And the depression we develop can be very different depending on the kind of life problems we are experiencing and where we are at a particular stage in life. For adults over the age of sixty-five, for example, the symptoms of geriatric depression, as it is known, can often be triggered by a growing sense of loneliness and often be confused with other medical problems such as dementia. While major depression appears to be much less common in seniors than it is in younger individuals (affecting as little as 1 percent according to recent studies), including other mood disorders raises the total number even higher (as much as 4 percent in women and 2.7 percent in men).
While these figures may not seem that alarming, the fact remains that people over the age of sixty-five represent the fastest growing population in the United States alone. In fact, one study suggests that two-thirds of all humans who have ever reached the age of sixty-five throughout history are still alive today. This means that the medical costs of dealing with new cases of geriatric depression may make it the most expensive medical condition to treat by 2025, if current trends continue.
Researchers looking at geriatric depression have also found that symptoms of depression are much more common in people over the age of seventy-five as they become more depressed due to developing other serious health problems.
7. What are some of the most common signs that someone is depressed?
Everyone is going to feel “the blues” at some point in their lives. Feelings of sadness or despondency are certainly common enough after experiencing a major loss or simply as part of the daily hassles we all go through. But, when these symptoms become overwhelming and refuse to go away, then things become more serious.
Even though depression is something that should only be diagnosed by a trained health professional (Dr. Google doesn’t count), here are some common signs that might indicate that a person may be clinically depressed:
Chronic fatigue, often to the point where it is difficult to get out of bed or take care of oneself.
Persistent feelings of personal worthlessness, guilt, or helplessness. While we all experience occasional bouts of self-doubt, people who are depressed may find themselves being overwhelmed by these feelings.
Feelings of pessimism and hopelessness.
Sleep problems, including insomnia; disturbed sleep; or, in cases of severe depression, spending too much time sleeping.
Concentration and memory problems. People who are depressed often find themselves unable to focus and often forget even trivial details.
Loss of interest in activities that were once enjoyable. This can also involve an overall inability to feel pleasure (a condition known as anhedonia).
Feelings of restlessness, whether due to racing thoughts that can’t be controlled or due to a sense of muscular tension that make it difficult to get to sleep at night.
Appetite problems, either eating too much or not eating at all.
Irritability, or having a “short fuse”; this is a common symptom in people with depression.
Persistent sad thoughts, usually linked to the feelings of pessimism and hopelessness already mentioned.
Aches, pains, or headaches that don’t seem to stop. These symptoms may not have a physical cause but can still seem very real to someone experiencing depression.
Not everyone experiencing depression is going to have all these symptoms, but they seem to be the most common ones. Again, however, nobody should try diagnosing themselves. People should seek medical attention immediately if they find these symptoms persisting for longer than a few days.
While there are no laboratory tests that can identify depression, medical doctors still need to conduct a thorough assessment to rule out other conditions that might be causing the symptoms. For example, in many people, conditions such as diabetes, hypothyroidism, and chronic fatigue syndrome can often produce symptoms that mimic depression. This is why doctors need to be cautious in the kind of diagnosis they make.
During the assessment, doctors may also ask questions about lifestyle, daily moods, and recent problems that could be triggering the symptoms as well as check on family history and past mental health problems. Some doctors may also want to try prescribing antidepressant medication, but the decision to take them should never be made lightly. Many antidepressants can have potential side effects, and nobody should take them without first educating themselves about whether or not medication is the best option available.
8. Are there other medical conditions that can mimic depression?
Though symptoms of depression seem unmistakable, there can be other medical issues that produce very similar symptoms. Here are just a few of the medical conditions that can be misdiagnosed as depression:
Hypothyroidism: This condition occurs when the thyroid gland isn’t producing enough thyroid hormones. This can lead to significant health problems as well as symptoms such as fatigue, poor concentration, and a depressed mood. In the United States alone, there are as many as twenty million Americans with thyroid disease, but most of them have no idea of what is happening. Though there are key symptoms that can suggest thyroid problems to a doctor, many people with hypothyroidism may conclude that they are depressed instead. In most cases, a simple blood test can help clear up any misunderstanding, and a pill a day is all they may need.
Diabetes: Yes, people with undiagnosed type 2 diabetes can, and do, develop depression-like symptoms such as weight loss, fatigue, and increased irritability. Undiagnosed diabetes can also mean becoming more vulnerable to diabetes distress due to the often-exaggerated fears linked with diabetic symptoms, including dizziness, vertigo, and frequent hypoglycemic episodes. In many ways, the symptoms of this kind of distress are often hard to distinguish from actual depression, although, as with hypothyroidism, a medical examination and proper blood testing can ensure proper diagnosis and treatment.
