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General Information
CBS CARES: What is depression?
DR. KAHN: Depression, aside from many other uses of the word in our language, is a serious medical condition in which specific symptoms are present to a degree that results in prolonged emotional pain, difficulty functioning, poor physical health and, when severe, even death by suicide.
CBS CARES: Why do people get depressed?
DR. GLASSMAN: Almost everybody gets depressed in relationship to some kind of disappointment or loss. Psychiatrists put the label "major depression" on episodes that are persistent, lasting weeks or months rather than hours or days, and involve not just unhappiness but also a loss of interest or motivation. Sometimes people even become suicidal. Like less severe depressions, they are usually the result of loss or disappointment or some similar stressful event. Some individuals are probably more vulnerable to experience more severe depressions, and depressions do have some propensity to run in families.
CBS CARES: Depression seems like a normal reaction to various events. At which point is it a healthy, normal response and at which point does it become clinical and require treatment?
DR. KAHN: Depression, in the sense of the disorder defined by the symptoms mentioned, is not a normal response to events. Sadness, frustration, reflection, and grief are normal, but if a person loses interest in normal activities, can't function at work or at home due to poor concentration, has disrupted sleep and appetite, voices suicidal thoughts, and has other symptoms, and if these last more than two weeks, there should be consideration that a depressive illness has developed.
CBS CARES: How is depression different from sadness?
DR. KAHN: Sadness follows losses or disappointments, and is a normal part of any fully lived life. Healthy people eventually rebound, and apart from periods of grief or mourning rarely cease functioning in daily activities. Moreover, healthy people do not tend to blame themselves for the normal losses of life, whereas depressed people often feel undue guilt or self-criticism. Finally, individuals with depression often experience marked sadness in the absence of any cause, whereas healthy individuals have moods that relate more to life experiences, and moods that are in proportion to the intensity of those experiences.
CBS CARES: What do you have to say to someone reading this who feels hopelessly depressed or suicidal and feels there is no way out?
DR. KAHN: If you feel hopelessly depressed you should know that, right now, human contact is the most important thing. Next, are you receiving treatment? No matter how hopeless you feel, there is always something that can be done to help alleviate a devastating situation, some way to make it to the future, and always more that can be done to provide effective medical treatment if the illness is ravaging your mind.
CBS CARES: How many Americans suffer from chronic depression?
DR. WEISSMAN: The prevalence of depression varies by whether you define it as moderate or severe or whether you include mild depressions without impairment. But let's just take the moderate case; I think the conservative figures are that about 10 percent of adults will experience a moderate depression sometime in their lives. Now, if you include the more mild depressions, then the figure gets up to about 15 percent.
CBS CARES: How many of these people are children?
DR. WEISSMAN: We have to separate out the difference between children and adolescents. The prevalence of depression in children, that's before puberty, is relatively low--probably less than half a percent. However, at puberty you begin to see the big increase in onset of depression. From age 15 it really starts to skyrocket, especially in females. A good number of adult depressions begin in adolescence and are recurrent into adulthood.
CBS CARES: If someone has a first serious depressive episode, how likely is it that they will have another depressive episode in their life?
DR. GLASSMAN: About half of individuals experiencing a major depression will only have a single episode in their whole life, but in the other half the episode will recur. Once it starts to recur, with each additional episode it becomes more likely to recur again.
CBS CARES: What is most misunderstood about depression?
DR. KAHN: Depressed people are often told just to get their act together, or snap out of it. This is no more possible than telling someone with arthritis to just stop feeling pain in his or her joints. Depression is real and persists longer if not treated. It is serious and can result in poor physical health or even death, including suicide. Moreover, people with depression may have the symptom of hopelessness about ever getting better and may be reluctant to begin treatment, so it is important for families to be involved.
CBS CARES: What does it say about human nature that depression and other mental illness are still viewed as a stigma?
DR. SILBERSWEIG: The stigma may reflect a residual dualism, whereby people have a hard time realizing that human emotions and behavior are associated with brain function, or in this case, dysfunction. The more that one understands about the biology of mental illness, the more one can realize that, even with all the important psychological factors, certain types of mental illness reflect brain dysfunction in a manner that is not fundamentally different in some regards from disease in someone with kidney or heart dysfunction (which manifest with different symptoms).
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