Depression & Stress Resilience

DEPRESSION & STRESS RESILIENCE What is Depression? Depression describes a range of syndromes where a person cannot function normally-either socially or occupationally-due to overwhelming sadness or an inability to experience pleasure. The exact symptoms of depression can vary dramatically from person to person. Many people with depression have sustained periods of stress either in the distant or recent past. Did You Know? Roughly 5% of the U.S. population suffers from severe forms of depression at some point in their lives, and up to 20% may suffer Did You Know? more mild cases. Depression can occur at any polnt in a person's lifetime and is twice as common.in femalés than males. VS. Females Males Did You Know? Depression is now one of the leading causes of disease burden worldwide, already the number one cause in females. Risk Factors for Depression Depression is highly heritable, with roughly 40% of the risk for depression being genetic. A period of stress greatly increases a person's risk for depression, although many people who develop depression have no antecedent stress. Depression occurs very commonly after childbirth. Such "postpartum depression" is particularly serious since it puts the mother as well as the baby and any siblings in danger. Symptoms of Depression As noted above, the symptoms of depression vary widely: in fact, two given individuals with a diagnosis of depression may have completely non-overlapping symptoms. Examples of prominent symptoms include: • Overwhelming sadness and feelings of dread • Decreased ability to experience pleasure (things that used to make you feel good no longer do); reduced interest in food, social interaction, sex, etc. • Increased pessimism, guilt, feelings of low self worth • Suicidality • “Neurovegetative" abnormalities: increased or decreased sleep, appetite, weight, and energy level Treatments for Depression Your thoughts More mild cases of depression respond well to several forms of psychotherapy. Cognitive behavioral therapy (CBT) has been shown to be particularly CBT Your Your behaviors emotions effective. More persisting or severe cases of depression require medication treatment. There are several classes of antidepressant medications, all of which are roughly equally effective, although one person might respond to one and not another. Examples include serotonin-selective reuptake inhibitors (SSRIS) and serotonin-norepinephrine reuptake inhibitors (SNRIS), as well as the older tricyclic antidepressants and monoamine oxidase inhibitors. About 80% of people who are depressed show significant inmprovement with medications available today, and Deep brain stimulation about 50% show full remission. Some people with particularly severe "treatment-resistant depression" may respond to electroconvulsive seizure treatments or to some treatments, which remain experimental, such as deep brain stimulation or ketamine. People treated with medications or other medical approaches still benefit from concomitant supportive psychotherapy. What is Resilience? While some people exposed to severe stress succumb, others do not-they're resilient. Recent work has identified several key features that make someone more resilient and many of these features can be learned. They include: • optimism facing one's fears • overcoming hardships • developing active coping skills • establishing a supportive social network • physical exercise Depression Research Rodents subjected to chronic social stress develop many of the symptoms (those that can be measured in an animal) seen in depressed humans. Interestingly, some individual rodents are more resilient to stress. This has made it possible for researchers to understand not only the bad effects of stress in susceptible individuals, but also factors in the brain that promote resilience. This research is guiding efforts at developing more effective treatments for depression. Efforts are underway to identify the genes that control a person's risk for depression (or other genes that make some people more resilient). Advances raise the possibility of developing new, treatments that target these genetic factors. Mount Sinai © 2014 The Mount Sinal Hospital, New York You are free to copy, distribute and transmit this content, but you must attribute the work to the Mount Sinal Hospiltal, New York. Visit: icahn.mssm.edu/depression or www.mountsinai.org/depression for more information.