Chronic fatigue syndrome (CFS): Also known as myalgic encephalomyelitis, this condition was, until fairly recently, routinely misdiagnosed as depression by medical doctors. Chronic fatigue symptoms can include concentration and sleep problems, extreme fatigue, and muscle pain. Since diagnostic testing for this condition is still limited, it is frequently underdiagnosed even today, and many CFS sufferers can be prescribed antidepressant medications. A similar condition, fibromyalgia, can also resemble depression, at least in the early stages. In fact, people suffering from either CFS or fibromyalgia often develop depression as well and may require treatment with antidepressant medication to help with their symptoms.
Symptoms resembling depression can also be linked to various problems associated with diet. This can include low blood sugar, vitamin deficiencies (particularly vitamin D), and dehydration, to name just a few possibilities. Even the withdrawal effects that can occur for people with different kinds of substance dependence, including caffeine, tobacco, and alcohol dependence, can often mimic depression.
There are also different cognitive disorders that can be misdiagnosed as depression. For example, while attention-deficit hyperactivity disorder (ADHD) is most often diagnosed in children, it can occur in adults as well. Since ADHD can produce symptoms such as insomnia, memory and concentration problems, and mood changes, many people developing these symptoms for the first time may assume they are depressed. For that matter, depression may often be misdiagnosed as dementia in older adults, as the symptoms can be very similar, at least in the early stages.
As I have already pointed out, it is essential that people not try diagnosing themselves when they are feeling depressed. There can be many different possible explanations for depression-like symptoms, and a wrong diagnosis can have serious consequences, in terms of delayed treatment.
9. What is learned helplessness?
Researchers have long recognized that laboratory animals kept caged away from other animals or otherwise enduring painful treatment that they cannot escape became passive and unresponsive. This has come to be known as learned helplessness and, due to the work of psychologists such as Martin Seligma
n, has become widely accepted as a way of understanding clinical depression and other types of mental illness.
According to the learned helplessness theory, people with depression become apathetic and despondent because they do not believe that they can control their own lives. In a sense, they have “given up” in much the same way that laboratory animals give up and become passive. Learned helplessness in people also means developing pathological symptoms such as disturbed sleep, inability to eat, ulcers, and other indicators of extreme stress, all of which are common signs of depression.
In one classic 1974 experiment on learned helplessness, human research subjects were split into three groups: members of the first group were exposed to a loud, unpleasant noise which could be stopped by pressing a button four times. The people in the second group were exposed to the same noise, but the button they were told would stop the noise did not work while there was no noise at all for the third group. In a second part of the experiment, subjects were then exposed to a loud noise in a room with a box that had a lever that could shut off the noise. Even though the lever worked, the subjects from the group who had previously been unable to control the noise made no attempt to push the lever while the subjects from the other conditions learned to turn off the noise very quickly. Essentially, the subjects from the not-in-control condition had learned to be helpless (even though they weren’t).
In writing about learned helplessness and depression, Seligman himself argued that “the label ‘depression’ applies to passive individuals who believe they cannot do anything to relieve their suffering, who become depressed when they lose an important source of nurture … but it also applies to agitated patients who make many active responses, and who become depressed with no obvious external cause.”
Studies looking at victims of domestic violence, childhood abuse, or frequent bullying have also shown that these victims often develop a sense of personal helplessness that make them less able to help themselves. This can result in passive behavior and emotional symptoms such as depression due to the belief that things are hopeless. Not surprisingly, victims often neglect their health and can experience weaker immune systems, slower recovery from injuries or illness, and a greater likelihood of medical problems such as heart disease.
Researchers have also identified parts of the brain that can play a critical role in both learned helplessness and depression. These can include the dorsal and ventral hippocampus, the prefrontal cortex, and other brain regions linked to the body’s ability to cope with stress. Studies of biochemical markers of learned helplessness such as GABA and serotonin have also been invaluable in the development of new pharmaceutical treatments for depression.
While critics suggest that the learned helplessness theory only explains some symptoms of depression (such as apathy, feelings of hopelessness, lack of energy, and sadness), its value in developing more effective treatments for depression has been profound. These include techniques for building up self-esteem and helping people with depression overcome the belief that life is hopeless and can never become better. Cognitive behavioral techniques such as problem-solving therapy and learning to replace negative thinking with more positive ways of thinking have also become widely accepted in treating depression.
Though learned helplessness may only provide a partial answer to why people become depressed, it does highlight how important the need for control can be for those who require treatment. Being willing to take charge of their own lives and seeking help can be an essential part of building a healthier future.
