Depression: Common, Miserable and Dangerous

Depression is dangerous: 1 in 16 people diagnosed with depression dies by suicide; depression also increases the risk of death from all causes, especially coronary heart disease.

Depression is common. Major depression affects an estimated 15 million U.S. adults each year, and as many as 8 percent of men and 16 percent of women will suffer a bout of major depression at some time during their lives.

An example of the frequency of depression: 12 percent of 1,190 male medical students who were here at Johns Hopkins between 1948 and 1964 went on to have at least 1 episode of clinical depression over the next 40 years of their lives.

Depression makes people feel miserable. The manifestations of depression, listed below, are a testament to this fact. Major depression is defined when a person experiences 1 of the first 2 symptoms listed below, along with 4 of the others, continuously for more than 2 weeks.

  • Depressed mood associated with overwhelming feelings of sadness and grief
  • Apathy with loss of interest and pleasure in activities formerly enjoyed
  • Fatigue or decreased energy
  • Insomnia, awakening early in the morning, or oversleeping almost daily
  • Changes in appetite along with significant weight gain or loss
  • Feelings of worthlessness, guilt, and helplessness
  • Inability to concentrate or think, leading to indecisiveness
  • Restlessness
  • Recurrent thoughts of death or suicide, or suicide attempts.

Depressed men often have additional symptoms, including irritability, anger, aggression, increased alcohol and substance abuse, reckless behavior, and loss of sexual desire and function.

Untreated episodes of major depression can last for 8 to 9 months, but proper treatment usually shortens the duration considerably.

And depression is dangerous. Dangerous not only because suicide is the 11th leading cause of death in the U.S., or because 1 in 16 people diagnosed with depression dies by suicide; but also because depression increases the risk of death from all causes, especially from coronary heart disease.

People who suffer a bout of major depression will have twice the risk later in life of dying of a heart attack, compared to those who have never had a major depression. The increased risk can last for 10 years or more after the episode of depression.

Conversely, about 20 percent of people who've had an acute heart attack will exhibit symptoms of major depression afterward, and they are at significantly higher risk of dying of another heart attack.

Several factors appear to account for the high incidence of heart attacks found in people who are or have been depressed:

  • People with depression are more likely to be previous smokers and are less successful than others in stopping smoking.
  • They more often drop out of rehabilitation or exercise programs and fail to comply with medications like aspirin or drugs to lower cholesterol and blood pressure.
  • Some antidepressant medications cause weight gain and so increase the incidence of type 2 diabetes.

What can be done to lessen these risks? People must

  • recognize symptoms of depression and seek early treatment
  • be aware that certain antidepressants can increase a person's weight, which in turn can lead to diabetes
  • aggressively treat risk factors for coronary disease with lifestyle measures and, if needed, medications

Unfortunately, there is no evidence yet that treatment with antidepressant drugs lowers the risk of heart attacks.


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