Depression and Its Grip Over Society

Depression, also known as affective mood disorder and depressive illness, is perhaps one of the most emotionally, mentally, and physically destructive health problems present in today's society that continuously goes unrecognized and untreated. The illness is often indiscriminate in who it resides, affecting more than 17 million Americans of all races, ages, and gender. However, there is an increasing discrepancy between depression and gender, with female sufferers of the disease almost doubling male sufferers, except in cases of manic depression where the gender rates are about equal. Depression has grown rapidly among Americans since World War II so that the estimated number of Americans living today that will suffer from major depressive illness at some point in their lives has grown to approximately 35-40 million people. This large portion of the American population often suffer in silence, refusing to seek help, relying on the notion that it is "all in their heads". Yet, if this disease goes untreated it can not only destroy ones quality of life, but lead to a variety of other health problems, and can eventually lead to death by means of suicide.

The severity of the disease itself and its widespread consequences along with the alarming rate of individuals who suffer from it that don't seek treatment are reasons enough to shed light upon this subject by way of this paper. Furthermore, depression has affected me personally, as I have been battling its demons for several years. Since I am a woman who has suffered from depression, the fact that it affects women at twice the rate it does men did not go unnoticed. In fact, it triggered my curiosity, formulating questions in my mind like: what allows for this discrepancy either socially, mentally, or physiologically, or is there a reason at all? Apparently I was not the only one who questioned the gender discrepancy. I found there were numerous studies done on this topic because, "A sex difference in the frequency of any disease is an epidemologic finding that attracts attention and stimulates explanations" (Formanek and Gurian 4). It is in this paper that I will present brief overview of these "explanations" and provide a general knowledge of depression in order address the topic of gender difference and relate the problem of depression to our current social and medical construct.

Depression is a "complex and multifaceted illness" considered to be a brain disorder, that affects ones thoughts, moods, feelings, behavior, and physical health (Jack 2). By current consensus among the medical community, major depression is caused by an interaction of biological, biochemical, and psychological reasons. No single factor can be held fully accountable for the onset of depression. For years it was thought that depression was "all in the head" and not a real medical disorder. Doctors now know that depression is very real, especially to its victims, and has a biological basis. Everyone at some point in their life experiences variations in mood, transitory depression, anxiety, grief from the loss of a loved one, and so on- these normal mood changes are not the hallmark of a medical problem. It is when these feelings of depression are severe and prolonged and interfere with one's ability to "function, feel pleasure, or maintain interest" that a medical problem is present (aol health watch website). Sometimes a stressful life event can trigger depression, while other times it seem to come out of nowhere.

Most often, the first episode of major depression occurs between the ages of 25 and 44. It is not more common in the elderly, but it often goes unrecognized in this age group as there is a tendency in American society to disregard the needs of the elderly. Depression rates are commonly lower among married people, especially married men, although former studies once concluded that marriage acted as a protective barrier of depression for married men, but actually had a detrimental effect for married women. It was thought that, "…the elements of traditional family roles may contribute to higher rates of depression among women" (Jack 8). However this has now been disproved, although certain elements of gender and society could have much to do with higher rates of depression among women-this will be discussed at greater lengths later in the paper. Couples in long term, intimate relationships also recorded lower rates in depression. Conversely , depression rates are higher among divorced people and those who live alone.

To be depressed is not necessarily to be mentally ill or in a pathological state. "It is only with greater degrees of severity or longer duration that such affective states come to be viewed as pathological, and even then the affective state is usually accompanied by other symptoms before being so judged" (Jackson 4). Depression, its degrees and severity along with its symptoms and reasons for onset are so varied that they have been broadly categorized into four types. The first type is major depression. This type of disturbance lasts more than two weeks. Symptoms often include overwhelming feelings of sadness or grief, loss of interest and pleasure in activities that once were enjoyed, and feelings of worthlessness and guilt. This particular type of depression may result in poor sleep, severe fatigue, difficult concentrating, a change in appetite, and finally suicide. The next type of depression is classified as Dysthmia. This is a less severe but more prolonged and continuos type of depression. To be diagnosed with this type the symptoms must last at least two years. Often times it lasts more than five years. As stated above, the symptoms are not as severe and usually are not disabling, and periods of depression can be alternated with periods of feeling normal. However, having Dysthymia puts an individual at an increased risk of developing major depression and can lead to suicide.

