6 Things Everyone Seems to Get Wrong About Depression
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The Truth—Joint pain, headaches and chronic fatigue syndrome are also associated with depression, possibly because pain and mood are regulated by the same pathways in the brain, says John Greden, MD, executive director of the University of Michigan Comprehensive Depression Center, in Ann Arbor. A recent study presented at the European Society of Cardiology Congress also found that depressed patients experience more frequent chest pain even in the absence of coronary artery disease. The combination of mental and physical pain can be debilitating—major depressive disorder is the leading cause of disability in the U.S. for those ages 15 to 44, according to the Anxiety and Depression Association of America.
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The Truth—The average age of onset for major depressive disorder is 32 years old, according to the National Institutes of Mental Health, and in any given year, 6.7 percent of Americans 18 and older suffer from it. Women are particularly vulnerable—1 in 5 will develop depression at some point in their life, and they're 70 percent more likely to experience it than men. And because of the stigma that's still attached to depression, people often hide their symptoms. Meaning "You may know someone with it and have no idea," says Sarah Lisanby, MD, director of the division of translational research at the National Institutes of Mental Health.
The Truth—"Sometimes there are major life stressors we can pinpoint, but sometimes there aren't," says Lisanby. "I've had patients who say that everything is wonderful and they have no reason to be depressed, but they are nonetheless." Depression with no identifiable trigger is called endogenous depression, and Ian Gotlib, PhD, director of the Stanford Mood and Anxiety Disorders Laboratory, estimates that it happens in roughly a third of cases. A person's first depressive episode may have an obvious trigger, like the death of a friend or family member or overwhelming stress, but the more episodes a person suffers, the more likely it is that future bouts will come on without a precipitating event.
The Truth—SSRIs were a game changer when they came to market in the 1980s, and there are many other types of meds available (tricyclics, MAOIs, SNRIs), but none offers a one-size-fits-all fix. Why? "We don't really know how to match patient to treatment very well," says Gotlib. "With cancer, researchers are looking at genotypes to predict response to specific treatments. We're not there yet with psychiatric disorders." At the moment, depression treatment typically involves a complicated, potentially lengthy process of figuring out the right medication, type of therapy or combination of the two, then waiting to see if it works. Even after that, "[only] 65 percent of people will get better," says Gotlib.
The Truth—Sadness (clinically known as depressed mood or irritability) is just one of nine criteria for major depressive disorder outlined in the Diagnostic and Statistical Manual of Mental Disorders 5, the go-to reference book on psychiatric illness. The other eight: loss of interest in activities you previously enjoyed, significant changes in weight or appetite, changes in sleep, fatigue or low energy, change in activity levels, feelings of guilt or worthlessness, trouble concentrating and thoughts of suicide. An official diagnosis of depression requires five of the nine persisting for at least two weeks, but depressed mood doesn't have to be among the five.
The Truth—Every expert we spoke with cited this as one of the most common and damaging myths about depression, because while there are factors that can increase your risk (family history, trauma, a stressful life event, to name a few), mental weakness isn't one of them. "Telling a depressed person that they need to pull themselves up by their bootstraps is like telling someone with pneumonia to do the same," says Stuart Eisendrath, MD, founding director of the University of California San Francisco Depression Center. "People don't understand that there's a physiological abnormality associated with, it just like there is with other illnesses."