Consider this: Elizabeth Wurtzel has struggled with depression throughout her life. She has a history of suicide attempts, self-mutilations, and serious mood swings. She took numerous antidepressants and medications in an attempt to regulate her irregular behavior. She quit using the medications due to the multiple side effects the drugs had on her. The result was chaos; after Elizabeth quit taking her medication her body experienced episodes of withdrawal. Despite her continued attempts to combat her illness, she experienced nervous breakdowns and alienation from her friends and family. Elizabeth Wurtzel reluctantly went back to taking medication despite the potentially serious side effects of taking so many drugs (Kim 46).
‘ In the news, on the streets, and in neighborhoods, individuals are confronted with a variety of social problems’;(Kim 7). A person may watch a loved one battle cancer, suspect a friend of having bulimia, or he/she may struggle daily with depression (Kim 7). The National Institute of Mental Health estimates that as many as 17 million Americans each year suffer from depression. About one in twenty-five of these sufferers is under the age of 18, and one in seven women will experience depression in her lifetime. The illness strikes regardless of age, gender, class, culture, or ethnic background (Kim 9). The occurrence and distribution of depression in a population may be related to a variety of factors. Such factors include a wide range of possibilities such as sex, age, living in the town, living in the country, nutrition, marital status, socioeconomic background, and genetic factors (Winokur 18). ‘Many people who are depressed do not seek treatment either because they are unaware that their condition can be helped or because they are all too aware of the stigma and shame associated with depression’;(Kim 9). Discovering and analyzing the complexities of issues that are associated with depression is a necessity in the goal of obtaining a comprehensive understanding of depression and of those who suffer from the disease (Kim 13). In order to completely understand the illness of depression, people should understand what the disease is, what factors cause the disease, and the how disease is treated.
‘Feelings of hopelessness, sadness, or discouragement occasionally tug at us all’; (Kim 13), but those feelings eventually fade away. These feelings of being depressed can easily be mistaken for the clinical illness of depression, but depression is quite different. The illness of depression is a state of psychological misery that does not go away (Kim 13). It may also be defined as a state of mind and body which is characterized by a change in mood towards being miserable, worried, easily discouraged or agitated, unable to feel emotions, fearful, despondent or hopeless (Winokur 3). People suffering from depression often have slowed mental reactions, trouble concentrating and remembering, and difficulty in interacting in social situations (Winokur XIV). ‘Clinical observations’; have shown that 84% of depression patients suffer from ‘impaired concentration’; (Winokur 6). Their responses to questions ‘will take a long time in coming’; (Winokur 4). Such forms of pleasure as food, friends, and sex no longer hold an appeal to people who suffer from depression. It has also been proven that 77% of people who suffer from depression lack an interest in ‘usual activities’; (Winokur 6). People who suffer from depression simply loose their joy for life (Kim 13). Many people who suffer from depression entertain the thought of suicide (Robbins 6). ‘Estimates are that the lifetime risk of suicide in persons with serious depression runs on the order of 15% while it is only about one percent for the general population’; (Robbins 6).
Not only does depression affect people mentally, but it also affects people physically. Many sufferers of depression experience an ‘increased or decreased appetite’; (Kim 14) which may result in weight and health problems. Irregular sleep patterns are commonly associated with depression (Winokur 98). Trouble falling asleep and ‘disturbed sleep’; (Kim 14) are also results of having depression. This problem is often called ‘sleep onset insomnia’; (Robbins 6). The experience of sleep deprivation inevitably leads to ‘fatigue’; (Kim 14) and over time ‘chronic fatigue’; (Robbins 6). Depression also slows down the physical reactions of people as well as their ability to perform everyday activities. Some victims of depression also experience physical feelings of being worn out, headaches, impaired vision, and hot and cold flashes (Robbins 17). Of course, not all people who experience some of these mental and physical symptoms are necessarily in a state of depression, and ‘not all of these symptoms will be present in each person’; who experiences depression (Winokur 4). In order to be diagnosed as victims of depression people must suffer from ‘a minimal number of five symptoms’;(Kim 14). Those people who experience the minimal of five symptoms are said to be suffering mild depression. Mild cases of depression involve ‘very little interference with normal functioning in usual social activities’; (Kim 14). The second type of depression is moderate depression, also known as dysthymic disorder (Robbins 22). Dysthymic disorder is typically not severe but it has the potential to last for many years (Robbins 4). Individuals who suffer from moderate depression ‘experience more symptoms and greater impairment in their daily lives’; (Kim 15). The worst case of depression is severe depression. ‘In severe depression symptoms are increased in both number and severity and take a much greater toll on the ability to function socially or professionally’; (Kim 15). Large scale studies done in California, Connecticut, Maryland, Missouri, and North Carolina indicated that about five percent of the American adult population has at one time suffered from major depression. When the percentages are calculated to numbers approximately nine-million adult Americans are figured to have suffered from depression (Robbins 22).
