The Why Files The Why Files --

Depression: Bluer than blue


Bad news = blues = depression?
White bearded author, in heavy sweater, gazes slightly off-camera, hair unkempt.Seen the headlines? Lebanon's been leveled by the latest Middle East war. Iraq is being eviscerated by sectarian warfare. One year after Hurricane Katrina, more than half the residents of New Orleans live elsewhere. AIDS has set back public health in Southern and Eastern Africa by 100 years. And a wholesale meltdown of Greenland's icecap could raise the oceans and flood cities around a warming planet.

The headlines are enough to cause us to feel depressed, but are they enough to cause the disabling mental illness called "depression"?

No, although a new study found that the rate of mental illness among Katrina's survivors has doubled.

Ernest Hemingway (1899-1961) was hospitalized for depression in 1961, just before he committed suicide. Photo: National Gallery of Australia

But for the rest of us who experienced Katrina's catastrophe through the media, the "depression" we feel after reading the newspaper is different from "depression" the mental illness, says Jon Allen, staff psychologist at the Menninger Clinic, and professor of psychiatry at Baylor College of Medicine. "The person becomes sick in a wholesale way, and this is the difference between feeling [the illness called] depression, and picking up the newspaper and thinking the world is coming to an end in a few days."

illustration of sad person, head on handNothing but the blues
Medical depression is a disastrous mind-body illness, says Allen. It affects not just your brain but "your whole physiology. You can think of it as a systemic illness."

The symptoms of depression include a persistent sad, anxious or "empty" mood; feelings of hopelessness, pessimism or worthlessness; loss of interest or pleasure in hobbies and activities; decreased energy; and difficulty concentrating and making decisions. Depression can cause insomnia, early-morning awakening, or oversleeping. It can cause weight loss or gain. Depression can cause physical symptoms that do not respond to treatment, including headaches, digestive disorders and chronic pain. And it's the major cause of suicide.

Depression is far more than just the blues:

14.8 million Americans are affected by depression in any particular year, with women about twice as likely to be affected as men.

Depression is a major risk factor for heart attack. According to a 2004 study, the higher risks of myocardial infarction (heart attack) associated with depression "have been statistically significant across studies and have been demonstrated for both men and women in the general population."

Depression can also follow a heart attack. A large study published in 2005 found that one in five patients with myocardial infarction suffer depression within four months of the attack.

Most people who commit suicide in the United States have depression.

Depression is also a huge cause of disability. "It has about the same impact as having a heart attack on your functional status and quality of life," says Kenneth Wells of the Rand Corporation, a think tank. Wells notes that a World Bank study of the global impact of disease placed depression among the top three conditions, and predicted that depression will move to second place by 2020.

The huge toll of depression reflects a common condition that can strike at any age, Wells adds. "There is a lot more depression than heart disease, and it's across the age span. It can strike young, and a large share of depressions can be recurrent, chronic, and you can have a whole lifetime to have the functional limits."

Chart indicates that in developing countries, depression is the leading cause of injury/disease
By 2020, depression will cause almost as much disability as blocked arteries in the heart, according to a study by the World Health Organization and World Bank. Comparisons use "disability adjusted life years," which measure the duration of disability. Source: "Alternative Projections..." (see bibliography).

Cause — and effect
The category of depressive disorders includes bi-polar disorder (manic depression), major depression, and other, milder conditions. The causes of depression are multiple and mysterious. Post-partum depression after childbirth may be due to hormonal imbalances. In general, genes, biochemistry and life experience all seem to play a role. Depression "usually results from an interaction" of factors, says Lynn Rehm,F.Scott Fitzgerald quote professor of psychology at the University of Houston. "There is probably a biological predisposition: Some people respond more extremely to stresses. That may then interact with a psychological predisposition: Some people grow up learning to be very efficacious in their lives, feel they are capable of things, but others develop a sense of helplessness, don't have much control. These may all interact with various kinds of environmental stresses and losses."

Individuals may respond to different factors, he adds. "Some people are very biologically vulnerable, some are psychologically vulnerable. For many people, depression is a matter of extreme stress." Nonetheless, most depressions are set off by a "triggering event," Rehm says, such as a divorce, death in the family, or job loss. Some depressions seem to come from nowhere, he adds, "but when they are examined closely, there is usually some kind of stressful event or sequence of events."

The course of depression is extremely variable, but the first bout of depression usually signifies a vulnerability to the disease, says Rehm. "Once you have had one episode of clinical depression, you have a 50 percent chance of having a second episode, and if you have two episodes, you have a 75 percent chance of having a third."

Bouts of depression are "typically episodic," says Rehm. "The episodes may last for months. Most people get through even without treatment, but there are certain people who develop very chronic depression, and have repeated episodes."

For some people, depression ends in suicide.


Megan Anderson, project assistant; Terry Devitt, editor; S.V. Medaris, designer/illustrator; David Tenenbaum, feature writer; Amy Toburen, content development executive

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