Depression: America’s Hidden Epidemic

Dr. Tzvi Doron
March 12, 2018

Depression: America’s Hidden Epidemic

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While heart disease is the leading cause of death in the United States, depression is responsible for damaging thousands of lives—ending many of those lives prematurely. 7.6% of Americans over the age of 12 have moderate to severe depression. Among 40-59 year olds, it’s even more common at nearly 10%, and about 3% of people in the US suffer from severe depression. Clinical depression is a silent killer, and it’s reaching epidemic levels in the US.

Suicide is the second most common cause of death in 15-34 year olds

The most direct way that depression kills is suicide. Suicide is the 10th most common cause of death in the US and the second most common cause of death in 15-34 year olds. That’s more than twice the number of homicides. In addition, while women are more likely to attempt suicide than men, guys are almost 4x as likely to die of suicide. And suicide rates have been climbing over the last two decades.

While depression is the number one cause of suicide, its harmful effects extend to all facets of Americans’ lives. Depression is even a major cause of lost work productivity due to chronic absenteeism and even “presenteeism.” That’s when you’re technically at your desk, but you’re either too sick or too out of it to get anything actually done.

Depression is still one of the most overlooked causes of death and suffering in the US. It’s important to understand the far-reaching negative impacts of depression—even if you’re not struggling with this illness—because chances are, someone you know is grappling with this silent killer. They just haven’t told you about it.

Table of Contents

What is Depression?

depression

The Fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM 5)—it’s what the American Psychological Association uses to classify and diagnose mental illness—defines major depressive disorder as “two or more weeks of 5 of the following symptoms that cause problems with social, occupational, or other areas of functioning” (at least one of the first two is necessary):

  • Depressed mood
  • Decreased interest or pleasure in doing things
  • Weight loss or weight gain, or increased or decreased appetite
  • Insomnia or sleeping too much
  • Moving slowly or being fidgety or restless
  • Fatigue or loss of energy
  • Feelings of excessive guilt or worthlessness
  • Difficulty concentrating or making decisions
  • Recurrent thoughts of death or suicide

7.6% of Americans over the age of 12 have moderate to severe depression

It’s important to note that having one or two symptoms of depression is normal. Don’t panic if you recognize some of these criteria in your own life. It’s even normal to have several symptoms for a day or two. That doesn’t make you depressed. It makes you a human being. You’re allowed to experience the range of emotions—even the bad ones.

It’s also common for people to go through similar feelings after a major loss, such as the loss of a loved one or losing your job. These don’t qualify as depression either—unless those feelings last for longer than the expected amount of time. There are also other types of depression like dysthymia and seasonal affective disorder (SAD) that I won’t discuss here in detail.

It’s important to note the distinction between feeling sad and clinical depression. People with depression aren’t having bad day or even a tough week. When you’re going through a depressive episode, it changes everything about your life. Depression disrupts your sleep patterns, diet, social interactions, energy levels, motivation, thoughts of self-worth. It isn’t something you can “power through”—nor should you. It’s important to reach out and get help so a depressive episode doesn’t spiral out of control. It’s also extremely important to recognize signs or symptoms of depression in your friends and family because people who are depressed often don’t reach out for help. And the consequences can be deadly.

The Health Risks of Depression

depression

While suicide is the worst result of depression, depressive episodes can harm you in a number of other ways. Insomnia alone is a contributor to all types of health risks like diabetes, hormone imbalance, and hypertension (which can lead to heart attacks and stroke). Clinical depression is a risk factor for many illnesses and even all cause mortality.

Depression and Heart Disease, Diabetes, and Stroke

Depression can increase your risk of heart disease by as much as 50%, including an increased risk of fatal heart attacks. Even worse, if you’ve already had a heart attack, depression increases the risk of actually dying from the next one. Similarly, depressed diabetics face an increased risk of cardiovascular disease and an almost 50% increased risk of dying from all causes.

Depression increases your risk of heart disease by 50%

Depression is also associated with a higher risk of stroke, and of dying from stroke and a higher risk of heart failure.