Thus far we have covered what the psychological disease of depression is. But this is not the whole picture. We still need to examine what factors cause the onset of depression.
Any illness that is contracted by a person doesn’t just happen; in order for a disease to be contracted specific risk factors have to be present. The severity of the disease depends on the prevalence of the risk factors. The more prevalent they are, the more severe the disease will be. Many questions are often asked about depression and the answers are often debated (Robbins 21) . ‘ Are men or women more likely to become depressed? Does being in a minority group increase one’s vulnerability? Does it make a difference whether one lives in an urban area or in the countryside? And what relation does the onset of depression bear to one’s age? The answers to these questions will help us better understand’; (Robbins 21) the causing factors of depression and who is at the highest risk of developing the disease.
Are women more susceptible to depression than men? Studies conclude that women are at a higher risk of developing depression than men; women are said to be twice as likely to suffer from the illness than men are (Winokur21). Women are said to be at higher risk because they are exposed to more risk factors than men (Robbins 24). There are three theories that explain why women are more likely to experience depression than men are. The first theory is based on culture. ‘The cultural definition of being female’;(Robbins 24) allows for women to be more emotional than men. When those emotions being expressed are negative the gate for depression to enter has been opened. The second theory is based on the roles of women in society. Society often places women at economic and psychological disadvantages (Robbins 25). Both of these disadvantages increase the women’s exposure to stress and anxiety; stress and anxiety are associated with depression as major causes of the illness by two-thirds of the people who suffer from it (Winokur 20) . The stress, present with other risk factors, make women even more vulnerable to depression. The third theory expresses the belief that women are more susceptible to depression over men due to the biological differences of men and women (Robbins 24). Even though many risk factors of depression aren’t biological, it is highly understandable that psychological factors might only exist due to biological liabilities (Winokur 86).
Does being a minority or living in the city also contribute to the risk factors of falling to the state of depression (Robbins 21)? Studies done on large minority groups in the United States-African, Hispanic, and Asian Americans, showed that being a minority isn’t a risk factor of depression. The studies results showed that whites were more likely to suffer from depression than blacks (Winokur 21). When the overall results were compared, it was concluded that the rates of depression among minorities and whites are consistent with one another and are very close to being the same (Robbins 27-29). From these studies it has also been concluded that rates of depression are strongly affected by social status. Those in the studies that were of the lower social or economic classes experienced higher rates of depression (Robbins 28). Another proven fact is that less depression exists in low-stress environments, which confirms that living in the turbulent atmosphere of urban life is indeed a risk factor of depression (Robbins 26-27).
A very common question asked about depression deals with age and its connections to depression. It has been found that depression among children is very infrequent and quite rare (Robbins 32), yet the second leading cause of death among people from the ages 15-24 is suicide (Robbins 34). A survey of 1,000 teens in 1988 revealed that four our of ten adolescent girls and one out of five adolescent boys had at some time in their lives seriously considered committing suicide . A large factor that attributed this statistic is the feeling of being lonely (Robbins 34). ‘Adolescents are noted for their gregariousness, but frequently feel lonely and sometimes alienated’; (Robbins 35). Many adolescents also report school difficulties such as academic failure and truancy as large contributing factors of their depression (Winokur 76). During the later years of life rates of depression tend to decline and remain at that point of declination (Robbins 37). All of these biological, psychological, and sociological risk factors contribute to the onset of depression, especially when many are prevalent simultaneously (Kim 89).
Thus far we have covered what kind of disease depression is and what kinds of factors contribute to the onset of the illness. But this is not the whole picture. We still need to examine how depression is treated.
Most diseases require professional intervention in order to obtain help; depression is one of those diseases (Kim 87). ‘ It has been estimated that about 15 percent of the population needs mental health treatment’; (Robbins 147). The treatment of depression can be divided into two major areas. Those two areas are biological and psychological. The two areas overlap a great deal, but both serve separate purposes. The biological services specialize in the prescription of medications and antidepressants to correct imbalances of chemicals in the human body (Kim 89); psychological services specialize in the areas of psychotherapies, commonly called counseling (Winokur 134). Despite the vast varieties of treatments that are available, it is assessed that ‘only one out of five persons with a mental disorder enter treatment with a mental health professional’; (Robbins 147).
