Though most Veterans Administration hospitals have treatment programs in place to help veterans dealing with posttraumatic stress and depression, the waiting lists for these programs can mean months of delay before receiving treatment. Also, recent studies show that many veterans don’t seek treatment until it is too late.
Despite the resistance many veterans may feel about asking for treatment, there are a wide range of options available in most communities. Veterans Administration therapists are even developing telehealth approaches for people in need who are living in remote communities or who may feel uncomfortable about seeing a counselor face-to-face. Check the appendix for contact information or for help finding the right program in your area.
25. Are sexual minorities more vulnerable to depression?
While different sexual minorities, including gays, lesbians, and transsexuals, have become more widely accepted in many places, they still face harassment and discrimination. Considering the stress of living in a society that regards heterosexual behavior as the norm, it’s no wonder that most gays and lesbians prefer to keep their sexuality hidden if at all possible. And it’s also no wonder that mental health problems such as depression can be so common as well.
For adolescents in particular, the kind of homophobic bullying faced by anyone who “seems” gay or lesbian can be devastating, especially for young people trying to come to terms with their own sense of identity. And many schools remain reluctant to do anything about it (though this is slowly changing). While some places have attempted to modernize sex education guidelines to help promote greater acceptance, this is often opposed by religious groups and parents, especially parents who come from cultures that are much more intolerant concerning same-sex relationships.
Along with greater vulnerability to depression, victims of this kind of bullying are prone to a wide variety of problems including substance abuse, academic problems, and even suicide. Cases involving children as young as nine who commit suicide due to homophobic bullying are hardly uncommon, though this rarely leads to significant improvement in how these children are treated.
Studies looking at lesbian, gay, bisexual, and transgender adolescents have found that as many as 31 percent have attempted suicide at least once and that depression and hopelessness can both play a role in suicide risk. The kind of emotional support received by sexual minority youths can also help protect them against depression and suicide. This includes the importance of having a strong emotional support network in place, whether that support comes from parents, siblings, friends, or concerned teachers or counselors. It is the sense of isolation that many sexual minority youths often feel that can be particularly damaging to their self-esteem and ability to cope.
In recent years, a number of new resources have become available for sexual minority youths dealing with depression or other emotional problems. As one example, the “It Gets Better” project was launched in 2010 by activist Dan Savage and his husband as a way of helping teens deal with homophobic bullying or who are considering suicide. Operating from its own website, the project features thousands of contributions from people sharing their own stories of bullying and abuse as well as how their lives have improved since high school.
For sexual minority youth or older adults dealing with depression, there are treatment resources available in most communities. Finding these resources may be difficult for many people reluctant to be open about their sexuality however. The appendix contains some suggestions of online resources that might be helpful in getting a referral to someone in your area.
Consequences of Depression
26. Can depression lead to drug or alcohol abuse?
Though not everyone dealing with depression will develop a drug or alcohol problem, there is no question that they often go together. According to the National Epidemiologic Survey on Alcoholism and Related Conditions, around 40 percent of people with a lifetime history of major depressive disorder (MDD) will develop a problem with alcohol. While the risk of depressed people becoming dependent on illegal drugs is much lower (17 percent), this is still far greater than we might expect from chance alone. For that matter, 30 percent of people with MDD will also become dependent on nicotine.
But why are depression and addiction found together so frequently? Intriguingly enough, some studies suggest that one possible reason for depression being much more common in women than in men is that men are more likely to rely on drugs or alcohol to control their symptoms. In one study looking at over twelve thousand Amish people (who have a cultural ban against drugs and alcohol), men and women were found to develop MDD at the same rate. This strongly suggests that undiagnosed depression may play an important role in substance abuse, at least in men.
Another possible explanation for this apparent link between substance abuse and depression deals with the effect that substance abuse has on the brain itself. For example, most addictive drugs work by producing a dopamine rush in key areas of the brain, including the ventral tegmental area of the midbrain. This leads to a sensation of pleasure and a strong need to seek out more of the drug to continue experiencing this pleasure. As the body adapts to continued use of the drug, users develop a physical dependence (i.e., their systems become dependent on regular dosages to avoid withdrawal symptoms) as well as a psychological dependence in which they come to rely on the drug to help cope with negative symptoms such as stress and depression.
For people who develop depression, drugs and alcohol can seem like an effective way of coping since it allows them to escape their symptoms, at least temporarily. Essentially, they have learned to medicate themselves through the use of various mind-altering substances, even if they are simply exchanging one problem for another.
