Seasonal affective disorder
According to major surveys, major depressive disorder affects nearly 15 million Americans (nearly 7% of the adult population) in a given year. While depression is an illness that can afflict anyone at any time in their life, the median age of onset is 32 (although adults age 49 -54 years are the age group with the highest rates of depression.). Other major risk factors for depression include being female, being African-American, and living in poverty.
Women, regardless of nationality, race, ethnicity, or socioeconomic level, have twice the rate of depression than men. (Women with depression also oftentimes have accompanying eating disorders, such as anorexia nervosa and bulimia. [For more information, see In-Depth Report #49: Eating disorders.]) While men are more likely than women to die by suicide, women are twice as likely to attempt suicide.
The causes of such higher rates of depression appear to be a mix of sociocultural and hormonal factors:
Depression is not rare in men. In fact, white men over age 85 have the highest rates of suicide of any group. Some evidence suggests that men are more apt than women to mask their depression by using alcohol, which may result in a lower reported (but not actual) incidence of depression in men. Some research suggests that depression in men is associated with the following indicators:
Depression can occur in children of all ages, although adolescents have the highest risk. Risk factors for depression in young people include having parents with depression, particularly if it is the mother who is depressed. Early negative experiences and exposure to stress, neglect, or abuse also pose a risk for depression. Sometimes depression develops after a physical illness. In adolescents, feeling alienated from parents is a strong predictor for depression.
Adolescents who have depression are at significantly higher risk for substance abuse, recurring depression, and other emotional and mental health problems in adulthood.
Studies suggest that 3 - 5% of children and adolescents suffer from clinical depression, and 10 - 15% have some depressive symptoms.
Symptoms for depression in children often differ from those in adults and may include:
Risk for Suicide in Adolescents. Suicide is the third most common cause of death among adolescents, and is one of the most devastating events than can happen to a family. Suicide is most commonly associated with depression in young people but it is also linked with anxiety, psychosis, substance abuse, or impulsivity. More girls attempt suicide but more boys succeed, most often because they choose guns or violent methods while girls tend to overdose, which is more treatable. Nevertheless, attempts are major risk factors for a later suicide. Any expression of suicidal intent should be treated very seriously.
The following are danger signs in young people:
Risk factors for suicide include a history of neglect or abuse, history of deliberate self-harm, a family member who committed suicide, access to firearms, and living in communities where there have been recent outbreaks of suicide among young people. A romantic break-up is often the trigger for a suicidal attempt in teenagers. Feeling connected with parents and family can help protect young people with depression from suicide.
Parents should not hesitate to seek professional help for their children if they suspect they are thinking about killing themselves. This is a medical emergency and requires immediate treatment.
Behavioral therapies and antidepressants are promising treatments for preventing suicide but need study. There has been a decline in adolescent suicides over the past decade, which some researchers attribute to the increased use of antidepressants in this population. However, recent evidence has indicated that antidepressants can also raise the risk for suicidality (suicidal thoughts and behavior) in some people. Children, adolescents, and young adults who are prescribed antidepressant medication should be carefully monitored by both their parents and doctor, especially during the first few months of treatment, for any worsening of depression symptoms or changes in behavior. [See "Suicide Risk" and "Antidepressant Medications" in Medication section of this report.]
About 1 - 5% of elderly people suffer from depression. However, the rate increases significantly for those who have other chronic health problems, especially medical conditions such as Alzheimer‚ ' s, Parkinson‚ ' s disease, heart disease, and cancer that interfere with functional abilities. Depression occurs in about 12 - 14% of elderly people who require home healthcare or hospitalization. In addition, older people often have to contend with significant stressful life changes such as the loss of a spouse. Suicide in the elderly is the third-leading cause of death related to injury. Men account for the majority of these suicides, with divorced or widowed men at highest risk.
Severe or Chronic Medical Conditions. Any chronic or serious illness that is life-threatening or out of a person's control can lead to depression. Many medications taken for chronic medical problems can cause depression. Among them are pain relievers for arthritis, cholesterol-lowering drugs, medications for high blood pressure and heart problems, and bronchodilators used for asthma and other lung disorders.
Thyroid Disease. Hypothyroidism (a condition caused when the thyroid gland does not produce enough hormone) can cause depression. However, hypothyroidism may also be misdiagnosed as depression and go undetected.
Chronic Pain Conditions. Studies have reported a strong association between depression and headaches, including chronic tension-type and migraine. Some research indicates that a syndrome of migraine headaches (and also possibly tension-type), anxiety, and depression is caused by common factors, such as abnormalities in chemical messengers, particularly dopamine or serotonin. Fibromyalgia and other chronic pain syndromes are also associated with depression.
Stroke and Other Neurological Conditions. Having a stroke increases the risk of developing depression. Also, patients with Parkinson's disease, spinal cord injuries, and other similar problems that impair movement or thinking are associated with depression.
Heart Failure. Patients with heart failure or patients who have suffered a heart attack may also be at increased risk for depression.
Insomnia and Sleep Disorders. Sleep abnormalities are an integral part of depressive disorders, with many depressed patients experiencing insomnia. Although stress and depression are major causes of insomnia, insomnia may also increase the activity of the hormones and pathways in the brain that can produce emotional problems. Even modest alterations in waking and sleeping patterns can have significant effects on a person's mood.
Diabetes. There appears to be an association between depression and type 2 diabetes. Recent research suggests that depression may modestly increase the risk for diabetes, and that diabetes may increase the risk for depression.
Smoking. There is a significant association between cigarette smoking and a susceptibility to depression. People who are prone to depression face a 25% chance of becoming depressed when they quit smoking, and this increased risk persists for at least 6 months. What's more, depressed smokers are unlikely to stop smoking. Only about 6% remain smoke-free after a year.
Smokers with a history of depression are not encouraged to continue smoking, but rather to keep a close watch on recurrence of depressive symptoms if they do stop smoking. The antidepressant bupropion (Wellbutrin), which is approved for helping people quit smoking (marketed under the name Zyban), is proving to be very useful in helping some smokers to quit.
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