The primary practitioners of biological services are the psychiatrists. They specialize ‘in the diagnosis and treatment of psychological disturbances, according to a medical model’; (Kim 89). Psychiatrists use medications, physically based treatments, along with psychotherapy techniques to help a patient recover from depression (Kim 89). The most popular treatment for depression is the prescription of antidepressants, but like most drugs, antidepressant medications may cause side effects (Robbins 148). A recent study indicated that about two percent of adult Americans use antidepressants and that an estimated 20 to 30 million prescriptions for antidepressants were filled that year of the study (Robbins 148). Before prozac there was three major groups of drugs used in the treatment of depression (Winokur 115). The first type of drug that is used is the tricyclic. Tricyclics work as an electrical or chemical connection by causing transmissions of impulses from one cell to another (Winokur 116). The side effects that accompany the trycyclic group includes weight gain, dizziness, blurred vision, sweating, constipation, sedation, and cardiovascular problems (Robbins 149). The second type of drug that is used is commonly known as a MAO inhibitor (Robbins 150). MAO stands for monoamine oxidase; monoamine oxidase is an enzyme that is breaks down neurotransmitters in the human body. The process turns the transmitters into inactive substances. The MAO inhibitors stop this process of neurological breakdown (Robbins 150). Like trycyclics, MAO inhibitors also have side effects. These include problems with blood pressure, a loss of appetite, insomnia, and multiple reactions with multiple foods(Winokur 122). The third type of drug used in the treatment of depression is lithium. Even though lithium is a natural occurring substance in the human body (Winokur 123), it is only used in severe cases because of its many side effects and complications (Robbins 153-154). Lithium is known to cause nausea, stomach cramps, thirst, muscle weakness and tiredness, and a loss of both motor speed and memory (Robbins 153). Another popular drug used to in the treatment of depression is Prozac. Prozac acts similar to a trycyclic and also has qualities of an inhibitor (Robbins 150). Prozac is widely used and prescribed because it is highly effective and has very few side effects (Robbins 151). Along with antidepressants, psychiatrists also use others methods of treatment such as electroconvulsive therapy, or ECT. ECT is more commonly known as shock therapy. Shock therapy is said be effective, but, like antidepressants, also has side affects; patients of ECT are commonly affected by memory loss (Winokur 127).
Along with psychiatrists, depression is treated by psychologists. Psychologists approach their method of treatment assuming that the patients emotional disturbance is due to past experiences (Kim 95). Psychotherapy, often referred to as talk therapy, is ‘usually an exchange between therapist and client of ideas, perspectives, and philosophies’; (Kim 91). This type of treatment is effective, but not on all types of depression. Psychotherapy is ‘most helpful for less severe patients’; (Kim 91), which makes up the largest group of sufferers. There are many types of psychotherapy, but three are said to work the best (Robbins 157). The first of the three types of psychotherapy is cognitive-behavioral therapy; cognitive-behavioral therapy assumes that depression stems from irrational negative thinking. In cognitive-behavioral therapy the therapists teaches skills that enables a person to recognize the irrationality of their thoughts. The client is also taught problem solving skills and coping skills (Corsini 145). A second type of talk therapy is known as interpersonal therapy. In interpersonal therapy the therapist helps the client resolve a problem in a relationship (Robbins 162). The third psychotherapy is psychodynamic therapy. Psychodynamic therapy focuses on events from a persons far past and focuses on internal conflicts (Robbins 157). Talk therapy is less effective for severe depressions, but is helpful in changing ‘thinking patterns and behaviors that may have led to depression’;(Kim 95). Regardless of which type of therapists a depression patient decides to see, the first step in getting help ‘ is to find a suitable therapist to guide the patient through the process’; (Kim 87) of recovery.
In conclusion, depression is a psychological ‘condition of general emotional dejection and withdrawal’; (Webster 311). Depression affects people both mentally and physically (Kim 14). In order for a person to enter the realm of depression different biological, psychological, and sociological risk factors must exist (Kim 89). The severity of the depression experienced by a person is predispositioned by the severity of the risk factors experienced by that person. Even the most severe cases of depression can be treated with the help of professionals. Psychiatrists can prescribe drugs and biological means of treatment (Kim 90); psychologists offer psychotherapy as a means of help (Kim 90). ‘It is (also) important to look at what is happening in life from a perspective that does not turn everyday problems into overwhelming ones………Remember that everyone has bad days. The trick is to take them in stride. Research tells us that people who don’t catastrophize are less likely to become depressed’; (Robbins 180).