Self-medication doesn’t apply to depression alone, however. There are a wide variety of physical and psychological conditions that can lead people to experiment with different substances as a way of getting their problems under control. Self-medicators often experiment with different substances, including herbal remedies, over-the-counter medications bought at pharmacies, or drugs purchased illegally until they find something that seems to work. They can often justify self-medicating as a way of escaping from conventional medicine and taking personal control of their health.
Unfortunately, many of the substances they may decide to use are also addictive in their own right, and as a result, users may develop long-term substance abuse problems in addition to their original symptoms. For this reason, self-medication often ends up making their symptoms even worse and leads to even more serious medical problems.
There is considerable overlap between the symptoms of drug withdrawal and the symptoms of depression. For people who are going through withdrawal, depression is often reported during the early stages as their brain’s biochemistry slowly returns to normal. How long this period of depression lasts often depends on what kind of addictive substance they are dealing with and how far back their addiction goes. For example, studies of patients who are withdrawing from alcohol suggests that depression is highest in the first week and drops slowly afterward.
Also, as we have seen, many users get started on drugs or alcohol because it was the only way to handle the depression they were feeling originally. This means that the depression will often persist even after they have successfully gotten “clean” of their addiction, something that may encourage them to start the entire drug/alcohol abuse cycle all over again.
Since the relationship between depression and substance abuse can often be very complicated, it is essential that people dealing with both depression and substance abuse seek medical help as soon as possible. Only a qualified health professional can make a proper diagnosis, especially for those patients dealing with more than one diagnosis. It also demonstrates how dangerous self-medication can be as a way of coping with depression.
We will be looking at different treatment options in later sections as well as exploring the kind of treatment that might be best for people dealing with other mental health
problems in addition to depression.
27. Why are depression and anxiety often seen together?
Though people dealing with depression often develop other mental health issues such as substance abuse, fatigue, and insomnia, they appear especially prone to chronic anxiety. Research studies looking at patients with MDD have found that anywhere from 42 to 72 percent also report anxiety symptoms that are often just as distressing as depression.
According to the DSM-V, there are different types of anxiety disorders that can often co-occur with depression. These include:
Generalized anxiety disorder (GAD). While we all experience day-to-day worries about different problems in our lives, people with GAD are prone to episodes of extreme worry, often without any apparent cause. The persistent anxiety seen in GAD can often be so severe that it becomes almost impossible to hold down a normal life. They are also much more easily startled, have trouble sleeping, and have various physical symptoms including headaches, sweating, and hot flashes.
Panic disorder. People are prone to severe panic attacks, often without warning. Panic attack symptoms can include shortness of breath, shaking, tremors, and a sense that something terrible is about to happen. While episodes can often be controlled with medication, many people who experience panic attacks may find themselves afraid to leave their homes or do regular activities out of fear of having an attack in an unfamiliar setting.
Posttraumatic stress disorder (PTSD). Already discussed elsewhere in this book, PTSD usually results from exposure to severely traumatic events and can result in emotional distress and flashbacks triggered by sensory stimuli that act as reminders of the trauma.
More specific forms of anxiety disorders including separation anxiety (inability to handle being separated from one’s home or attachment figures), different phobias (irrational fear of specific objects or themes), and health anxiety disorder (also known as hypochondria, or the fear of illness).
Though the symptoms for these different disorders can be very different, they are all characterized by overwhelming worry that can often strike in a wide variety of ways. As you might expect, such symptoms can be especially devastating for people already dealing with depression (and vice versa).
In many cases, experiencing chronic anxiety can often cause depression to develop due to the despair people feel over symptoms of anxiety that don’t seem to go away. Chronic depression can often produce chronic anxiety as well due to persistent fears about the future and whether the depression will ever improve.
Whatever the causes or whether the anxiety or the depression begins first, people experiencing both types of symptoms are often much harder to treat than patients developing one disorder alone. While there are different medications that can be used to treat chronic depression and different kinds of anxiety disorders, there is no one medication that can be used to treat both at once. People dealing with both depression and anxiety may often need to try different medications as well as different treatment programs to help them come to terms with their symptoms.
For both chronic anxiety and depression, the key to getting the right kind of help is to be open about your symptoms and to ask for help. These symptoms never go away on their own.
28. How does depression affect families?
The important thing to remember about depression is that it never just affects the person who has it but also the people around them. This includes family members, friends, coworkers, fellow students, or just about anyone that a depressed person interacts with on a regular basis.
