The Who, What and Why of Depressive Disorders Part 1

“Depression can seem worse than terminal cancer, because most cancer patients feel loved and they have hope and self-esteem.”

– David Burns

Have you ever wondered why some people are always sad or grumpy? What makes certain people see the glass as half full while others find the negative in every situation?

What is Depression? If I Get Sad Does That Mean I Have Depression?

Emotions are important to alert us when something may not be right. For instance, if we are being mistreated or in a relationship that is not functioning optimally, our mind wants us to know that something is off. This allows us to try to improve the situation or escape it before more damage occurs. Sometimes these emotions become excessive and extreme. When this happens it can negatively impact our friendships, family life, work, and school functions and may mean that we have a depressive disorder. Depressive disorders cause persistent sad, empty, withdrawn or irritable moods. These feelings are often accompanied by decreased motivation, increased physical complaints, and changes in sleep, appetite, and cognitive function.

 

Children don’t always have the same signs of depression as adults. Clues that they may be suffering from depression include changes in personality and deviations from their normal behavior. This may manifest as refusal to go to school, dropping grades, substance use or engagement in illegal or culturally inappropriate activities.

 

The elderly have a very high rate of depression, with some estimates of up to 50%. Depression in this age group often goes unrecognized as people attribute personality changes to old age. Not infrequently, older individuals are misdiagnosed with dementia, when in fact they are depressed. It is important to differentiate these two conditions because they have very different treatments.

 

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Demographics

Depression is quite common. In fact, about 17% of people will suffer from a depressive disorder in their lifetime. Almost all countries and cultures have a 2:1 female to male ratio. This is attributed to hormonal differences, childbirth and rearing responsibilities and behavioral models of learned helplessness. The exception to the 2:1 ratio is Jews. For unknown reasons, Jewish men have twice the rate of depression as the general population and a 1:1 ratio compared with Jewish women.(1)

 

The average age of onset is 40 years, but it is increasingly being diagnosed in children and adolescents. Proposed explanations for this trend include higher rates of substance use and the rise of social media engagement with resultant cyber bullying and a decrease in genuine friendships. It is more common in people who lack close relationships and are unmarried. Positive prognostic factors include strong friendships, stable families and lack of substance abuse. Depression spans all socioeconomic statuses, but is more common in rural areas than urban ones.

 

Does it Ever Get Better?

Untreated depression is likely to improve within 8 months, but sometimes takes up to 18. When treated, depression generally resolves within 3 months. After a first episode, 60% of people will have a second episode and there is a 20% chance of it becoming a chronic disorder. Men are more likely to develop chronic depression. In chronic depression there is usually at least a couple of years between episodes and each episode tends to last longer and be more severe than the previous one.  These numbers are lower for people who continue taking antidepressants even after their symptoms have resolved. Not all depressive disorders are the same. Some forms are less severe, but more chronic. Other types only occur during specific seasons or events such as childbirth or menstruation. The important thing to remember is that these disorders are common, and with the right treatment, the episodes can be substantially shortened.

 

What are your thoughts? How does this information compare to your own experience or that of someone you know? Please post comments and questions below. Stay tuned for the next post which will explore the causes of depression.

 

(1) Study showing Jewish males are at increased risk of depression

 

Ariel Mintz, MD
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Ariel Mintz, MD

Founder and President at Refuat Hanefesh
Dr. Ariel Mintz grew up in Minneapolis, Minnesota. After spending two years learning in Israel, at Derech Eitz Chaim and Shaalivim, he earned his BA in Psychology at Yeshiva Univesity in New York. He went on to obtain his MD at Oakland University William Beaumont School of medicine. He is currently a licensed physician working to complete his training in General Psychiatry at Hennepin County Medical Center in Minneapolis. After that, he hopes to subspecialize in Child and Adolescent Psychiatry. He has a supportive and talented wife and two wonderful children. He is very passionate about destigmatizing mental illness in the Jewish community and bringing comfort to those who are suffering. Ariel can be reached at [email protected]
Ariel Mintz, MD
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