Depression

BY ROBERT CANCRO, MD

Editors Note: Over the course of several months, EP is exploring the subject of traumatic brain injury (TBI) sustained by military personnel in the line of duty and will highlight the conditions that may result from TBI, such as depression and symptoms of post-traumatic stress disorders (PTSD). The following was written as a primer article on depression. Subsequent articles will provide details about depression specific to the experience of military service members.

War is traumatic, not only in terms of physical injuries but psychological ones as well. The veterans presently returning from Iraq and Afghanistan have experienced hand-to-hand combat, blast injuries, traumatic brain injury, etc. In addition, they have experienced severe stress, loss of comrades, family separation and breakup, loneliness, etc. It is not a surprise that we face a near epidemic of depressive disorders with our returning troops. Hopefully, a better understanding on our part can be of help in their recovery. We owe them no less!

DEPRESSION: AN UNDER-RECOGNIZED HEALTH CRISIS

Mental illnesses are an under-recognized public health crisis. They are the last of the medical illnesses, hidden because of the unrelenting stigma associated with them. People frequently are ashamed to admit the presence of a mental illness

and tend to deny its existence in themselves and/or their family members. This is particularly unfortunate because of the tendency of mental illnesses to run in families. This tendency is most true for the more severe forms of mental illness, which have a significant genetic component.

TRAUMATIC BRAIN INJURURY PART TWO

DEPRESSION AND GENETICS

Concerning the genetic component, it is important to realize that it is frequently misunderstood that genes have an inevitable outcome in an almost Calvinistic sense. People believe that if you have the gene you must have the consequence of that gene. Though this is usually true for simple traits such as hair color, it is not true for complex traits such as mental illnesses. The genes represent a potential or a tendency. They are necessary but not sufficient to produce an illness in most cases. A common example is Type II diabetes. If the individual gains weight, they may develop the illness, but if they remain slender, they may well go through life without ever knowing that they have the tendency.

The cumulative and acute stressors of living act as the precipitating events for most mental disorders. Obviously, there are certain periods of life in which the individual is at increased vulnerability. Yet, it must be emphasized that having the potential is not the same as becoming sick. This article will focus on the mental illness of depression. Depression is a genetically loaded disorder that runs in families but does not necessarily affect every member. Again, while genes play a role in predisposing an individual to depression, they do not preclude either successful treatment or avoidance of illness.

SYMPTOMS AND ASSOCIATIONS

Depression is a disease that must be distinguished from unhappiness or an appropriate response to a loss or injury. Sadness in the face of unhappy events is not an illness. Depression, furthermore, is not just a disease of mood. It is characterized by a loss of energy, by fatigue, social withdrawal, confusion, cognitive dulling, a loss of ability to enjoy the