Not your grandfather’s depression

My grandfather was a caricature of the stolid working-class, blue-collar, hard-scrabble miner whose parents came to this country with virtually nothing. Nonetheless, he had nearly a dozen children, bought some land in the Pocono Mountains of Pennsylvania, and built himself a house. He provided for his family without fail, and although they were never rich, they always had a roof over their heads and food on the table.

But he had his problems, too, not unlike those many of us face in modern life. He was a functional alcoholic, and it seems likely he suffered bouts of depression, especially in the later years of his life. What seemed like an interesting yet reclusive life to me as a child was actually something far worse.

Fifty years ago, very few people were diagnosed with depression, because our understanding of this mental disorder was pretty limited. Back then, mental health concerns were divided into either neurosis or psychosis. Depression was usually a type of neurosis, and treatment often involved rudimentary forms of psychotherapy and medications. More often than not, most people with depression neither recognized it, nor were treated for it. People like my grandfather.

We’ve come a long way since that time, and while some people still try and cope with their mental health concerns with alcohol, our understanding of how to identify depression and effectively treat it is significantly improved.

Depression today is defined by someone who has a significantly depressed (or “blue”) mood for at least two weeks, but more often has experienced such a mood for much longer before seeking treatment for it. The depressed mood has to have significantly affected a person’s everyday life in virtually all areas — work, school, home life and with friends. People with depression most often have little interest in things that they used to enjoy doing, whether it be a hobby, work, hanging out with friends, etc.

A major depressive episode is also characterized by the presence of five or more of these symptoms:

• Depressed mood most of the day, nearly every day (e.g., feeling sad or empty)
• Loss of interest or pleasure in all, or almost all, activities most of the day, nearly every day
• Significant weight loss when not dieting or a significant weight gain (e.g., a change of more than 5% of body weight in a month); or decrease or increase in appetite nearly every day
• Insomnia (inability to sleep) or hypersomnia (sleeping too much) nearly every day
• Significant restlessness
• Fatigue or loss of energy nearly every day
• Feelings of worthlessness, or excessive or inappropriate guilt nearly every day
• Diminished ability to think or concentrate, or indecisiveness, nearly every day
• Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

As you can tell, a lot of this is subjective. But that’s the nature of mental disorders — they are not pure medical diseases like cancer or asthma. They are biopsychosocial conditions, meaning they involve and are caused by three different components — the biological (and genetic), the psychological (the things you tell yourself, your personality, how you’ve learned to cope with stress, etc.), and the social (your interactions with others, your relationships, etc.). Despite the common misperception that depression may be caused by a set of genes, research has demonstrated this not to be the case.

It’s no surprise then, that recent research has shown that depression is becoming more frequently diagnosed. And with more diagnoses comes more treatment. A recent study found that antidepressant prescriptions — a significant component of treatment for depression — are also rising: 75 percent in a nine year period.

But antidepressants are only one component of successful treatment, as most people benefit more quickly from a combination treatment approach — psychotherapy and medications. Most antidepressant medications generally take 6 to 8 weeks to kick in, and most people will need to try more than one antidepressant before finding one that works for them. By combining medications with psychotherapy, a person can feel better sooner, and also learn what changes they can make in their life to help combat the stress and other risk factors that can lead to depression.

Today people who suffer from depression have a lot more options available to them than my grandfather did. Most physicians didn’t understand depression fifty years ago, and treatments were significantly limited. While we still have people who resort to alcohol to treat their depression, better treatment options now exist. Health professionals today have a much better understanding of depression, and can help people be successfully treated for it.

John Grohol Psy.D. Bio

Dr. Grohol researches and writes about mental health, psychology and technology issues.

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