by Melvin J. Stern, M.D., P.A., FAPA
Even though the National
Comorbidity Survey estimates that 17 percent of the population will experience a
major depression during their lifetimes, depression continues to be
underdiagnosed. This may be because depression takes many forms and has equally
many causes. Biochemistry, genetics, stress, personality patterns, and negative
attitudes all have been implicated as causal agents. The onset of depressive
episodes can begin at any time, including childhood. Prevalence is unaffected by
race, culture, or socioeconomic status. Some patients will have one episode.
More than half will experience recurrences. Twenty percent of patients will be
depressed for a year or more. Some patient's symptoms may disappear without
therapeutic intervention, symptoms usually disappear within three
SYMPTOMS of DEPRESSION
Depressive symptoms have a broad range. The most common symptoms are feelings
of hopelessness, despondency, gloom, or sadness. These feelings tend to be the
strongest in the morning and improve somewhat in the evening. Patients may
neglect their grooming and frequently express the thought that "they just don't
care." Patients often lose interest in things that had been important to them,
including their family, sex, food, hobbies, their job, and so forth.
In mild cases, patients can still perform tasks, but only with great difficulty.
They have difficulty concentrating, completing or putting thoughts together.
They often have problems making decisions. They may ruminate or worry
excessively. Severely depressed patients may lose their ability to perform any
task. The difficulty in performing tasks is often accompanied by extreme fatigue
or feeling run-down, drained, or overworked.
Many patients report that
they have repeated thoughts of inadequacy, low self-esteem, and failure. They
view the world pessimistically with little hope for the future, and often have
repeated thoughts of death or suicide. Most depressed patients think about
suicide and about one percent commit suicide during the first year of illness.
Recurrent episodes increase the likelihood of suicide to 10 to 15
Sleep patterns may become disrupted. About 80 percent of
depressed individulas have problems with insomnia, staying asleep or awakening
in the early morning, while others sleep excessively. Patients may also
experience problems with losing or gaining weight, loss of appetite or
exaggerated hunger pangs. Some patients manifest agitation and have difficulty
sitting still or may wring their hands or pace to release tension. Physcial
complaints of indigestion, nausea, headaches, backaches, and other somatic
symptoms may develop.
MEDICAL ILLNESS is AN UNDER-RECOGNIZED CAUSE of DEPRESSION
Although popular culture associates depression with broken hearts or the
death of a loved one, it can be caused by many other things. One of the
little-recognized causes of depression is chronic illness. In my practice, I see
many ill people who are suffering from depression over the loss of their
physical abilities...or, after recovering, from the fear that the illness will
return. Cardiac patients often are so overwhelmed by feeling physically
incapacitated or fearing that they will have another heart attack or die that
they become depressed. Cancer patients, too, often suffer from depression.
Elderly patients may become depressed over their lost mental and physical
"TYPE A" PERSONALITIES HAVE PARTICULAR DIFFICULTY
DEALING WITH ILLNESS
While medical illness can cause emotional problems for anyone, it seems to
particularly trouble those individuals accustomed to a high degree of control in
their lives. Many of these people function with a high sense of time urgency,
are driven to succeed at work, and are highly explosive in their personal
relationships. They are reluctant to trust others and find it very difficult to
seek help for depression and other emotional problems. They may not even realize
that some of their physical symptoms are caused by emotional
During the time I have spent as Clinical Professor of Psychiatry
at George Washington University School of Medicine, I have studied and reported
on this phenomenon in professional journals, including the Archives of Internal
Medicine, the Journal of Chronic Disease, General Hospital Psychiatry, as well
as in several books. My studies revealed that managing the depression component
of an illness is a key to good recovery.
SOMETIMES TALKING is NOT ENOUGH
In this age of heightened awareness about the
psychological impact of trauma, counseling has been increasingly accepted as a
valuable therapeutic modality. Unfortunately, while talking about fears, pain,
and grief is helpful, it is often not enough. Patients frequently don't "feel"
better because, in their distress, they may not be able to "hear" what is being
said in therapy. Or, they may already be so depressed that they son't have a
perspective within which therapy may be assimilated. For this reason, when I see
a depressed patient, I first try to alleviate the depressive symptoms with
medication prior to beginning therapy. Once the patient begins to "feel" better,
further progress can be accelerated with individual, group or family
If someone you are caring for seems to have
trouble recovering from an illness or is suffering from nonspecific physical
symptoms, it may be a sign of depression. For a consultation in handling or
patient's particular situation, call my office at: 301-593-4222.