This week, part 1: depression

By Alan Koenigsberg, M.D.

I want to express a big thank-you to all those friends and family I have run into this past week, who have taken me aside and thanked me for the articles that the TJP has published these last few months.

At a recent bat mitzvah, several family members commented on past articles and suggested new topics, specifically about gun control and universal health care.

At my shul, during a Men’s Club breakfast, suggestions for additional ideas were shared, mostly about getting along with family during the holidays.

And just yesterday I ran into an old friend, who thanked me for the articles and told me how they have been personally helpful and asked me to write more about depression.

So here goes:

Everyone gets “depressed.” That’s what I have heard for years, in the context of why is depression made into such a big deal. Here is my response: Yes, everyone gets sad, grieves and feels down at times. That’s a normal, healthy response to loss, trauma, stress, sleeplessness, being let go at work, giving birth and so on.

If those in psychiatry knew more about the inner workings of the brain years ago, perhaps we would have called these conditions “ neuronal brain dysfunction” or “amygdala dysregulation,” but instead, we termed those conditions “major depressive disorder,” which many people have shortened to “depression.”

It’s unfortunate because, in my opinion, it’s confusing and diminishes how serious these conditions can be. Depressive disorders account for the second-highest cause of disability. People with depressive disorders suffer from a very real, debilitating condition which affects them physically, emotionally, in their relationships, work and just about everywhere.

Symptoms include sadness, anxiety, change in appetite, change in sleep patterns, helplessness, hopelessness, physical pain, fatigue, apathy, difficulty concentrating, lack of pleasure, lack of motivation, low energy, difficulty making decisions, lowered sex drive, feelings of worthlessness, guilt and suicidal thoughts.

Many of these symptoms may occur at times in most of us, and they go away quickly. Many of these symptoms may overlap with a serious loss, and are part of normal grieving. Some of these symptoms may be caused by general medical illnesses, such as diabetes, cancer and low thyroid. Some may be the result of other medications taken.

Chronic consumption of alcohol may induce many of these symptoms and mimic a depressive illness. Alcohol is a depressant of the central nervous system.

Chronic use of some drugs may do the same, as may withdrawal from drugs or medications.

The proper evaluation and diagnosis of these conditions is a serious one and needs a lot of time to ascertain and review. The symptoms vary considerably from person to person.

Depressive illnesses may last for months or persist for years. There are genetic factors for many people, meaning that the vulnerability for depressive disorders is in part genetic. This should not be surprising, given how many of our traits are inherited, and the brain, being the most complex organ of the human body, is not exempt from this process.

The prevalence of depressive disorders is about 12%, meaning about 12% of the population will experience a depressive disorder at some time. That’s a lot of people and, obviously, it’s not rare.

I’ll write about treatment in the next article.

Alan Koenigsberg, M.D., is a practicing psychiatrist and clinical professor of psychiatry at UTSW Medical School in Dallas.

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