Elderly men have a particularly high risk of suicide. Men older than 60 are more likely to take their own lives than any other combination of age and gender. If you have any doubts, check out the possibility of depression with a doctor or mental health professional.
Men don’t do depression, or do they?
Most studies show that men are half as likely as women to report that they get depressed. Men tend to cover up and hide their depression; they feel far more reluctant to talk about what they see as weaknesses and vulnerabilities than women do. Why?
Many men have been taught that admitting to any form of psychological or emotional problem is unmanly. From early childhood experiences, men get to know how to hide such feelings.
Francis looks forward to retirement from his job as a marketing executive. He can’t wait to start travelling and having time for all those hobbies he’s wanted to take up for ages. Three months into retirement, his wife of 20 years asks for a divorce. Shocked, yet showing little emotion, Francis makes light of his situation to friends and family, saying, ‘Oh well! Life goes on.’
But gradually Francis starts drinking more heavily than usual. He becomes interested in extreme sports. He pushes his abilities to the limit in rock climbing, hang-gliding, and skiing in remote areas. Francis distances himself from family and friends. His normally even temperament turns sour. Yet Francis denies the depression, so obvious to those who know him well.
Rather than admit to disturbing feelings, men commonly turn to drugs or alcohol in an attempt to cope. Some depressed men express anger and irritation rather than sadness. Others report the physical signs of depression, such as lack of energy, body aches, changes in sleep and in appetite, but strongly deny feeling depressed. The cost of not expressing feelings and not getting help may account for the four-fold rate of suicide among depressed men compared to women.
Treating depression in old age
Doctors frequently fail to diagnose depression in the elderly. A report in 2007 concluded that the majority of depressed elderly patients who only see their G.P., and not specialist mental health professionals are likely to go undiagnosed and untreated, with negative mental and physical health consequences. Why? Because the signs of depression are often attributed to the process of normal aging. That’s unfortunate, because depression is common – and treatable – in the elderly.
Sometimes antidepressant medications don’t work for older people. However, researchers found that interpersonal therapy (see Chapter 4) significantly decreases depression in patients over 60 who previously failed to respond sufficiently to antidepressant medication. There is increasing support for the idea that dealing with personal issues, such as grief, loss, and transitions, may be particularly useful for people in this age group.
Women and depression
Why are women around twice as likely as men to report depression? Biological factors, including those related to reproduction, may play a role. The rates of depression during pregnancy, after childbirth, and before the menopause are higher than at any other times in women’s lives. Research on women in 2002 found that women who had given birth had a 27 per cent higher rate of depression or anxiety compared to men. For women who had not given birth, 19 per cent were more likely than men to suffer from anxiety and depression.
Cultural and social factors are likely contribute to women’s depression. For example, women are more likely than men to have been sexually or physically abused, and such abuse increases the likelihood of depression. Likewise, risk factors such as low income, stress, and multiple responsibilities like juggling housework, childcare, and a career, occur more frequently in women than men.
Janine gently lays her baby down in the cot. Finally, the little one falls asleep. Exhausted after a tough day at work, Janine desperately longs to go to bed herself. But the washing’s piling up, she’s got to pay those red bills, and the house is a total tip. Six months ago, her husband changed jobs and became a long-distance lorry driver, and life hasn’t been the same since his lengthy absences started. Janine realises her overwhelming fatigue and loss of appetite are quite possibly because she’s starting to suffer from depression.
Depression and diversity
Almost everyone has a different experience of depression. Attempting to generalise about depression based on, for example, ethnicity or a cultural group can lead to misperceptions. But risk factors for depression include discrimination, obesity (see the sidebar ‘Children, depression, and obesity’), social ostracism, poverty, and major losses such as loss of a job or loved one. And unfortunately, many of these risk factors occur more frequently among minority groups. Being different may take the form of race, culture, physical challenge, or sexual orientation.
As well as these risk factors, many groups face particular obstacles when dealing with depression. For example, some ethnic populations still have limited access to mental health care because of language differences, embarrassment, cultural pressures to deny such problems, and economic pressures. However, the UK government is trying to improve access to resources for minority groups.
Depression and miscarriage
The loss of a baby through miscarriage is a devastating event that often causes depression. The rates of depression are reported as high as 22 to 55 per cent in the year following a miscarriage. And new evidence suggests that depression may play a role in bringing about miscarriages. A recent study published in the scientific journal Human Reproduction studied the relationship between depression and miscarriage. A group of women who had previously miscarried were given questionnaires to find out if they had emotional problems. Of the women who then got pregnant, 22 per cent miscarried again. What predicted miscarriage? Depression. So, if you or someone you care about is planning a pregnancy, be sure to get help for any existing depression first.
