Depression is one of the more common mental health issues that afflict people, and it’s occurrence is on the rise. The World Health Organization already cites depression as the fourth most significant cause of suffering and disability worldwide (behind heart disease, cancer, and traffic accidents), and by 2020, it is projected to escalate to the number two position. Also noted by the WHO is that most people who need help for depression do not receive it (due to a number of factors). In America, 23 million Americans suffer from depression at any given time; it is the most common mood disorder in the United States. The average age of onset is the mid-20's, but this average has been trending downwards. In fact, adolescents are the fastest growing age group of sufferers of depression. Only about 25% of people with depression in the United States receive treatment for it. About twice as many women as men are diagnosed with depression, and depression is 1.5 to 3 times more common among first degree biological relatives.
The best way to conceptualize depression is as a biopsychosocial phenomenon. That is, depression has a biological, psychological, and social component. The biological component consists of an individual’s genes and biochemistry, as well as diseases and substance use/abuse (one can end up with depression as a stand-alone diagnosis as a result of a medical condition, as well as from certain types of substance use - even if the substance abuse is subsequently discontinued). The psychological component of depression consists of cognitive distortions, certain attribution styles, previous history and experiences (and resultant “lessons learned” from those experiences). Lastly, the social elements of depression include social disturbances, social distress, and cultural influences. Taken together, it is important to view depression as a complex syndrome, with many facets, rather than with a single explanation.
Depression can exist as a stand-alone disorder, but it often co-exists with other disorders (remember, it is more common to have more than one mental health issue, rather than just one). Disorders that are frequently co-morbid with depression include anxiety disorders (in fact, anxiety is often a precursor to depression), substance abuse problems (especially alcoholism), anorexia/bulimia, personality disorders, and medical conditions. The presence of one or more disorders in addition to depression must be factored into a treatment plan, and it makes treatment more complex.
Anxiety, in particular, is strongly associated with depression. Approximately 60-70% of people with Major Depressive Disorder also suffer from an anxiety disorder, in this order: social phobia, simple phobia, PTSD, generalized anxiety disorder, and agoraphobia. Intuitively, this makes sense. If one is worried all the time (or experiencing or symptoms of anxiety), that interferes with your life, which gets depressing. If one is chronically depressed, things don’t get done, which creates anxiety. They go hand-in-hand. If someone has anxiety first (that is, anxiety is the primary disorder), the risk for secondary depression onset is 2-4 times greater than for people without an anxiety disorder. The relevant issues are the number of anxiety symptoms/disorders present, the presence of avoidance behavior, and the degree of psychosocial impairment - the more these are present, the greater the likelihood of onset of depression.
In one of my next posts on this subject, I will continue to chronicle the overlap between depression and anxiety. The good news - therapy for both is similar, and improvement in one area often leads to improvement in the other.
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