It’s important to note that while depression is associated with higher risks for heart disease, stroke and heart failure, we don’t know if it’s a risk factor (aka it causes the diseases) or simply a risk marker (it’s associated with the diseases, but it’s not the cause). Either way, depressive episodes are bad for your health, especially if you’re at risk for stroke, heart disease, or diabetes.

Depression and Cancer

Overall, depression doesn’t appear to be associated with an elevated risk of cancer. However, it is associated with an increased risk of dying in those who already have cancer. Again, it’s not clear whether depression itself is the cause of this increased mortality or simply a marker for it. For example: It’s completely plausible that people struggling with cancer are more likely to be depressed. Especially as their illness progresses.

Depression and Dementia

depression and dementia

The part of the brain associated with memory shrinks in people with depression

Both early and late life depression are associated with an increased risk of various types of dementia, including the most common type of dementia—Alzheimer’s Disease. However, it’s not clear why depressed people have higher rates of dementia. Some theories include the toxic effects of cortisol on parts of the brain, like the hippocampus. The hippocampus is involved with memory, and actually gets smaller in depressed people. Conversely, inflammation in different parts of the brain and a decrease in neurotrophins (chemicals that keep the brain healthy) are other likely culprits for this loss of function.

Depression and Mortality

An extensive Journal of American Medicine analysis of over 2,000 studies showed that depression (and other mental disorders) increases your risk of mortality. In other words, depressed people don’t live as long. In fact, the study found that depression shortened life expectancy across the board by 10 years. 10 whole years. That’s more than just significant. That’s catastrophic.

Depression can take 10 years off your lifespan

Treating Depression

Although we don’t know for sure whether depression itself is the cause of increased mortality in all of these patient populations, we know it’s an important risk factor. Thankfully, there are treatments available to decrease the suffering caused by this disease as well as perhaps lower the risks of depression’s interaction with the other diseases discussed.

1. Rule Out Medical Causes

If you or a loved one are suffering from depression, go see a doctor. Your doctor can rule out medical causes of depression like hypothyroidism, vitamin B12 deficiency, low testosterone, and other complications and side effects of medications. If a potential medical cause is found, it’s important to treat the cause prior to instituting depression-specific treatment.

Unfortunately, depression isn’t often caused by the straightforward medical issues listed above. If your depression doesn’t have a diagnosable medical cause, the two mainstays for treatment of depression are medication and psychotherapy.

2. Antidepressants

antidepressants

The most common antidepressant medications are Selective Serotonin Reuptake Inhibitors (SSRIs) which include drugs like Prozac, Zoloft, and Lexapro to name a few. Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) are also popular including drugs like Effexor, Cymbalta, and Pristiq. Talk to your doctor about potential interactions and side effects before beginning treatment cycles for these drugs so you can become a participant in your care and track any adverse reactions as they occur instead of reacting months after the fact. Not everyone reacts favorably to each prescription, so work with your doctor to find the right medication for you.

3. Psychotherapy

If you react poorly to depression medication, or simply want to try alternative therapy, the data looks promising. Research shows that antidepressants and Cognitive Behavioral Therapy (CBT) are about equally effective. However, CBT may have the more long lasting effects.

If you’re unfamiliar, CBT treats depression by encouraging practitioners to replace harmful thoughts with more positive ones. CBT is the most well researched form of psychotherapy for depression. What’s more, there’s a growing body of research to support the efficacy of Mindfulness Based Cognitive Therapy (MBCT)—like CBT—in depression. MBCT and CBT are akin to meditation therapy. Essentially, they combine mindfulness practices aimed at experiencing the present moment with breathing exercises and awareness. See if either technique is right for you.

Treating Depression with Diet and Exercise

What’s good for your physical health is also good for your mental health. So it should come as no surprise that both aerobic and resistance exercise are effective at relieving depression. What might be surprising is that a healthy diet may also decrease the health risks of depression.

In one study of over 10,000 participants, researchers found that the Mediterranean Diet (olive oil, “good” fatty foods, nuts, fruits, and legumes) appeared to lower the risk of clinical depression. In fact, the study coincides with data showing that Mediterranean countries routinely report the lowest rates of depression and suicide of anywhere in Europe. Other factors that may have an impact on the risk for depression include poor sleep, lack of social interaction, and excessive use of alcohol and tobacco. But it’s worth noting that a healthy diet and regular exercise can have a positive effect on depression.

