Depression basics
He came into my office for the first time smiling and with a firm shake of my hand. He patiently, albeit reservedly, answered my questions. He was blunt but not in a mean way. He had started hurting himself which had prompted his worried parents to give me a call. “In all honesty”, he reported to me with an ironic smile, “I don’t remember the last time I felt happy.” He was, like a third of Americans right now, experiencing a depressive episode. Yet, to look at him, you probably wouldn’t know.
This is the first post in a series on the most common mental health condition in America: depression. In this article, I’ll look at how common depression is in America, who is at risk for experiencing it, and how it can impact our lives.
When you’ve finished reading, I hope you can better identify with either your own struggles or that of someone near to you. I hope you understand the need and the urgency of getting professional help. As depression has a strong link to life-threatening behaviors (from suicide attempts to substance use), my hope is that you will see the importance of calling a mental health professional like me even if you are not sure.
How many people are affected?
Historically, about 7-10% of Americans in any given year would experience a depression-related mental disorder. These historic numbers were stable. These older statistics featured a skew toward the young and toward women. As Americans aged, rates of depression generally dropped. Women were more represented among the depressed (8% of women reporting depressive symptoms versus 5% of men).
In the previous decade (2010-2019), a new trend developed in which the incidents of depression overall increased, but the increase among teens and young adults doubled. As NYU professor and author Jonathan Haidt pointed out, this increase bore out not just in diagnosis but also in behavior. Teen rates of self-harm and suicide attempt increased dramatically from 2011 to 2018.
Then we hit the pandemic. Rates of depression soared for the population from 7 percent to 40 percent. Rates of teen self-harm and suicidality nearly doubled in 2020-2021 according to the US federal government. Keep in mind the pandemic doubling was atop already elevated rates from the previous decade.
Behind these statistics is the painful reality that, among adults, if you are not experiencing a depressive episode, you know several who are. These are your coworkers and neighbors and family members. Many are medicated or in therapy, but depression remains (stubbornly) among the most undertreated illnesses in our country.
“Depression remains the most undertreated mental health problem in America.”
So, who is vulnerable?
First and foremost, the young. Rates of depressive episodes are many times higher for each successive age cohort. This makes some sense when we account for stage of life development issues. Young people are full of potential and have their entire lives ahead of them, true. Yet that potential and blank slate also presents many vast unknowns. Serotonin, an important neurotransmitter that mediates the emotions of happy and sad, elevate as our status in society and community increases. Teens and young adults, often by definition, lack that status. For some, the physical changes of adolescents, the uncertainty of starting out in life, and the drumbeat of relationship changes (read, relationship losses) connected to moving through high school, to college and/or early career produces a perfect storm for depression.
Exacerbating the challenge is the universal adoption of social media in the US by younger cohorts. Social media is engineered to inflame negative emotion to keep users engaged. Social media is engineered to create addictions to the platform. This double-hit means younger generations of Americans are more primed for negative emotion and more isolated than any previous generation.
Women are the other vulnerable subgroup. Women account for 60 percent of depression diagnoses. The female brain is (on average) more connected across hemispheres which enhances emotional awareness. The female brain is also (on average) slightly more sensitive to negative emotion – a biological feature which serves the role of primary caregiver to infants. Yet in modern society, these biological traits mean women are more likely to experience depression than their male counterparts.
Finally, men who our society has trained to ignore emotions are vulnerable to depression. Men are sometimes trained in culture to push away, hide, or ignore emotion. When combined (on average) with a more hemispherically separated brain, some men have great difficulty identifying or processing emotions. But emotions are, alas, biological, and when the thinking bits of the brain do not acknowledge and coordinate a response with the emotion-generating bits of the brain, the signal gets pushed to the body. This means some men experience and express depression through physical symptoms like digestive problems, headaches, loss of interest, risky behavior, and explosive anger.
“Adolescents, young adults, and women are statistically more likely to experience a depressive episode, but undiagnosed depressed men are more likely to die from depression related suicide.”
What’s the damage?
The damage caused by depression, and especially untreated depression, is considerable and multi-faceted. Physically, depression wreaks havoc on the rest of our body as it affects the control center of the body – our brain. Depression increases the body’s inflammatory response, increases the production and use of stress hormones, changes the heart and circulatory functioning, and the metabolic (digestive) processes. While many past clients of mine have associate depression as either a brain issue or maybe even a behavioral problem, it is vital to remember that that which hurts the brain, hurts the body. [Expand this list]
Tragically, depression also is present among those at risk for taking their own lives. Left unchecked, depression can be fatal in this way as some lose hope altogether. Women are more likely to attempt and men more likely to complete a suicide act.
Psychologically, untreated depression is both cause and effect to feedback loops between the emotional center of the brain and the thinking (cognitive) parts of the brain. Depression means that we experience negative emotion - especially sadness - too intensely and for too long. Our thinking brain, which functions much more slowly than our emotion centers, becomes coopted to reinforce the negative emotion. We feel sad. We think in ways that reinforce that emotion. We feel more sad. Depression can cause a person to feel trapped in a psychological prison of their own making.
Depressive episodes (and especially untreated depressive episodes) pummel our relationships. The emotion of sadness naturally occurs when we experience loss and motivates us to isolate for recovery. When depression makes our sadness too intense or last too long, we isolate and conserve energy for no reason. Those around us may misinterpret these actions as rejection or anger or antisocial cues. These interpersonal disconnects in our relationship can create a feedback loop in a depressed person’s outside world not unlike the one happening in their inner world. Lethargy, low interest, and low energy get misinterpreted by those with whom we need to connect. Friends, family and coworker react negatively. Their reaction drives us further into isolation which reinforces the sadness.
Prepandemic research estimated the 2018 cost in the US of depression to be $236 billion (a significant rise from 2010 even when adjusted for inflation). This figure included lost productivity at work, the cost of treatment, and suicide related costs. To put that in perspective, depression cost the US the same as the federal government’s Department of Education budget. Depression costs Americans some six times the amount provided to support Ukraine this year.
“Depression hurts our bodies and relationships and wallets.”
When in doubt, get help!
For all the harm depression inflicts on those affected by it, those experiencing depressive episodes are among the least likely to seek help. Many times it is their spouse, their parent, or their close friend that needs to help them get help. When you feel depressed, it’s sometimes easier to minimize the experience to themselves than to confront the sadness that seems so overwhelming.
“I’m just in a funk,” I’ve heard more than one depressed person say. “Others have it worse than me.” This can be the second heartache of this problem: those who need help find reasons to avoid it.
But as this whole post has endeavored to show– there is a lot at stake. Getting help - or getting your teen help - can avoid so much misery. You are not likely trained to diagnose depression related dynamics in your family and friends. So, please! Err on the side of getting seen. Err on the side of getting help. Err on the side of yes.
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