Depression

Description

Alternative Names

Complications of Depression

Depression is often chronic, with episodes of recurrence and improvement. Approximately one-third of patients with a single episode of major depression will have another episode within one year after discontinuing treatment, and more than 50% will have a recurrence at some point in their lives. Depression is more likely to recur if the first episode was severe or prolonged, or if there have been recurrences. To date, even newer antidepressants have failed to achieve permanent remission in most patients with major depression, although the standard medications are very effective in treating and preventing acute episodes.

Risk for Suicide

About 90% of suicides are due to treatable disorders, most commonly depression or substance abuse. People with depression have up to a 15% risk for suicide, with the highest risk in patients who are hospitalized for depression. Some studies indicate that atypical depression poses a higher risk for suicide than typical depression and that dysthymia may pose a higher risk than episodic major depressive disorder. Depressed men are more likely to commit suicide than depressed women, and in the U.S. and around the world, suicide is most common in men older than 60. Suicidal preoccupation or threats of suicide should always be treated seriously in anyone, however. [For the risk of suicide in young people or the elderly,see Depression in the Elderly or Depression in Children.]

Effect on Physical Health

Major depression in the elderly or in people with serious illness seems to reduce their survival rates, even independently of any accompanying illness. In one study, even minor depression was associated with a higher risk for a shorter life in men (although not in women). Decreased physical activity and social involvement certainly play a role in the association between depression and illness severity. Some research also suggests, however, that depression produces biologic factors, such as low serotonin levels, which trigger stress-related responses in the body that cause blood clotting problems, inflammation, and damage to organs and cells.

Effect on Heart Disease and Other Age-Related Problems. Many studies have now reported strong associations between depression and a worse and even shorter old age. Depression increases the incidence and severity of heart attacks, stroke, and death after these events. Depression is also associated with mental decline and even osteoporosis in older people. [For more detailed discussion,see Depression in the Elderly.]

The link between heart disease and depression has long been thought of as cause-and-effect. Studies are now showing that depression itself may contribute to heart disease.

Click the icon to see a depiction of stroke.

Click the icon to see a depiction of osteoporosis.

Obesity. Both obesity and depression are increasing in American. In a 2002 study, for instance, adolescents who were depressed had a high risk for obesity. The conditions may have common risk factors. For example, being in a lower social and economic group increases the risk for both obesity and depression. Low physical activity may also be a common factor. Few studies have investigated common biologic or behavioral factors.

Increasing Sensations of Pain. Depression coincides with high pain scores in people with chronic pain, such as those arthritis or fibromyalgia.

Cancer. The relationship between depression and cancer has been explored for years with only a few clear-cut associations (e.g., with pancreatic cancer). Certainly depression and anxiety can have a profound impact on quality of life in cancer patients. A 2002 study reported a worse outlook in cancer patients with a history of depressive symptoms -- but not in patients whose depression occurred after the illness.

Impact on Daily Activities and Relationships

Effects of Parental Depression on Children. Depression in parents can have profound effects on their children. It not only increases the risk for depression in their children, but, according to one study, it may even increase a child's risk for many medical conditions (e.g., urinary and genital disorders, headaches, lung problems).

Effects on Marriage. In one survey, nearly half of people who suffered from psychiatric disorders before or during their first marriage were divorced, compared to a divorce rate of 36% in those who never suffered from emotional disorders. Spouses of partners with depression are themselves at higher risk for depression.

Effect on Work. Depression is well known to adversely affect a person's work life. It significantly increases the risk for unemployment and lower income. Major depression, according to a major 2003 survey, accounts for nearly half of the nation's excess lost productive time (in most cases because of reduced performance at work). Workers with depression also lose significantly more time due to ill health than non-depressed workers. Such lost time is estimated to cost the country billions of dollars each year.

Substance Abuse

Alcohol and Drug Abuse. It is estimated that up to 25% of people with alcohol or drug abuse problems also have major depression. Studies on the connections between alcohol dependence and depression have still not resolved whether one causes the other or if they both share some common biologic cause.

Smoking.Depression is a well-known risk factor for smoking, and it increases the danger of starting young. Indeed, nicotine may stimulate receptors in the brain that improve mood in certain people with genetically induced depression.