Treatment-Resistant Depression

The thing about depression is that it’s a moving target, and highly personalized. Unfortunately, about 15%-33% of people don’t respond to multiple treatments for their depression. But that doesn’t mean to give up after the first failed attempt. Many people respond to variations on treatment, and even combination of medication, therapy, and lifestyle changes. There are even several non-conventional treatments available for people who don’t respond to the more standard options.

Alternative Depression Treatment: Electroconvulsive Therapy

Probably the oldest alternative treatment method for depression is Electroconvulsive Therapy (ECT). ECT is technically a conventional treatment method, but I include it here because most people have only seen it in the context of horror films from the last century.

Basically, ECT works by placing electrodes on specific parts of the scalp and applying enough current to produce a seizure that affect neurons and chemicals in the brain. It sounds grizzly, but the procedure is done under general anesthesia (people are asleep during the procedure) and has been upgraded significantly since it first came into practice in the 1930s. ECT is more effective than medication and generally safe, but its main undesirable side effect is short term memory loss.

A leading theory for how ECT works is that it increases the growth of neurons and the connections between neurons though increasing levels of Brain Derived Neurotrophic Factor (BDNF). People who receive ECT can still struggle with depression. However, electroconvulsive therapy is very effective at aborting an episode of depression and may be very useful in severely depressed and acutely suicidal people. Most people undergo four to six treatments before major improvement is seen.

Repetitive Transcranial Magnetic Stimulation

Although ECT is very effective (it really is), it does have a few downsides including the need for general anesthesia and short term memory loss. These shortcomings, and the public opinion of ECT has lead to developing other ways to stimulate the brain to produce an antidepressant effect. The most popular method of alternative brain stimulation is Repetitive Transcranial Magnetic Stimulation (rTMS).

This treatment uses magnets (think of an MRI) to stimulate certain areas of the brain instead of an electric current. The method is different than ECT, but the goal is the same—neural growth and connection. rTMS has been found to be somewhat effective for and treatment-resistant depression, but it’s still not as effective as ECT. Therefore, for acutely suicidal hospitalized patients, ECT is usually the route that is taken when medication isn’t effective or patients want faster results.

Ketamine Treatment

Ketamine is another really interesting option for treatment-resistant depression. Generally used for inducing anesthesia, smaller doses of intravenous ketamine appear to have rapid antidepressant effects—especially in suicidal patients. The downside is that the antidepressant effects of ketamine aren’t permanent. The other problem is that ketamine is a drug that’s often sold illegally and routinely abused. It’s extremely important that you get ketamine treatment for depression from an experienced physician if you decide to explore this option.

Depression: Get the Help You Need

Depression not only robs people of years of their lives, but also severely decreases quality of life. Many people will experience at least one depressive episode at some point in their lives. However, there are numerous things you can do—like eating a healthy diet, exercising, getting regular checkups, and cultivating active relationships with friends and loved ones to decrease your risk of developing clinical depression.

Many conventional and alternative treatments exist for depression. If you or a loved one are experiencing depression, help is out there. You don’t have to suffer in silence and depression doesn’t have to end your life early.

Geek Out: More Depression Information and Resources

This information isn’t a substitute for professional medical advice, diagnosis, or treatment. You should never rely upon this article for specific medical advice. If you have any questions or concerns, please talk to your doctor.

Dr. Tzvi Doron is board certified family doctor and the Clinical Director of Roman. He’s a member of the American Osteopathic Association (AOA) and the American Academy of Family Physicians (AAFP).

Dr. Tzvi Doron

Dr. Tzvi Doron is board certified family doctor and the Clinical Director of Roman. He’s a member of the American Osteopathic Association (AOA) and the American Academy of Family Physicians (AAFP).

All stories by:Dr. Tzvi Doron
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Dr. Tzvi Doron

Dr. Tzvi Doron is board certified family doctor and the Clinical Director of Roman. He’s a member of the American Osteopathic Association (AOA) and the American Academy of Family Physicians (AAFP).

All stories by:Dr. Tzvi Doron