstances, unhappiness can certainly become depression if it goes on for longer than a few weeks. This is why anyone who is coping with feelings of unhappiness that don’t seem to go away needs to talk to a qualified health professional as soon as possible. We will be getting into the different ways people can seek out help in the next section.
4. How widespread is depression?
As we can see from the previous question, depression can take many different forms, which makes it hard to estimate how common it really is. Still, recent statistics presented by the National Institute of Mental Health (NIMH) show that an
estimated 16.2 million adults in the United States alone have had at least one major depressive episode in their lives. This represents about 6.78 percent of all adults aged eighteen or older. Of these, 10.3 million Americans will develop symptoms severe enough to be considered a serious impairment (4.3 percent of all adults).
Research looking at U.S. adolescents aged twelve to seventeen suggests that an estimated 3.1 million (12.8 percent) have had at least one major depressive episode. For females, in particular, the prevalence of major depression is even higher (19.4 percent compared to 6.4 percent for males). Of those adolescents with full-blown depression, 2.2 million of them will develop symptoms severe enough to leave them seriously impaired. This works out to 9 percent of the total population between the ages of twelve and seventeen.
Though these statistics apply to major depressive disorder alone, factoring in the prevalence rates for other mood disorders pushes the total number of people developing depressive symptoms even higher. When looking at bipolar disorder, for example, recent statistics by the NIMH indicate that 4.4 percent of all adults over the age of eighteen will experience bipolar disorder at some point in their lives. Of these, 2.8 percent had experienced at least one bipolar episode in the past year alone.
In many ways, however, these numbers are just the tip of the iceberg. Not only does major depression often go undiagnosed but many people may also develop severe symptoms that do not fit any particular diagnosis. According to the World Health Organization, there are more than three hundred million people around the world who suffer from depression, making it the leading cause of disability worldwide. In the United States alone, organizations such as the Depression and Bipolar Support Alliance estimate that depression affects twenty-three million Americans each year. That makes it the most common brain disease in the United States and one of the major contributors to long-term disability.
Despite there being effective treatments for depression, less than half of all sufferers of depression will receive any form of treatment. In the United States alone, 37 percent of adults with depression fail to get any form of treatment while only 44 percent received the full range of recommended treatment (with both psychotherapy and medication). An additional 6 percent only received medication with no additional treatment.
When looking at adolescents alone, these numbers seem even bleaker. According to U.S. statistics, 60 percent of depression sufferers between the ages of twelve and seventeen fail to get any form of treatment. Of those who do get treatment, only 19 percent receive both psychotherapy and medication. For the rest, almost all receive counseling alone, with only 2 percent receiving some form of medication.
In many developing nations that lack mental health resources, over 90 percent of people suffering from some form of depression will not receive any treatment. Though global health agencies are calling for more resources to help people suffering from depression and other mental health problems, the lack of trained health professionals and the stigma that surrounds mental illness in many countries still pose significant barriers for people in need.
And many mental health professionals suggest that cases of depression will continue to increase in future as more people come to accept that the symptoms they are experiencing may be a sign that they need professional help, which makes it more important than ever for people suffering from depression to reach out in any way they can to find the right treatment for themselves.
5. Who is most likely to develop depression?
While depression is something that can strike anyone at any time, researchers have identified different factors that may increase the risk of developing depression. Some of these factors will be explored in more detail later in the book; they include:
Gender: In general, the risk of women developing major depression at some point in their lifetimes is around 20 percent compared to 10 percent for men. At this point, it isn’t clear whether this can be due to biological differences or due to the fact that men are less likely than women to report emotional problems. Also, women tend to be more sensitive than men to the emotional pain resulting from relationship problems and are also more likely to seek treatment early when depressive symptoms develop.
Age: Again, while depression can strike at any age, it appears most likely to affect people between the ages of 25 and 45 (with 32.5 being the average age). While late-life depression in people over the age of sixty-five also remains common, they are also less likely to seek treatment until their symptoms become much more severe. There can also be more difficulty in diagnosing depression in older adults since the symptoms may be confused with other medical conditions such as Alzheimer’s disease, at least in the early stages.
Family history: People with a family history of depression seem much more vulnerable to developing depression themselves. For someone with an identical twin suffering from depression, the likelihood of developing it as well is about 50 percent. For people who have a parent or sibling with depression, the risk of developing depression appears to be around 25 percent. It still isn’t clear whether this is exclusively due to genetics or from growing up in a household with a depressed family member. Interestingly enough, even people who have an adopted family member with depression have an increased risk of developing the same symptoms themselves.
Marital status: Though there are prominent exceptions, married people in general are less likely to develop depression than people who are either single or divorced. Also, the likelihood of depression rises sharply following divorce or the death of a spouse, often due to the grief that follows.
Socioeconomic status: Not surprisingly, people who are unemployed, have an uncertain job situation, or are dealing with financial problems are prone to depression. There also appears to be a link between depression and education, with people who are well educated being less likely to develop depression over time. Again, however, there are prominent exceptions, and the likelihood of depression often depends on how well people are able to cope with the financial and social problems in their lives.
Ethnic background: For reasons that are still not clear, people from different ethnic backgrounds often vary in terms of whether they will develop depression at some point. This is often linked to differences in family support as well as the greater stigma concerning mental illness in some cultures. This stigma may make people from some ethnic groups less likely to admit to having emotional problems such as depression. As a result, the depression goes untreated and may become life threatening.
Chronic health problems: People who suffer from chronic pain or other persistent medical conditions that affect the overall quality of their life often develop symptoms of depression that can make their recovery even harder. The relationship between pain and depression often leads to a vicious cycle, which can make coping much more difficult. Many people with chronic pain also develop problems with poor self-esteem and become pessimistic about their ability to move on with their lives.
Being a victim: Whether it involves childhood physical or sexual abuse, being a target of bullying, or being a victim of violence, people who have been victimized are especially vulnerable to developing serious depression. This is usually linked to learned helplessness (i.e., losing confidence in our ability to take control of our life). We will explore this further later in the book.
As we can see, there are many different risk factors for depression. Even when these risk factors aren’t causing the depression (such as with chronic pain), they can certainly make the depressive symptoms much worse. This is why treatment can be so important, both in terms of treating the depression itself as well as helping sufferers cope with the additional life problems.
6. How does depression change across the life span?
As people grow and mature over the years, the problems they face at each stage of life will change as well. In adolescents, for example, this means coming to terms with puberty and learning how to develop intimate relationships. As they grow older and become young adults, however, new problems will arise in
cluding the need to start careers, enter long-term romantic relationships, and take on new adult roles. As time passes, new responsibilities lead to new challenges, and it can also lead to problems with depression depending on how successfully these challenges are met.
While people can develop problems with depression at any age, the symptoms of depression that you experience will often change depending on the unique problems that you tend to face at these different stages of life.
Research looking at depression across the life span suggests that people may become more vulnerable at different stages in their life. Many of these studies have focused on factors that can lead to depression. These factors include loneliness, life satisfaction, and psychological well-being, and longitudinal studies reveal an interesting pattern, reflecting how we change and grow over time.
In one 2013 study looking at reported loneliness in over sixteen thousand adults ranging in age from eighteen to over one hundred, reported loneliness tended to peak around the age of thirty and decrease slowly until it started rising again when people were in their sixties and seventies. This basically means that loneliness (and depression) can occur at any age, though the reasons are often very different, depending on the particular stage in life. It also means that the methods we use to cope with loneliness and depression as adolescents or young adults aren’t necessarily going to work as well when we are middle-aged or older.
Depression Page 3