Melvin J Stern, M.D., P.A.

5015 Cedar Croft Lane, Bethesda, MD 20814
Bethesda, MD 20814


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 months.


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 percent.

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.


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 capabilities.


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 upset.

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.


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 psychotherapy.

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.