September 15, 2012

Depression-The Silent Killer

Yes, depression kills.  People do commit suicide.  I am thinking instead about the many sufferers who live their lives so much less fully than they might because depression saps them of vitality, enthusiasm and pleasure.  Many more people experience debilitating depression than seek help because of continued lack of knowledge, understanding or appreciation of the true harm it can cause to their lives.


The US Center for Disease Control reports that one in 10 adult Americans suffers from depression in any given year.  The National Institute for Mental Health gives an estimate for lifetime risk of depression in a range of 7 to 25%.  The World Health Organization states that depression is the leading cause of disability for Americans aged 15 to 44. Additonally studies indicate the following statistics related to serious health conditions:

25% of cancer patients experience Depression

10-27% of post stroke patients experience Depression

1 in 3 heart attack patients experience Depression

50% of all Parkinson’s patients experience depression

Depression doubles the risk for heart attack



There are typical symptoms which are in the current Diagnostic and Statistical Manual, the standard diagnostic tool used by psychologists and required by insurance companies.  I will list these below but it’s important to understand that they are not as obvious and clear cut as they appear.  Five from the list of the following nine symptoms need to be present for a period of at least two weeks and should represent a change from prior functioning.  Depressed mood or loss of interest have to be included.

I. Depressed mood, can be a sad or empty feeling.  In adolescents it can be a primarily irritable mood.

II. Greatly diminished interest or pleasure in all or most activities most of the time.

III. Weight changes, either a gain or a loss.

IV. Sleep changes, either an increase or a decrease.  Typically in insomnia there is not great difficulty falling asleep but in staying asleep, the person tends to awaken before they need to or be up in the middle of the night for extended periods.

V.Feeling very slowed down or the opposite, feeling very restless.

VI. Fatigue or loss of energy nearly every day.

VII. Feelings of worthlessness or excessive guilt.

VIII. Diminished concentration or indecisiveness.

IX. Recurrent thoughts of death and hopelessness, wishing you were dead, thinking you might as well be or that you would be better off dead.



The list may seem straightforward but human beings are very complex and how the Symptoms of Depression manifest in different people can look very dissimilar.  Except in the most severe cases, people can often still enjoy some things some of the time so it is easy to think, “well, I’m really okay or I wouldn’t have had such a good time when I was out with my friends today.”  In moderate depression, the mood can still lift temporarily when something particularly pleasant occurs.

Another common misconception is that suicidal thoughts mean you want to kill yourself.  Most people who are depressed do not want to die, but they do find themselves dwelling on thoughts of death such as wondering what the point of living is, thinking others would be better off if they were dead or having vague fantasies without any real intent of ways they could kill themselves.

One of the most important symptoms to look for, I believe, is insomnia.  So many people accept chronic insomnia as just something that is normal which they have to endure.  It is always a sign that the mind is not at peace, that life is overly stressful and that the individual is having trouble coping.  It is NOT normal and does not need to be tolerated.

Loss of interest, pleasure and enthusiasm is usually central although, as I discussed above, that doesn’t mean the person can never enjoy themselves.  People may still continue to participate in their usual pastimes but the pleasure is greatly diminished.  A loss of interest in sex is very common.  A depressed person may no longer enjoy eating and eat only because they have to.  Depressed people often withdraw from friends and loved ones.  Life frequently feels dull and flat, without color or texture.

A very interesting aspect of symptoms is they can fall along either extreme-the point is the change and the extreme.  For example someone with depression can feel very slowed down OR agitated and edgy.  They can sleep too much or too little.  Someone might worry too much or feel empty and blank.  These differences add to the confusion and the difficulty in recognizing the problem as depression.



The important think to know is that depression is highly treatable.  Estimates are as high as 80 to 90% of those treated get relief.  Modern psychology has a vast arsenal of tools with which to treat depression.  There are a variety of medications which can be enormously effective as well.  Estimates are as high as 50% of people needing treatment receiving the care from which they could benefit.  That, to me, represents a great tragedy.  There are so many people living lives unnecessarily diminished by depression.  That is why education and awareness are so critical.  Depression saps the joy from life, limiting our ability to reach our potential and fully explore the fulfillment a happy life can bring.




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