The third type of depression is bipolar disorder or manic-depressive disorder. This disorder is characterized by having recurrent cycles of depression followed by a period of mania or euphoria. This type of depression can be extremely dangerous due to the lack of judgment and impulsiveness that is characteristic of individuals in the manic stage. This lack of judgment can lead to unwise decisions that could be harmful to one's health, such as extreme promiscuity. Some people experience bursts of creativity and productivity during their manic stages of bipolar disorder. It has been speculated that some of the world's most famous artists, Mozart for example, had bipolar disorder. Other symptoms of mania include exaggerated optimism and self-confidence, decreased need for sleep without feelings of fatigue, delusion of grandeur, inflated sense of self-importance, aggressiveness, irritability, racing speech, and increased mental and physical activity. In some of the most severe cases people in their manic states have been known to hallucinate. The last type of depression is known as seasonal affective disorder. This is the least severe type of depression and is related to changes in seasons and a lack of exposure to sunlight. It is most common in areas with drastic seasonal changes and hours of sunlight, like Alaska. It may cause headaches, irritability, and low energy levels. (aol health watch website)
It is important to be aware of the symptoms of depression in order to evaluate whether a problem exists or not. The two symptoms that generally are used to confirm diagnosis are: a loss of interest in normal daily activities (anhedonia) and a depressed mood, meaning a sense of sadness and hopelessness that may be accompanied by crying spells. In order for a doctor to diagnose someone with depression not only do these signs need to be present but a host of other symptoms must also be present most of the day, every day, for two consecutive weeks. These signs and symptoms are as followed:
-Sleep disturbances: sleeping too much or having trouble sleeping.

- Weight loss or gain: an increased or reduced appetite, weight loss or gain of more than 5 percent of normal weight.

- Agitation or slowing of body movements: easily annoyed, doing things in slow motion and answering questions in a slow, monotonous voice.

- Fatigue: lack of energy or motivation/weariness.

- Low self-esteem: feelings of worthlessness and guilt.

- Thoughts of death: a negative view of oneself and the future; thoughts of death, dying, and suicide.

- Impaired thinking or concentration: trouble with concentrating or decision-making, problems with memory.

- Loss of interest in sex: decreased sex drive, if any at all.
(Mayo Foundation website)

As stated above, there has been no conclusive evidence to prove that depression is caused by a single source. A multitude of factors are often at work at the onset of depression. Research shows that some people may have a genetic predisposition to affective mood disorders, as the illness often runs is families. Even if one has no genetic predisposition for depression, other events can trigger its onset such as stress or physical illness. Reaction to stressful life events may trigger an imbalance in brain chemicals called neurotransmitters which, and it is this imbalance is what biologically causes depression. Scientists do not fully understand how imbalances in neurotransmitters cause the actual symptoms of depression because it is not certain whether changes in neurotransmitters are the cause or a result of depression. (Mayo Foundation website) Other factors that have been known to help cause depression are: the long term use of certain medications such as pills to control blood pressure, sleeping pills, and occasionally birth control pills; having a chronic illness, such as heart disease (research has shown an unexplained link between heart disease and depression), stroke diabetes, cancer, and Alzheimer's disease.

