Myths & Facts: Depression
The best way to help individuals suffering from depression is to spread awareness about the misconceptions surrounding this mood disorder.
- By Ronale Tucker Rhodes, MS
DEPRESSION IS the leading cause of disability in the world. In October 2020, the World Health Organization (WHO) reported more than 264 million people suffer from depression worldwide.1 Also in 2020, the National Institute of Mental Health reported an estimated 21 million adults (8.4 percent) in the United States had at least one major depressive episode, with episodes higher among adult females (10.5 percent) compared to males (6.2 percent). The prevalence of adults with a major depressive episode was highest among individuals 18 to 25 years old (17 percent). But, depression doesn’t affect only adults. An estimated 2.9 million (12 percent) children and adolescents 12 to 17 years old in the United States have had at least one major depressive episode with severe impairment.2
One of the most common mental health disorders in the U.S., depression has affected some of the most noted people in history, including Abraham Lincoln, Stephen Hawking, Michelangelo and Winston Churchill.3 Unfortunately, even for them, there were and continue to be countless stigmas and misconceptions about this serious mood disorder that need to be debunked to help heal those suffering from it.
Separating Myth from Fact
Myth: Depression is all in a person’s head.
Fact: Depression is very real. It is a serious mood disorder caused by a combination of biological, environmental and social factors that impact a person’s thoughts and emotions and how they handle daily activities such as sleeping, eating or working. Depression can also cause individuals to feel physically sick with fatigue, aches and pains.4
There are several types of depression, including major depression and persistent depressive disorder (the two most common forms), perinatal depression, seasonal affective disorder, depression with symptoms of psychosis and bipolar disorder. With major depression, symptoms that typically interfere with the ability to work, sleep, study and eat persist most of the time for at least two weeks. With persistent depressive disorder (dysthmia), the symptoms are less severe and last typically for at least two years. A couple of types of depression develop due to specific circumstances. For instance, perinatal depression is major depression either during pregnancy or after delivery, and seasonal affective disorder comes and goes with seasons. Depression with symptoms of psychosis is the most serious, causing individuals to experience delusions (disturbing, false fixed beliefs) or hallucinations (hearing or seeing things others don’t see or hear). Bipolar disorder, previously referred to as manic depression, causes depressive episodes, as well as manic episodes that include elevated moods such as feeling happy, irritable or “up” with a marked increase in activity level.5
Myth: Depression is a normal part of life; everyone feels sad from time to time.
Fact: While depression can involve sadness, depressive symptoms go far beyond that. As mentioned, depressive symptoms can be emotional, cognitive, psychological or physical (see Signs and Symptoms of Depression). They can also vary in severity, duration and impact, and they can be unexplained, even when things in life seem to be going well.6 For instance, feelings of sadness usually go away on their own, but depression can last from a few weeks to an entire year or longer.
Signs and Symptoms of Depression8
- Persistent sad, anxious or “empty” mood
- Feelings of hopelessness or pessimism
- Feelings of irritability, frustration or restlessness
- Feelings of guilt, worthlessness or helplessness
- Loss of interest or pleasure in hobbies or activities
- Decreased energy, fatigue or being “slowed down”
- Difficulty concentrating, remembering or making decisions
- Difficulty sleeping, early morning awakening or oversleeping
- Changes in appetite or unplanned weight changes
- Aches or pain, headaches, cramps or digestive problems without a clear physical cause and that do not ease even with treatment
- Suicide attempts or thoughts of death or suicide
Myth: Depression and anxiety are the same thing.
Fact: Anxiety and depression can be related, and they can cause similar symptoms, but they are two different conditions with their own causes. According to the Anxiety and Depression Association of America, many people diagnosed with depression have a history of anxiety; however, many also experience one without the other.7
Myth: Only adults are affected by depression.
Fact: Depression can develop at any age. While depression often occurs during adulthood, approximately three million children and adolescents suffer from it as well.
What’s important to know is that depression isn’t a one-size-fits-all condition. Symptoms differ depending on factors such as gender, life situation and age, and include:8
- Young children: being anxious or cranky, pretending to be sick, refusing to go to school, clinging to a parent or worrying a parent may die.
- Older children and teens: getting into trouble at school, sulking, being easily frustrated, feeling restless or having low self-esteem. This age is more likely to experience excessive sleepiness and increased appetite. Older children and teens may also have other disorders such as anxiety and eating disorders, attention-deficit hyperactivity disorder or substance use disorder.
- Young adults: being more likely to be irritable; complaining of weight gain and/or hypersomnia; and having a negative view of life and the future. They also often have other disorders such as generalized anxiety disorder, social phobia, panic disorder or substance use disorders.
- Middle-aged adults: having more depressive episodes, decreased libido, middle-of-the-night insomnia or early morning awakening. They may also experience gastrointestinal symptoms such as diarrhea or constipation.
- Older adults: symptoms that may be less obvious, but generally include sadness, grief or an overall lack of emotion. They are more likely to have other medical conditions or chronic pain that may cause or contribute to depression. Memory and thinking problems may also be prominent.
Myth: Only sensitive or emotional people are affected by depression.
