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Who Gets Depressed and Why?

Depression, the most common of mental illnesses, can strike anyone at any age. Although most cases occur in adults between ages 25 and 44, depressive illness seems particularly troublesome for certain groups such as women, adolescents and the elderly. The depression among these groups mirrors that in the rest of the population, but with some distinct features.

WOMEN: About 26 percent of American women experience clinical depression at some time in their lives. With the exception of bipolar depression, the incidence of depressive illness is twice as high for women as for men, and not simply because women are more likely to talk about their feelings, as was once believed. The National Task Force on Women and Depression concluded that unreported depression also occurs twice as often in women as in men.

As many as 80 percent of women have mild to moderate mood changes during the premenstrual period, although only a few experience the severity of depression. About half of women also have at least mild symptoms of depression during the first two weeks after giving birth. Prolonged or severe postnatal depression is the exception not the rule except in women with a history of depression. Mid-life physical changes and the flight of children from the home can trigger feelings of irritability and despair, but these probably are not related to menopause because they also occur in men.

Most counselors think social and cultural factors play at least as significant a role in depression as biology. A study by the National Institute of Mental Health found that about 50 percent of wives in unhappy marriages are clinically depressed and, according to other studies, are three times more likely than their husbands to get depressed about relationship problems. Some believe women in bad relationships are more prone to low self esteem because they have been taught by their culture to be passive and put others' needs before their own.

One study found that unemployed women in unhappy marriages had a higher rate of depression than working women who also suffered from high stress at home. Mothers of young children, particularly single mothers with several youngsters, are at high risk of depression, as are women who have been assaulted, low-income women, minorities, lesbians, the elderly and women who are alcohol or drug dependent.

ADOLESCENTS: Adolescence is considered a time of emotional turmoil, but most young people of both sexes actually get along fairly well with their parents, teachers and friends and do not feel miserable and misunderstood. Adolescent depression may be expressed in angry, aggressive behavior as well as lethargy and listlessness. A young person who starts
to use drugs and loses interest in school work, friends and outside activities may well be demonstrating depression rather than teen rebellion. Perhaps because they are more impulsive, teenagers are more likely than adults to attempt suicide, and they are also frequently successful.

One study comprised of 67 adolescents who committed suicide found that more than 80 percent had been severely depressed. Some studies found low levels of 5-HIAA, a byproduct of the neurotransmitter serotonin, in the spinal fluid of teens and adults who committed suicide.

The more serious forms of depression tend to run in families. A child with a depressed parent or sibling has a 15 percent risk of becoming depressed. Among grandchildren, nephews and nieces, the risk is about seven percent. A child with no depressed relatives has only a two to three percent risk.

Depression in children and adolescents can be due to alcohol
or drug abuse; it may also be linked to stresses related to the loss of a parent or sibling, a move to a new town or neighborhood, divorce, or a disability that leads to poor performance at school.

SENIORS: Recent surveys found a relatively low rate of major depression among Americans 65 and over living within the community. Even though seniors may be less likely to have a diagnosis of depression, they report at least as many symptoms of depression as younger Americans. Moreover, seniors account for about a quarter of the nation's suicides, even though they comprise only 12 percent of the population. The reason for the discrepancy may be that seniors are prone to milder, lingering forms of depression as well as symptoms of depression following a heart attack or stroke or brought about by medications such as those used to treat high blood pressure or arthritis.

Depressed seniors often exhibit hypochondriasis, a preoccupation with physical complaints. In addition to the usual symptoms, depressed seniors often have memory loss, confusion and disorientation leading many
doctors to confuse depression with Alzheimer's disease or other dementias. To make diagnosis even more difficult, 20 to 25 percent of Alzheimer's patients display symptoms of depression, particularly during the early stages of the disease.

Seniors, like adolescents, have so many reasons to feel blue that depression is often overlooked. The death of a spouse may bring on moderate to severe symptoms such as problems with sleeping and eating. Traumatic life events often do precede the initial episode of depression. Some believe that this stress may bring about long-lasting changes in the biology of the brain, making one vulnerable to a recurrence. Depression can and does occur when least expected and for no apparent reason.

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Last modified: Saturday, April 19, 2014

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