Getting to the Root of Depression
There are lots of theories about what causes depression. Some experts suggest that depression is caused by imbalances in brain chemistry, while others believe that the chemical imbalances are due to genetics. Others experts are convinced that the cause of depression goes back to childhood. Still others say that depression is a result of negative thinking. There are also those who suggest that depression is caused by impoverished environments and/or cultural experiences. Unwanted patterns of behaviour are also seen as a cause of depression. Finally, some experts have identified relationship problems as the major contributor.
You may well come to the same conclusion as the dodo bird in Alice in Wonderland and declare that ‘All have won and all must have prizes’. In another sense, nobody deserves a prize. Even though you can find evidence to support each of these views, nobody really knows how these different factors work, which is the most important, which ones influence the others, and how they do so.
In spite of the evidence that scientists don’t yet know exactly how the multitude of depression-related factors function and interact, you may come across doctors, psychologists, and psychiatrists who have very strong opinions about what they believe is the definitive cause of depression. If you meet a professional who claims there is one single, definitive cause of depression, question that professional’s credibility. Most sophisticated experts in the field of depression research know that a single, definitive cause of depression remains elusive and is unlikely to ever be discovered, as depression has many causes.
Yet the field of mental health does have both knowledge and ideas about how depression develops. There is strong evidence supporting the theory that education, thinking, biology, genetics, childhood, and the environment all play important roles in the development, maintenance, and potential treatment of depression. All these factors interact in amazing ways.
For example, a growing body of studies shows that medication alters the physical symptoms of depression such as loss of appetite and energy. And antidepressant medication also improves the negative, pessimistic thinking that accompanies most forms of depression. Perhaps that’s not too surprising. (See Cha
pter 15 for more information about medication.)
Similarly, studies show that psychotherapy alone decreases negative, pessimistic thinking (see Chapters 5, 6, and 7), much like medication does. Some medical practitioners are shocked to find studies showing that certain psychotherapies, even if carried out without antidepressant medication, also alter brain chemistry.
Overall, recent studies on the roots of depression fail to support any theory that puts forward one specific cause of depression. Rather, they support the idea that a variety of physical and psychological factors interact with each other.
The brain’s brew
Your brain contains around 100 billion neurons (nerve cells), give or take a few. Busy neurons take in information about the state of the world outside and inside the body. These 100 billion nerve cells don’t touch each other. They send information back and forth by releasing tiny molecules which the next nerve picks up. This communication process involves chemical messengers, called neurotransmitters that move through and between the neurons.
Depressed people do show changes in the balance of brain chemicals. Several theories have been offered to explain the relationship between depression and the chemical messengers. Many researchers believe that neurotransmitters such as norepinephrine, serotonin, and dopamine play important, interactive roles in mood regulation. Furthermore, these neurotransmitters may interact with other brain chemicals in as yet unknown ways.
What researchers do know is that for some people with depression, the chemical ‘soup’ may need a different balance of ‘spices’ or medication. So one person’s brain requires a dash of salt (one medication), and for another, pepper (a different medication) may be necessary to lift the depression. But that doesn’t necessarily mean that the depression was caused by a lack of pepper or salt, that is, a particular chemical! Experts haven’t yet reached agreement on how all this works.
Calculating the Costs of Depression
Depression has always been part of human experience. But some reports suggest the rates are rising (or, at least, the rates of people receiving treatment are rising). No one knows why for sure, but the risk of depression for those born after World War II has mushroomed to the point where the World Health Organization (WHO) estimates that by 2020 depression is going to be the second largest cause of death and disability in the world.
Estimates vary greatly, but today depression appears to occur in 15 to 20 per cent of all people over the course of a lifetime. Furthermore, in any given 12-month period, just under 10 per cent of the population experiences an episode of significant depression. And at this very moment, an estimated 121 million people are suffering from depression throughout the world. That’s an awful lot of people.
Guess what? Estimates of depression can only be rough figures. Because many people with depression don’t seek help, and many of those with depression don’t even realise they’re depressed, reliable statistics are almost impossible to find. Whatever the actual figures are, huge numbers of people suffer from depression at some point in their lives. And depression is associated with all kinds of costs.
