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Risk Factors

Although depression is a condition that can affect anyone, regardless of age, race, or gender, the following factors may increase an individual's risk for an initial or recurrent episode of depression:

• Prior episodes of depression
• Family history of depression
• Suicide attempt—a former attempt of suicide during a major depressive episode increases the likelihood of another episode of depression
• Female gender—the incidence of depression appears to be greater in women than in men, however, some researchers speculate that women may simply report their symptoms more frequently than men and that men may be more apt to mask their depressive symptoms with alcohol. Therefore, it is still unclear whether women truly have a greater risk for depression.
• Young adulthood or middle age—the highest occurrence of depression is between the ages of 25 and 44; the elderly are also at particular risk due to death of loved ones, physical illness, and loss of independence
• Stressful life events (such as the death of a loved one), particularly if the event occurs at a young age
• Postpartum period
• Chronic medical or psychological conditions including autoimmune diseases (such as lupus), cancer, heart disease, chronic headaches, chronic pain, anxiety, obsessive-compulsive disorder, and borderline personality disorder; medical conditions that cause shifts in hormones, such as thyroid disorders or menopause, may also contribute to depression.
• History of abuse (such as mental, physical, or sexual)
• Lack of social support system (such as a network of close friends or family)
• Current or past alcohol or drug abuse—25% of people with addictions have depression

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Diagnosis

If feelings of depression or any of the related symptoms are present, it is important to address them with a physician or someone who can help direct care appropriately. Unfortunately, many people with depression tend to refrain from disclosing any or all of their symptoms in this setting. Occasionally, even when the symptoms are discussed during an appointment, a physician may try to treat them individually, rather than recognizing the complete picture of depression. Working together with a primary care physician is extremely important, however, because he or she is often the person who makes a referral to a psychiatrist who, in turn, makes a definite diagnosis of depression. Proper diagnosis of depression is the first step toward proper treatment.

Only psychiatrists can prescribe medication, but psychologists and social workers, as well as psychiatrists, use psychotherapy as an important mode of treatment. These specialists will often administer a screening test, such as the Beck Depression Inventory or the Hamilton Rating Scale, which consists of about 20 questions that assess an individual's risk for depression. Even before these psychological screening tests, however, several blood tests will be performed to determine whether nutrient deficiencies or underlying medical conditions (such as a thyroid disorder) may be causing or contributing to depression.

Although the vast majority of people with depression are treated as outpatients, hospitalization is necessary for people who intend or attempt suicide, and may be necessary under other circumstances as well.

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Preventive Care

The following steps can help prevent depression or decrease the chances of relapse:

• Adequate sleep, regular exercise, and a balanced, healthy diet may help prevent depression and diminish symptoms of this mood disorder.
• Using mind/body techniques, such as biofeedback, meditation, and tai chi, are effective ways to prevent or reduce symptoms associated with depression.
• Psychotherapy directed at coping skills generally helps prevent relapse.
• Family therapy may prevent children or teens of depressed parents from becoming depressed later in life.
• Compliance with the prescribed treatment regimen decreases the chance of relapse.

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Reviewed: 03/2006