Fact: People with specific personality types are not more likely to be affected by depression. And, while it is unknown what truly causes depression, whether it’s genetics, behaviors, the environment, etc., it is known that chemical messengers in the brain regulate individuals’ functions, including mood. Three transmitters are currently linked to mood: dopamine, serotonin and norepinephrine. When the brain produces too many or too few of these chemicals, their levels become unbalanced, which may lead to depression or other mental health disorders. And, since physical and emotional changes take place internally over time, depression can affect anyone, regardless of how sensitive they may be.6
Myth: Depression is caused by a traumatic event.
Fact: A traumatic event such as the loss of a loved one can trigger sadness and loneliness, but it doesn’t cause depression. On the other hand, a traumatic event can heighten or intensify the symptoms of depression.3
Myth: Depression isn’t genetic.
Fact: Research shows there is a 50/50 chance of someone developing depression if it runs in the family. However, it’s a combination of genetic and external life experiences that determine whether depression surfaces.3 In addition, other possible contributing factors of depression include certain medications, co-existing mental health conditions, substance use, chronic physical illness, gender identity, poor diet and nutrition, chronic stress and certain personality traits.6
The upside to a genetic link is that family members with depression may have a better understanding of the signs and symptoms, which can lead to a better chance of discovery and treatment. And, better medications to treat different kinds of depression could possibly be developed by current genome mapping research.3
The Connection Between Disease and Depression13
- Depression is experienced by:
- 25 percent of cancer patients
- 10-27 percent of post-stroke patients
- One in three heart attack survivors
- 50 percent of Parkinson’s disease patients
- One-third of persons with diabetes
- About 20 percent of women living with polycystic ovary syndrome
- Depression is the second-most common mental health condition among patients living with HIV
- Adults with a depressive disorder or symptoms have a 64 percent greater risk of developing coronary artery disease
- 33-50 percent of anorexia patients have a comorbid mood disorder such as depression
- More than 20 percent of Americans with an anxiety or mood disorder such as depression have an alcohol or other substance abuse disorder
Depression Statistics in the U.S.13
- Major depressive disorder is the leading cause of disability in the U.S.
- Major depressive disorder affects approximately 17.3 million (7.1 percent) of the U.S. population age 18 years and older in a given year.
- Major depressive disorder is almost twice as likely to affect women than men.
- 1.9 million children age 3 to 17 years have diagnosed depression.
- Seven million adults age 65 years and older are affected by depression.
- 40-70 percent of adult caregivers have clinically significant symptoms of depression.
- 17 percent of women with major depressive disorder have a high prevalence of low bone mass compared to 2 percent of women without major depressive disorder.
- Depression contributes to the estimated $100 billion annual cost of depression for employers, including $44 billion a year in lost productivity.
- Depression is the cause of more than two-thirds of suicides in the U.S. each year.
Myth: Depression can’t be diagnosed.
Fact: Depression can be diagnosed. The criteria for diagnosis is having five depression symptoms (see Signs and Symptoms of Depression) every day, nearly all day, for at least two weeks. One of those symptoms for adults must be a depressed mood or a loss of interest or pleasure in almost all activities. Children and adolescents, on the other hand, may be irritable rather than sad.
When being evaluated for depression, physicians will ask when symptoms began, how long they last, how often they occur and whether they keep the individual from going out or performing their usual activities. The physician will also rule out certain medications or medical conditions that can cause the same depression symptoms.8
Myth: Depression does not need to be treated.
Fact: People who are depressed can’t just “shut it off.” Treatment is necessary to address symptoms. Otherwise, without treatment, depression can worsen and lead to self-harming behaviors or suicide.4
Myth: Depression can be treated only with medication.
Fact: Treating depression usually involves medication, psychotherapy or both, and in some instances may require electroconvulsive therapy (ECT) or other brain stimulation therapies. Choosing the right treatment plan is based on each person’s individual needs and medical situation, and it often takes trial and error to find the plan that works best.
Antidepressants are commonly used medications to treat depression, but they take time — usually four to eight weeks — to improve symptoms. These medicines help to improve the way the brain uses certain chemicals to control mood or stress, and several different types may need to be tried. Typically, a course of antidepressants will last between six and 12 months, and the medication will be tapered before being stopped.5,8 It’s important to note that while antidepressants impact the chemicals in a person’s brain, they have no impact on personality, which is a common patient concern.4 Currently, there are six different classes of medications approved to treat depression: selective serotonin reuptake inhibitors (the most commonly prescribed), serotonin and noradrenaline reuptake inhibitors, tricyclic antidepressants, monoamine oxidase inhibitors, norepinephrine and dopamine reuptake inhibitors, and noncompetitive N-methyl-D-aspartate receptor antagonists (see Antidepressant Medications and Common Side Effects).
