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Depression: Who's at Risk?

Anyone can become depressed, but many experts believe genetics play a role. Having a parent or sibling with depression increases your risk of developing the disorder. Women are twice as likely as men to become depressed.

How Common Is Depression?

Depression is remarkably common. In fact, depression is often called "the common cold of mental health problems." More than 5% of Americans -- some 15 million people -- suffer clinical depression at any given moment. Another 5% experience mild symptoms of being "down in the dumps." At least one person in six has a serious, or "major," depressive episode at some point in life. The average age at diagnosis of depression is slowly dropping, and though depression among the elderly remains common, depression in young people is on the rise.

Authorities estimate that depression costs the nation $43 billion a year for medications, professional care, and lost school- and workdays. The toll in human misery is incalculable. The dark cloud of depression has an even darker lining -- thoughts of suicide. Each year, tens of thousands of depressed people attempt suicide. About 16,000 succeed.

* Suicide is now a leading cause of death among teens and young adults. *

The myth is that people with depression cannot function. In fact, 72% of depressed individuals are in the workforce. Some are taking medication or are in some other form of treatment. Many simply carry on despite their deep emotional pain.

Depression Is Often Overlooked

One reason the suicide rate is higher among those who suffer from depression is that friends and family members often don't know much about depression and its underlying causes, and may not take potentially suicidal remarks or actions seriously. As a general rule, if anyone you love seems unusually and persistently down in the dumps, lethargic, or hopeless, and alludes to life not being worth living, call a doctor.

Another reason why depression is often overlooked is that an enormous number of other symptoms can mask it. A century ago, Henry Maudsley, M.D., put it this way: "The sorrow that has no vent in tears may make other organs weep." Depression often manifests as headaches, back pain, irritable bowel syndrome, chronic fatigue, anxiety, sleep problems, shortness of breath, and many other conditions. If you or anyone you know experiences persistent symptoms that resist treatment, the underlying problem might well be depression. Call a doctor and ask to be examined for depression.

Finally, depression may be missed because its complex and varied symptom picture confuses some family doctors. "Depression is often overlooked in the primary care setting," according to the American Psychiatric Association. A recent report by the National Depressive and Manic Depressive Association finds that 55% of depressed individuals are neither diagnosed nor treated by their family doctors.

This is not a criticism of family doctors. Rather, it's an indication of the confusing diagnostic puzzle depression often presents. Most family physicians do not receive much training in recognizing depression, which is why the National Institute of Mental Health launched its Depression Awareness, Recognition, and Treatment (D/ART) Program -- to help doctors intervene earlier, more confidently, and more successfully.

Patients can also help. If you or anyone you know has symptoms that you suspect might be depression, ask a doctor to consider it seriously, and if necessary, refer yourself or your loved one to a psychiatrist.

Why Depression? The Biochemistry of Loss

Depression may be difficult to diagnose, but at the cellular level, it has clear biochemical roots that affect the way nerve cells in the brain work. Severely depressed people have unusual levels of one hormone (cortisol) and several brain chemicals (the neurotransmitters serotonin, dopamine, and norepinephrine). The unusual levels of these chemicals may be inherited, which is part of the reason why depression tends to run in families. Researchers suspect a genetic connection, but to date, no "depression gene" has been discovered.

Authorities also believe that depression runs in families because children pick up depressed parents' gloomy world view, as well as miss out on a fully enriching environment.

Without a family history, deep emotional losses may trigger the biochemical changes that cause depression. Profound trauma in early childhood -- physical or sexual abuse, a bitter divorce, the death of a parent, or other deeply disturbing experiences -- can set the emotional stage for depression later in life.

But equally often, the brain chemistry of depressed individuals slips for no apparent reason. Just as people who are never exposed to smoke can get lung cancer, people who have lived happy, well-loved lives can become seriously depressed