Someone dealing with depression is going to be prone to feelings of self-doubt, isolation, and the sense of being worthless and unloved. This is where the emotional support that friends and family can provide can be critical in keeping the depression from getting worse. Though they may not have experienced depression themselves and often have misconceptions about what is happening to a loved one with these symptoms, their very willingness to be there for that person and refusal to give up on them can help with the process of recovery.
Research studies looking at the impact of family support on depression show that supportive family members can help buffer the stresses of life that can often lead to depression. Even though family members can find this frustrating due to feelings of helplessness, simply reminding the person affected that depression is treatable and that they will get better in time may be enough.
But the burden of dealing with a depressed family member is frequently draining, especially for someone with a depressed spouse or a parent with a depressed child. Acting as a full-time caregiver for someone with depression is an enormous challenge. Even when the depression is relatively mild, encouraging depressed people to be more active, to take proper care of themselves, or even to communicate more can be a thankless task. Many depressed people may even resent these efforts or view themselves as being hopeless.
Along with caretaking responsibilities, caregivers may also be required to do many of those activities that depressed people may not have the energy to do themselves. This can include managing finances, taking over work responsibilities (if possible), and interacting with legal and government services on their behalf.
Considering the kind of strain faced by caregivers, it’s hardly surprising that they are especially prone to developing emotional problems themselves, not to mention the physical problems that go along with chronic stress. While friends and family members may try to take over some of this burden, it is extremely easy to burn out because of the pressures as well as develop a sense of hopelessness if the depression fails to improve.
For family members dealing with a depressed person, it is vital that they learn to take care of themselves as well as their loved one. This means making time for themselves by getting out socially and doing the kind of things they enjoy. But they also need to be more open about the frustration that often results from providing this kind of care. Caregivers need to take care of their personal health by making sure to eat and exercise properly and finding outlets for the frequent stress that caregiving can bring.
Though caregivers often end up feeling completely alone, there are resources available in the community that can help, including support groups for people dealing with this kind of stress. Check with local or online mental health care resources for contact numbers.
29. What are the real costs of depression to society?
As we have seen in Question 3, over 10 to 16 million adult Americans and over 3.1 million U.S. adolescents will develop symptoms of depression severe enough to be considered a serious impairment. And these figures don’t take into account those people who are never diagnosed, who are diagnosed with other health problems, or who commit suicide.
The World Health Organization estimates that there are over three hundred million people with severe depression worldwide making it the fourth leading cause of disability overall (and will have risen to the number- two spot by 2020). Though numerous research studies have been carried out to estimate the actual impact of depression to society, this can be extremely difficult considering that many people suffering from severe depression are never diagnosed or receive treatment.
According to one recent U.S. study published in 2015, the total economic burden of MDD alone is approximately $210.5 billion a year (up from $173.2 billion a year in 2005). Along with the actual costs of treatment, this figure also includes the economic costs of time lost from work, reduced productivity, and shortened work careers caused by long-term disability and suicide. According to the report’s authors, depression “is the leading cause of disability for people aged 15–44, resulting in almost 400 million disability days per year, substantially more than more other physical and mental conditions.”
But there are other costs that are harder to determine. As we have already seen, many people who suffer from symptoms of depression may turn to drugs or alcohol to medicate themselves. Considering that substance abuse is a major health problem in its own right, this means that the effects of depression may be more far
-reaching than anyone realizes. For that matter, depression can be linked to other health problems including chronic pain, insomnia, anxiety, adjustment problems, and posttraumatic disorders.
Also, as we have seen in Question 27, many of the economic and health problems linked to depression can also affect family members who need to dedicate themselves to caring for affected loved ones. This can mean lost time from work and reduced productivity due to time lost from work as well as stress-related medical issues. The long-term costs may be even greater considering that caregivers may often be in need of health services themselves due to the impact of chronic stress.
Though the actual costs associated with depression may be impossible to estimate, it’s clear to see that it represents a major drain on health resources around the world. While research has shown that providing better treatment for people with depression can help reduce some of these costs, as well as make life better overall, making these treatment options available worldwide continues to be an enormous challenge.
30. Are people with depression at risk for suicide?
Numerous research studies have consistently shown that well over 90 percent of all people who committed suicide or attempted it were suffering from some form of mental illness (usually untreated). The single most common diagnosis linked to suicide is major depression (occurring in 56 to 87 percent of cases), closely followed by substance abuse (26 to 55 percent), and schizophrenia (6 to 13 percent). Though diagnoses such as anxiety disorder are also common, they are usually seen in conjunction with depression.
Depression Page 8