Shedding Light on Depression
History has not been so kind in addressing the medical illness known as depression. In fact, today it is still seen by some as taboo to speak of. Michael Escamilla, M.D., director of the Texas Tech University Health Sciences Center (TTUHSC) El Paso Center of Excellence (COE) in Neurosciences, sheds some light on its problematic past. “The mode of thinking is tied to previous historical periods when we did not know what caused mental illnesses, and there were a variety of theories to explain things like depression – including everything from moral failings, to possession by spirits or demons, or a ‘lack of willpower’. For those who have not experienced depression, it can be hard to understand why someone cannot just ‘will’ himself or herself out of it. And since all humans go through periods of sadness and grief, those who haven’t experienced depression first-hand often assume others are just going through a normal ‘down’ spell. We now know that in depression, people experience biochemical changes and cognitive changes that, without treatment (therapy, medications or a combination) can go on for months or years. Mental illness has had a historical uphill battle in terms of ensuring that those who suffer from it get equitable medical treatment. The reasons are mostly historic and cultural – there is a major problem in almost all cultures with stigma associated with mental illnesses,” he said.
This is unfortunate considering that anyone can become depressed over a lifetime – from childhood to late adulthood. Women have a higher risk of having at least one major depressive episode – twice the risk than men. According to Dr. Escamilla, the onset of depression usually peaks during the early to mid-twenties, but there are significant numbers of persons who develop depression in childhood and adolescence and mid-life (35-49 years old). “Depression can look somewhat different depending on when it has its onset,” said Dr. Escamilla. “In children, it may be expressed more through irritability or destructive acts. In the elderly the predominant symptom might be more a lack of ability to find pleasure in life activities than the more typical sad mood. But in all ages, the general diagnostic criteria are the same and usually involve some combination of changes in mood (sadness or irritability), feelings of fatigue, sleep and appetite changes.”
Whether one gets depression is due to a combination of genetic predisposition (something one is born with) and the environmental stressors one goes through. Those at most risk for depression are persons who experienced early traumas (sexual, emotional, physical abuse) and early losses/separations,” said Dr. Escamilla. “In later life, grief reactions (through loss of a loved one by death or breakup) are often similar to depression and can develop into major depression. Other triggers can include loss of a job, moving, or more recent traumatic experiences. Also persons with anxiety disorders often develop major depression as time goes on, if the primary problem isn’t treated.”
Knowledge is power. This is why organizations dedicated to educating the public on mental health issues are creating campaigns to educate the public (starting with school age children), to bring equity to treatment of mental illness in insurance plans, and to do research in how to better assess and treat these illnesses. “Minority groups often have the most difficult time with access to treatment,” said Dr. Escamilla. “The World Health Organization has helped to change perceptions by showing that major depression is, globally, one of the most costly (in terms of lost productivity for those who suffer from it) medical illnesses on the planet. By addressing it as the medical illness it is, we can hopefully change perceptions in future generations.” Dr. Escamilla also said Hollywood, the music industry, and media in general, continue to present stigmatizing views on mental illness.
Faculty at the TTUHSC El Paso COE in Neurosciences are conducting epidemiologic studies to find out if Hispanics living on the border are harder hit by depression than the rest of the population. “What we have found so far, in the El Paso area, is that although there may be differences in depression rates between Hispanics and non-Hispanics, the major factors influencing risk for depression are more likely to be related to social (education levels) and economic factors,” he said. “We are finding higher rates of depression in El Paso than is reported in national samples and are trying to assess what factors might be accounting for this. The main risk factors are not being Hispanic per se, but are the number of early life traumas, and lower socioeconomic status, which does affect many Hispanics in the border region.” Studies have been done suggesting a “Latino Health Paradox” suggesting that mental health problems are lowest in Latinos living in their country of origin (i.e. Mexico), yet increase with amount of time living in the United States, and are highest in children of immigrants born in the United States. “However, we have not seen that pattern with regard to depression in El Paso,” said Dr. Escamilla. “Another factor we have seen is that access to treatment increases with successive generations and higher income and treatment, of course, is the key to getting out of depression.”
Aside from studying depression, the COE in Neurosciences has several studies underway regarding bipolar disorder, schizophrenia, and other serious mental illnesses. The studies range from work with adults to children, and aim to better understand the causes of the illnesses. Treatment studies using psychotherapy interventions, currently being led by Rebecca Pasillas, Ph.D., assistant professor in the Department of Psychiatry, are also being done.
What’s most important is to see a health care professional, whether it is a psychiatrist or psychotherapist, so that it may be treated seriously. “It is like any other medical illness and you need to do your part by getting treatment. Current treatments are excellent and you have a great chance of improving. Discuss options with your doctor or therapist,” said Dr. Escamilla.