Depression occurs in up to half of the people who have suffered heart attacks and if left untreated, depression may put one at a higher risk of death in the early years after a heart attack. Certain personality traits can also predispose someone to depression (these traits include low self-esteem, being overly dependent or self-critical, etc.). Finally, alcohol, nicotine, and drug abuse have been linked to the cause of depression and anxiety disorders. (Mayo Foundation website)

It is speculated that up to seventy percent of the people who commit suicide may have some for of depression. People with severe, untreated depression have a suicide rate among themselves as high as 15 percent. In fact, the number one cause of suicide in the U.S. is untreated depression. These statistics represent the utterly destructive powers of depression. As many as one in eight teens may have depression and the suicide rate in this age group (15 to 25) has risen in recent years. As mentioned above, depression in older people is often overlooked and therefore goes untreated. Consequently, the suicide rate for older people is more than 50 percent higher than the general population. The act of suicide is "…is very often a desperate, final effort of control over the symptoms of depressive disorders. What happens to people during severe depression, as the systems that regulate emotion become disturbed, is they selectively retrieve memories that are dark and sad" (Mayo Foundation website). Only remembering the bad times is simply a symptom of their illness, not the actual truth of their reality. More severe depressive symptoms and suicidal attempts have been correlated with more self-targeted anger, less eternally directed anger, higher levels of shame and guilt, more negative views of relationships, and a greater use of self-sacrificing defenses (Carmen, Russo, Miller 138). It is necessary to take any warning or threat of suicide very seriously. In many cases the victim has repeatedly alluded to committing suicide or has actually threatened doing it before they finalize the act. It is important to be aware of certain warning signs that indicate serious depression and suicide, such as:
- Pacing, agitated behavior, and sleeplessness
- Actions or threats of assault, violence
- Threats and/or talk of death and suicide, such as "I don't care anymore."
- Withdrawal from relationships and normal activities
- Putting affairs in order, such as making a will and saying goodbye to friends
- A sudden brightening of mood after period of depression
- Unusually risky behavior
(Mayo Foundation website)

Although the symptoms and possible complications from depression seem grim, if given proper care approximately 80 percent of patients with major depression improve significantly and are able to lead productive and happy lives. However, research shows that only one-third of people suffering from major depression will seek help and receive proper treatment; and two-thirds of those that have some sort of depression and do get treatment will be misdiagnosed. The symptoms of depression are often mistaken for other medical problem or are dismissed as a manifestation of someone's age, personality, social influence or background. These facts portray the importance of education and awareness of both the general public and the medical community.

In recent years a plethora of treatments and medications have been developed to aid in the treatment of depression. The development of mood-stabilizing and anti-depressant medications in the last 20 years has transformed the treatment of depression. It is often the first option of treatment for patients today. Treatment may also include psychotherapy, which can help the individual to cope with problems that come up in day-to-day life that can trigger another bout of depression. For people suffering from mild to moderate depression a combination of medication and psychotherapy is usually effective. If one is severely depressed, initial treatment is commonly with electroconvulsive therapy (an effective, but archaic treatment) or medications, followed by psychotherapy once the person had improved. Medications vary from mood-stabilizers, like Lithium, to MAO inhibitors, such as Nardil. Stimulants such as Ritalin and Dexadrine are sometimes prescribed in conjunction with anti-depressants in more severe cases because anti-depressants take several days to start working. Statistically, most anti-depressants have similar levels of effectiveness; however, they are designed for different types of depression and one type of medication that is successful on one person might be totally useless for someone else. Doctors choose anti-depressants based on family history and the match between one's symptoms and the medication's side effects. For example, if someone has signs of lethargy a more stimulating and energizing anti-depressant may be helpful. It is important for people with depression that are receiving treatment to maintain some for of treatment even after their symptoms subside. Continuing therapy, seeing doctors, and avoiding alcohol and other drugs are forms of maintenance therapy that can be used to curtail immediate and future relapses.