When at least two antidepressants are tried, and they don’t improve symptoms of depression, it is known as treatment-resistant depression. A newer U.S. Food and Drug Administration-approved medicine for treatment-resistant depression is esketamine (sold under the brand names Spravado, Ketanest and others), also known as ketamine or S-ketamine, a dissociative hallucinogen medication. Ketamine is delivered as a nasal spray and often acts rapidly, typically within a couple of hours. This medication is usually given in connection with an oral antidepressant. Another option for treatment-resistant depression is to add a different type of medicine that makes an antidepressant more effective such as an antipsychotic or anticonvulsant.9
Psychotherapy (talk therapy or counseling) can help by teaching new ways of thinking and behaving and ways to change habits that contribute to depression. Two effective psychotherapies are cognitive behavioral therapy (CBT) and interpersonal therapy (IPT). With CBT, individuals learn to challenge and change unhelpful thinking patterns and behavior using mindfulness principles and specialized forms of therapy targeting particular symptoms such as insomnia. The goal of IPT, which focuses on interpersonal and life events, is to help improve communication skills with relationships, establish social support networks and develop realistic expectations when crises or other issues arise.5,8
There are two common forms of brain stimulation therapy: electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS). ECT involves a brief electrical stimulation of the brain while the patient is under anesthesia, typically administered by a team of trained medical professionals that includes a psychiatrist, an anesthesiologist and a nurse or physician assistant. Extensive research has found ECT to be highly effective for the relief of major depression, with clinical evidence indicating that for individuals with uncomplicated, but severe major depression, ECT will produce substantial improvement in approximately 80 percent of patients.10 rTMS uses painless, magnetic pulses to help lessen the symptoms of depression. Patients do not have to be hospitalized, and they don’t need sedation or anesthesia. A course of rTMS is five times a week usually lasting four to six weeks.11
Myth: Depression is not a big deal.
Fact: Depression is a serious condition that can cause individuals to withdraw from loved ones, take dangerous risks or start conflicts with others. It can also lead to thoughts or actions of a suicidal nature, which makes it a very big deal.
Dispelling the Myths Now
More than 47,000 Americans died by suicide in 2017, according to the Centers for Disease Control and Prevention. And, it is estimated that up to 60 percent of people who commit suicide have major depression. Thankfully, estimates suggest the suicide risk for the millions of individuals suffering from mental disorders, including depression, hovers around 5 percent to 8 percent.12 While that’s somewhat reassuring, depression is a serious illness, so it is imperative that health professionals help to dispel the myths surrounding it and the stigmas accompanying it.
While many wear pink ribbons in October in honor of breast cancer awareness month, there is another color to add to the mix in October: green. For millions of people, a green ribbon represents depression awareness month, and much like those who don pink in October, the green ribbon of depression awareness asks individuals to recognize signs and symptoms of the disease, promote funding in research and treatment and be aware of the importance of screening.
Antidepressant Medications and Common Side Effects9
| Medication | Side Effects |
|---|---|
| Selective serotonin reuptake inhibitors |
|
| Serotonin and noradenaline reuptake inhibitors |
|
| Tricyclic antidepressants |
|
| Monoamine oxidase inhibitors |
|
| Norepinephrine and dopamine reuptake inhibitors |
|
| Noncompetitive N-methyl-D-aspertate receptor antagonists |
|
References
- Single Care Team. Depression Statistics 2022 (Updated Feb. 15, 2022). Accessed at www.singlecare.com/blog/news/depression-statistics.
- National Institute of Mental Health. Major Depression. (Updated January 2022). Accessed at www.nimh.nih.gov/health/statistics/major-depression#part_155029.
- Unity Point Health. 11 Common Myths & Misconceptions About Depression, April 15, 2022. Accessed at www.unitypoint.org/desmoines/article.aspx?id=a655c7e2-fe37-4817-887b-c762ff455b23.
- The Recovery Village. 12 Common Myths About Depression, May 26, 2022. Accessed at www.therecoveryvillage.com/mental-health/depression/depression-myths.
- National Institute of Mental Health. Depression Overview. (Revised July 2022). Accessed at www.nimh.nih.gov/health/topics/depression.
- PsychCentral. Lingering Myths About Depression. Accessed at psychcentral.com/depression/what-depression-is-and-what-it-isnt.
- UPMC Western Psychiatric Hospital. Myths and Facts About Depression, May 28, 2020. Accessed at share.upmc.com/2020/05/myths-and-facts-about-depression.
- National Institute of Mental Health. Depression: Does Depression Look the Same for Everyone? Accessed at www.nimh.nih.gov/health/publications/depression.
- Cleveland Clinic. Depression Medications. Accessed at my.clevelandclinic.org/health/treatments/9301-depression-medicines.
- American Psychiatric Association. What Is Electroconvulsive Therapy (ECT)? July 2019. Accessed at www.psychiatry.org/patients-families/ect.
- WebMD. What to Know About Repetitive Transcranial Magnetic Stimulation (rTMS), June 29, 2021. Accessed at www.webmd.com/depression/repetitive-transcranial-magnetic-stimulation.
- Holmes, L. Rates and Statistics for Suicide in the United States. VeryWell Mind, June 24, 2021. Accessed at www.verywellmind.com/suicide-rates-overstated-in-people-with-depression-2330503.
- Depression and Bipolar Support Alliance. Depression Statistics. Accessed at www.dbsalliance.org/education/depression/statistics.
