Almost everyone gets "down in the dumps" or has "the blues" sometimes. Feeling sad or dejected is clearly a normal part of the spectrum of human emotion. This situation is so common that a very important issue is how to separate a normal blue or down mood or emotion from an abnormal clinical state. Most clinicians use measures of intensity, severity, and duration of these emotions to separate the almost unavoidable human experience of sadness and dejection from clinical depression.
Depression is seen in all social classes, races, and ethnic groups. It is so pervasive that it has been called the common cold of mental illness in the popular press. It is approximately twice as common among women as it is among men. Depression is seen among all occupations, but it is most common among people in the arts and humanities. Famous individuals such as American president Abraham Lincoln and British prime minister Winston Churchill had to cope with depression; Churchill called the affliction "the black dog." More recently, United States senator Thomas Eagleton and astronaut Edwin "Buzz" Aldrin were known to have bouts of serious depression.
Of all problems that are mentioned by patients at psychological and psychiatric clinics, some form of depression is most common. It is estimated that approximately 25 percent of women in the United States will experience at least one significant depression during their lives. Contrary to a popular misconception that depression is most common among the elderly, it is actually most common in twenty-five- to forty-four-year-olds. About 10 percent of the college population report moderate depression, and 5 percent report severe depression. Suicidal thoughts are common in depressive clients. In long-term follow-up, it has been found that approximately 15 percent of depressed individuals eventually kill themselves. Alternatively viewed, approximately 60 percent of suicides are believed to be caused by depression or by depression in association with alcohol abuse. As has been vividly portrayed in the media, teenage suicide in the United States is increasing at an alarming rate.
The role of family or genetic factors in depression was addressed long ago by Robert Burton in The Anatomy of Melancholy (1621), in which he noted that the "inbred cause of melancholy is our temperature, in whole or part, which we receive from our parents" and "such as the temperature of the father is, such is the son's, and look what disease the father had when he begot him, his son will have after him." More than 350 years later, the role of family factors in depression was addressed in a major collaborative study in the United States. In what was called the National Institute of Mental Health Collaborative Study of the Psychobiology of Depression, a large number of standardized instruments were developed to assess prevalence and incidence of depression, life histories, psychosocial stressors, and outcome of depression. The family members of depressed persons were assessed along with the depressed individual. It was found that bipolar depression was largely confined to relatives of individuals with bipolar disorder. Unipolar depression, however, was common among relatives of both unipolar- and bipolar-depressed individuals. The different patterns of familial transmission for bipolar and unipolar disorders strengthen the general conviction that these two disorders should be kept distinct from each other.
One explanation for increased vulnerability to depression in close relatives of depressed individuals is an inherited deficiency in two key compo-
nents of brain chemistry: norepinephrine and serotonin, both of which are neurotransmitters. If depressions could be reliably subtyped according to the primary neurotransmitter deficiency, the choice of antidepressant medication would logically follow. Research is conflicting, however, on whether there is one group of depressed individuals who are low in norepinephrine and normal in serotonin and another group of depressives who are low in serotonin and normal in norepinephrine. Future developments in the study of neurotransmitters may have practical implications for the matching of particular pharmacotherapy interventions with particular types of depression. Evidence does indicate that for many depressed patients, substantial alteration in neurotransmitter activity occurs during their depression. This altered activity may directly mediate many of the disturbing symptoms of depression.
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Are You Depressed? Heard the horror stories about anti-depressants and how they can just make things worse? Are you sick of being over medicated, glazed over and too fat from taking too many happy pills? Do you hate the dry mouth, the mania and mood swings and sleep disturbances that can come with taking a prescribed mood elevator?