Although treatments for depression can be very effective, they can only work for those who seek help. This notion is especially important for women to understand seeing as they suffer from depression at roughly twice the rate of men, except for bipolar disorder; yet only one out of every three women who experience clinical depression will ever seek care. It is unlikely that one factor will ever be pinned for the cause of this enormous discrepancy between the rates of male and female depression; however it is conceded upon that " . . . socialization practices heighten women's vulnerability to depression" (Formanek and Gurian 5). Despite the number of women who experience depression it is not a "female weakness" or a normal part of being aging. According to a recent National Health Association Survey on the public's attitudes and beliefs about clinical depression more than one-half of the women surveyed believe depression is a normal part of aging and menopause. Of these same women, 41 percent of them cited embarrassment or shame as barriers to seeking treatment. More than half of the women cited denial as a barrier to treatment. These misconceptions about depression prevent women from seeking help and coming to terms with their depressive states.

Since depression comes about from a multitude of factors, the discrepancy between the rates of depression for women and men must too me explained by the interaction of numerous aspects. Several studies have been done exploring this concept and thus far there has been no proof that the difference in depression rates among gender is caused by biological factors; however certain studies have just scratched the surface of this issue, and promise lies in furthering research in certain areas.

Therefore, the weight of the explanation about different gender rates of depression comes from psychosocial analyses. Two main hypotheses for the gender difference have been proposed, "…specifying the pathways where by women's disadvantaged status might contribute to depression" (Formanek and Gurian 9). The first hypothesis is the social status hypothesis that states that women find their situation depressing since the real social discriminations make it difficult to achieve mastery by direction and self-assertion. It is hypothesized that these inequities lead to legal and social helplessness, dependency on others, chronically low self-esteem, low aspirations, and ultimately clinical depression. The second hypothesis is known as the learned helplessness hypothesis. This proposes that's socially conditioned stereotypical images of men and women produce in women a, ". . . cognitive set against assertion and independence which is reinforced by societal expectations. In this hypothesis, the classic femininity values are redefined as a variant of learned helplessness, characteristic of depression." (Formanek and Gurian 10).

Other factors like postpartum depression, where women experience lows after the hormonal high of giving birth, and menstruation and premenstrual syndrome also account for the gender difference in depression. These factors may trigger the onset of depression, making women more vulnerable to clinical or major depression. Many times menopause is cited as a reason for depression among women; however women are at no greater risk for depression than at other times in their lives. It is women who have already had a history of clinical depression that may have a reoccurrence during this time.
Through the research presented here one is able to concede that depression is not just a medical disease, but a social disorder as well. The combination of social and biological factors that combine to foster the growth of depression call for the education and socialization of America's youth to recognize the signs and symptoms of the disease as well as the internalized stereotypes engendered in women that make them exceptionally vulnerable to clinical depression. Women need to be taught that depression is not, by any means, a normal part of aging and that help is available. The inequities or stereotypes that are hypothesized to aid in the onset of depression in women need to be shattered in order for women to fight against the disease on equal ground as men. There also needs to be a negation of shame placed upon seeking help for depression, while society needs to accept that its symptoms are not "all in the head." Ignoring depression as a real problem has very real consequences, destroying people's quality of life and sometimes resulting in suicide. Depression acts as a model for the need of health promotion in our country, and more specifically in our schools. It is only with education and awareness that depression's impact can be diminished and its victims saved.

Bibliography
Ballou, M., and Galabac, N.: A Feminist Position on Mental Health. Springfield,Thomas, 1949.
Carmen, E., Russo, N.F., Miller, J.B.: Inequality and Women's Mental Health. AmericanJournal of Psychiatry, pp.138, 1319-1330, New York, Plenum, 1981.
Chesler, P.: Women and Madness. Garden City, Doubleday, 1972.
Formanek, R., and Gurian, A.: Women and Depression. New York, Springer, 1987.
Jack, Dana Crowley: Silencing the Self. Cambridge, Harvard, 1991.
Jackson, Stanley W.: Melancholia and Depression. New Haven, Yale, 1986.
Travis, Cheryl: Women and Health Psychology. Hillsdale, Lawrence ErlbaumAssociates, 1988.
Weissman, Myrna: The Depressed Woman. Chicago, University of Chicago, 1974.

Internet Sources:
www.aol/healthwatch.com
www.mayofoundation.com