Adding up the costs of depression
The WHO has created a statistic called the Global Burden of Disease (GBD), listing the economic cost of various diseases worldwide. Depression is now the fifth largest contributor to the GBD. By the year 2020, the WHO predicts that depression is likely to be the second most costly disease.
The financial cost of depression is staggering. Costs have increased sharply and are now estimated to be more than £9 billion a year in the UK. Of this, the direct cost of treatment is an estimated £370 million. The British Journal of Psychiatry reported that more than 100 million working days were lost every year due to depression, and in the year 2000, 2,615 deaths were recorded as due to depression.
What are the costs in manpower? Depressed people are off work more often and are less productive when at work. Parents of depressed kids may have to miss work to get their children to therapy appointments. The cost of psychological therapy and medication, even if provided by the NHS, is also part of the total. But remember, treating and easing depression reduces absenteeism, increases productivity, and cuts medical costs.
Personal costs of depression
Economic facts and figures don’t begin to describe the human costs of depression. The profound suffering caused by depression affects both the sufferer and the carer. These include:
The anguish of a family suffering from the loss of a loved one to suicide.
The excruciating pain experienced by someone with depression.
The diminished quality of relationships suffered by people with depression and those who care for and about them.
The loss of purpose and sense of worth suffered by those with depression.
The loss of joy.
The composer, Berlioz, wrote about his fits of depression:
The fit fell upon me with appalling force. I suffered agonies and lay groaning on the ground, stretching out abandoned arms, convulsively tearing up handfuls of grass and wide-eyed innocent daisies, struggling against the crushing sense of absence, against a mortal isolation. Yet such an attack is not to be compared with the tortures that I have known since then in ever-increasing measure.
Detailing depression’s physical toll
Depression’s destructive effects go beyond personal and economic costs – depression can damage the body itself. Research provides a constant flow of new information about the intricate relationship between mood and health. Today, we know that depression affects:
Your immune system: Your body has a complex system for warding off infections and diseases. Studies show that depression changes the way the immune system responds to attack. Depression exhausts the immune system and makes people more susceptible to disease.
Your skeletal system: Untreated depression increases your chances of getting osteoporosis, though it’s unclear exactly how depression may lead to this problem.
Your heart: The relationship between depression and cardiovascular disease is powerful. Johns Hopkins University studied healthy doctors and found that among those doctors who developed depression, their risk of heart disease increased two-fold. This risk is comparable to the risk posed by smoking. Likewise for those with heart problems, having depression doubled the chance of having another heart attack.
Your mind: Although depression can mimic dementia in terms of causing poor memory and concentration, depression also increases the risk for dementia. We’re not sure why, but scientists have discovered that an area in the brain thought to govern memory is smaller in those with chronic depression. If left untreated, depression can disrupt and possibly damage connections in your brain and may lead to the degeneration and death of brain cells.
Your experience of pain: Depression contributes to the experience of physical pain. Thus, if you have some type of chronic pain, such as arthritis or back pain, depression may increase the amount of pain you feel. Scientists aren’t entirely sure how depression and pain interact, but the effect may be due to disruption of neurotransmitters (see Chapter 15 for more information about neurotransmitters) involved in pain perception. Many people with depression fail to realise they’re depressed and only complain about a variety of physical symptoms such as pain.
Depression seems to affect everything about the way the whole body functions. For example, altered appetite may lead to obesity, or to under nourishment and serious weight loss. Also, depression is associated with disrupted hormonal levels and various other subtle physiological changes.
Don’t get depressed by all these frightening effects that depression can cause! If you’re depressed, you can feel better – and we spend the rest of this book helping you to do so. Effective treatments for depression are available and new ones are emerging.
Psychotherapy for your heart
If you have heart disease, depression increases your risk of dying from it. How’s that for an opening line? Now, the good news. Psychotherapy can improve your chances o
f survival. A report suggests that 14 hours of psychotherapy cuts re-hospitalisation rates for cardiac patients by 60 per cent. As well, counselling before medical procedures leads to shorter stays in the hospital following surgery. Unfortunately, only about 12 per cent of hospitals treating heart disease offer psychotherapy to their heart patients. We suspect that if a pill came on to the market that reduced re-hospitalisation rates by 60 per cent, there would be pressure for this to be recognised and available on the NHS. But there’s only so much we authors can do: just know that if you have heart disease, don’t ignore the importance of your emotions, and do seek help if you notice you are becoming depressed, in relation to your physical condition, or any other area of your life.
Overcoming Depression For Dummies Page 4