10. How far back in history does depression go?
For as long as humans have been around, depression has likely existed as well. In fact, depression almost certainly existed long before there were any humans at all. As we can see from the section on learned helplessness, laboratory animals often display symptoms that resemble human depression in many ways, and this has been seen in animals living in the wild as well. Emotions such as grief and loss have been observed in all the different primate species and quite a few nonprimate species as well. Though we are in no position to ask these animals directly about their symptoms, animal models of depression have remained an important part of research into developing new and better ways of treating depressive symptoms.
Treatments for the symptoms of depression can be found in traditional medicine systems from around the world. Ancient Greek and Roman doctors frequently wrote about a condition called melancholia and similar essays on treating depression have also been written by doctors in ancient India and China. Even in the Middle Ages, the early Christian church fathers often wrote about a disease called acedia that could strike monks and nuns living isolated lives in desert monasteries (and which was often seen as being caused by laziness instead of depression).
In other cultures, healers often reported on symptoms very similar to what we would call depression in Western countries. In the highlands of Ecuador, for example, natives may develop what locals call pena whenever they experience a terrible loss. The symptoms of pena certainly seem familiar enough, including crying episodes, poor concentration, sleep and appetite problems, stomach and heart pains, and poor hygiene in severe cases. According to tradition, pena is due to a disturbance of the heart caused by being wronged by another person. While it is usually treated with herbal remedies, getting the accused person to make restitution appears to be part of the treatment process as well.
People living in different parts of Latin America can also report a condition known as susto (often called “soul loss”) resulting from the soul leaving the body following a traumatic experience. Symptoms of susto can include insomnia, lethargy, diarrhea, lack of motivation, and nervousness. Largely seen as a spiritual illness, susto is usually treated by a visit from a spiritual healer who uses ritual cleansings and herbal teas to purge the sufferer of these symptoms.
Though healers and shamans have tackled the perennial problem of depression using whatever remedies they had available, they still had very different explanations for why people become depressed. The ancient Greeks blamed melancholia on an overabundance of black bile in the body while Chinese medicine blamed it on diseases of the liver. Avicenna, the Islamic physician whose writings on medicine would spread to Europe and beyond, believed that depression was caused by indigestion.
And, of course, there was always the old standby, demonic possession, which was often invoked to explain away symptoms of mental illness in men and (particularly) women. The fact that cases of mental patients being forced to undergo exorcisms occur even today says a lot about how popular the idea of depression having a supernatural cause can be.
Part of the problem in dealing with depression was that, for long stretches of history (and still today in many places), depression was regarded as being a spiritual and moral condition rather than a problem of the body. People who couldn’t overcome depression on their own were often seen as too weak or too lazy to “get over” what was happening to them. This meant that people dealing with depression also had to cope with the shame of what was happening to them.
While our understanding of the causes of depression is much greater today, we are still dealing with many of the same issues relating to mental illness faced by our ancestors long ago. As we will see when we discuss how depression is viewed by different cultures, making real progress in how depressed people are treated and cared for remains a major challenge.
11. Why do so many people with depression try to hide their symptoms?
Along with the stigma attached to mental illness, there are numerous popular fallacies about depression, some of which have already been covered in the section on misconceptions.
Considering that everyone has episodes in which they feel down or unwanted, many people may not be too concerned when they begin experiencing symptoms of clinical depression. Not only might these symptoms not seem that severe at first but they may subside on their own after a while. It’s only when the symptoms return or persist long enough to have a serious impact on lif
e quality that people may realize that something is seriously wrong.
Even then, unfortunately, people are often afraid of telling friends or family about what they are going through. Along with the fear of being thought of as “crazy,” there is also the sense of guilt that comes from being a burden to others. Whether the depression strikes a close family member, a friend, or a romantic partner, the stress of being a caregiver is going to make life harder and, not surprisingly, will make depressed people more despondent than ever.
There is also the fear of how medical doctors and other health professionals might respond to someone reporting feelings of depression. Along with the stigma surrounding psychiatric treatment, people may actively avoid seeking help due to the fear that it might get them “locked up” if they admit that they were having suicidal thoughts.
Another reason that people might want to conceal their symptoms is the belief that other people just won’t understand what they are going through, something that is often a legitimate concern. Many people who discover that a child, a spouse, another family member, or even a close friend is suffering from depression often have no idea what to do about it. Most of us have only limited experience with mental illness aside from the various misconceptions we may have picked up from movies or television.
This either leads people to overreact and assume that their loved one is at immediate risk for suicide or a nervous breakdown or else to refuse to accept that the depression is a problem at all. Whether they try to cheer up the depressed person in the belief that this will cure their symptoms somehow or else urge them to go on antidepressant medication that might not be suitable for them, many people do not have the necessary facts to offer true help.
Depression Page 4