Depression an Enormous Public Health Issue


Many in the United States do not regret the passing of 2008. For the majority of Americans, it has been a difficult year with a serious economic recession, increasing rates of unemployment, rising violence at home and abroad – the latter with increasingly open anti-American sentiments, and a contentious presidential election, to name only a few struggles.

For some, stressful events such as these will unmask psychiatric illnesses, such as depression.  There is a danger that if our country suffers more economic and security problems, many more of us will experience mental health problems.  The apparent suicide of Thierry de la Villehuchet, a financial manager directly affected by the Bernard Madoff scandal, is a tragic example of what  might become a more common occurrence.

Depression is already an enormous public health issue.  An estimated 20 million Americans already suffer from depression (approximately 6 million men and 14 million women).  In the late 1990s, the surgeon general stated that, including substance abuse, roughly 2 in 7 Americans have an active, diagnosable psychiatric syndrome.  Mental health disorders affect people of every race, age, and income level.  Financially, depression costs an estimated 83 billion dollars annually in the US, both directly (treatment costs) and indirectly (absenteeism and lost productivity).

• The most common is major depression, meaning that a person has symptoms for most of the day, almost every day, for at least two consecutive weeks.  The classic symptoms of depression include a persistent sad, anxious, or empty feeling, or feelings of hopelessness, worthlessness, helplessness, or pessimism.  These feelings are accompanied by a constellation of other significant symptoms, which can include low energy, fatigue, restlessness, crying, irritability, problems concentrating or remembering details or making decisions, insomnia or excessive sleepiness, loss of interest in activities or hobbies previously enjoyed – including sex, overeating or appetite loss, thoughts of self-harm, and such physical symptoms as pain, headaches, cramping, digestive issues, tingling or numbness, and feeling disconnected from oneself.

• Individuals who experience some of these symptoms, but to a lesser degree, have minor depression.
• Those who have less severe symptoms but experience them for more than two years, are termed dysthymic.
• Bipolar disorder includes symptoms of depression, alternating with periods of “mania,” defined as excitement manifested by mental and physical hyperactivity, disorganization of behavior, and elevation of mood. There is no cure for this illness, but even severe forms of bipolar disorder can be successfully treated.  Unlike depression, which can be episodic in nature, bipolar disorder is a chronic illness.
• Reactive, or situational, depression is a normal response to a traumatic or very stressful event, such as financial problems, job loss, or violence, and typically includes some of the symptoms listed above. Individuals who experience these reactive symptoms for more than two weeks, whose symptoms interfere with the activities of daily life or lead to substance abuse, most likely have a genetic predisposition to depression, and may also be candidates for treatment, even though the proximate cause is a specific event.

Depression is caused by a combination of genetic, biochemical, environmental, and psychological factors. Neurotransmitters are chemicals that our brains use to communicate. Depressed individuals have an imbalance of these chemicals, most often serotonin and norepinephrine.  Mental illness tends to run in families.

Rarely, medical conditions may cause, or contribute to, depression.  Most likely causes would be certain medications, drugs or alcohol, thyroid abnormalities, severe anemia, or such neurologic conditions as stroke or Parkinson’s disease. There are many other potential contributing factors; a health care provider can help you sort through potential confounding factors.

Treatment options typically center on prescription drugs and counseling.  Anti-depressant medications restore the proper balance of the neurotransmitters, the chemicals in the brain.  Medications take up to four weeks to become effective.

Most primary care providers are well versed in treating mood disorders or else could refer the patient to an appropriate mental health professional. Depression is typically treated for 6-12 months once remission, or symptom resolution, is achieved.  For recurrent bouts of depression, a longer duration of medication is required.

Bipolar disorder is usually treated with mood stabilizers, and in some cases with anti-depressants as well.  Because bipolar disorder is a chronic illness, long-term preventive prescription medication is required to maintain mood stability. Cognitive behavioral therapy is also advised.

Counseling is an integral part of recovery for many and, on a personal level, we can all make changes in our lifestyle to help combat depression.  For example, exercise has been proven in numerous studies to carry an emotional benefit, as well as improving our physical health.

Even 10 minutes of activity a day can help improve our mood in the short-term.  Setting realistic goals, establishing priorities, not isolating oneself, postponing important decision-making, confiding in others, and positive thinking can all be crucial factors in combating depression.

Unfortunately, the majority of depressed individuals do not seek treatment.  Suicide is tragic, and often a preventable result of severe, untreated depression.  Nationally, the rate of suicide is 11 per 100,000 persons.  In Oregon, the rate of suicide exceeds the U.S. rate; 15.4 of every 100,000 Oregonians take their lives, according to data from the American Association of Suicidology based on 2005 data.

Warning signs of suicide include thoughts of self-harm, substance abuse, purposelessness, anxiety, feeling trapped, hopelessness, withdrawal from previous activity/commitments/social encounters, anger, recklessness or mood changes. If you suspect someone you know may have such thoughts or displays these kinds of changes in their behavior, you should consider it a crisis and act upon your intuition by urging them to get help.  Options for those who are suicidal include calling their doctor, going to the local emergency room or calling 911, or calling the National Suicide Prevention Lifeline (800/273-TALK), where a trained professional is available to talk at anytime of day or night.

There have been a lot of press reports to the effect that anti-depressant medications can actually cause suicide.  Naturally, there has been a great deal of attention paid to this concern, and it turns out to be inaccurate.   Studies have shown no correlation in adults between suicide rates and anti-depressant medicine usage.

In children and adolescents, close study revealed that there is a slight increased risk of suicidal thoughts or behavior, but NO increased rate of completed suicides in a small group treated with anti-depressants versus those treated with a placebo.  Evidence argues that currently there is no known association between anti-depressant treatment and suicide, and that depressed teens/children should be treated with medication, albeit with close monitoring, particularly during the first three months of treatment.

It is important to appreciate that mental health problems , like depression, are biological in nature, meaning that certain people are born with a predisposition to these illnesses.  Depression is an illness like other chemical problems, such as diabetes or thyroid dysfunction. Mental health must be addressed by both the medical community and society, just like other common medical illnesses, so that those who suffer from mental illness can get the help they deserve.  Don’t hesitate to see your health care provider to address your concerns.

Jennifer Bechman, M.D., High Lakes Health Care,, 541/389-7741.


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