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Depression: An Overview

Depression is a common, treatable mental illness with a clear biological component.  Evidence from neuroscience, genetics and clinical research demonstrates that depression is a disorder of the brain.  Depression is the most common psychiatric disorder in the United States.  Approximately 1 in 10 adults, or more than 19 million Americans suffer from depression each year.  While depression is almost twice as common in women than men, an estimated three to four million men also have clinical depression.  The average age of onset of depression occurs in the early twenties.Nevertheless, depression can occur at any age.  At any time, between 1 and 2 percent of people over the age of 65 experience symptoms of depression,but it is not a "normal" part of aging.

Men are not as likely to show the typical signs of depression such as crying, sadness or loss of will.  Therefore, their depression may be hidden from family and friends who may encourage them to seek help.  In general, men are less likely to seek help for mental health problems than women.  Doctors are less likely to suspect depression in men and are more likely to diagnose depression in women even when there may be another medical explanation for their symptoms.  Men's depression is often masked by substance abuse or by working excessively long hours.  Nearly twice as many men (35.4%) as women (17.9%) suffer from a substance abuse/dependence problem during their lifetime.

Symptoms of depression include sadness or depressed mood; loss of interest or pleasure in usual activities; significant change in appetite or weight; insomnia or sleeping excessively; agitation or slowing down that is noticeable to others; fatigue or loss of energy; feelings of worthlessness or excessive guilt; difficulty concentrating, thinking or making decisions; and recurring thoughts of death or suicide.  Depressed mood or loss of interest or pleasure, plus at least five or more of these symptoms, occurring nearly all day for at least two weeks, are indicative of major depressive disorder.

There are a number of factors that may play a role in depression:  the biochemical basis, genetic influences, environmental factors, and comorbidity (concomitant illness).  Depression is believed to be biologically related to an imbalance in the activity of the chemical messengers called neurotransmitters. These messengers convey electrical signals between nerve cells in the brain.  Substantial evidence suggests that an imbalance in the serotonin neurotransmitter system, in particular, is involved. Family studies suggest genetic factors may contribute to the development of a depressive disorder. Studies show that major depressive disorder is more common among first-degree biological relatives of persons with this disorder than among the general population. Some people may also have a biologic predisposition toward depressive illness that remains dormant until it is triggered by environmental factors. They may include death of a loved one, separation from loved ones through divorce or other events, relationship difficulties, serious financial problems or other medical illnesses.  For example, men with depression are more than twice as likely to develop coronary heart disease than those who are not depressed. In addition, men with depression have a 71 percent higher heart-disease risk, and are twice as likely to die of heart disease than men who do not suffer from depression.

More than 90 percent of people who commit suicide have a diagnosable mental disorder, commonly depression or a substance abuse disorder.  Four times as many men than women complete suicide.

Depression is frequently treated with medicines, psychotherapy or a combination of the two. Psychotherapy, otherwise known as "talk therapy," helps a patient identify, understand and resolve life difficulties that may be contributing to the depression.  The most common choice of prescription medical therapy for patients with depression is selective serotonin reuptake inhibitors (SSRIs) such as Paxil CR™, Prozac, or Effexor among others.

If you or someone you care about might be suffering from depression, seek medical attention. 

Created: 1/27/2004  -  Donnica Moore, M.D.

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