Depression
Depression
The Sneaky Stealer of Youth
On most days, Bonnie Brand feels really good. But occasionally, when the pressure of juggling a career and the needs of her family overwhelm her, a dark shadow of depression descends, and she feels age creeping up on her.
"Like most women, I worry about my weight, I worry about my appearance, and yes, I worry about getting older," says the 33-year-old word processing supervisor at a legal firm in Newport Beach, California. "When I feel good, I feel attractive. But when I'm depressed, I definitely feel older. Every ache and pain in my body seems to be magnified when I feel that way."
That wouldn't surprise many doctors who say depression affects the body as well as the mind.
"Certainly, depression can slow you down and make you look and feel older," says Janice Peterson, M.D., a clinical psychiatrist at the University of Colorado Health Sciences Center in Denver. "If you look at some of the major symptoms of depression--lack of energy, lowered sex drive, loss of appetite, difficulty concentrating, changes in sleeping patterns and generalized aches and pains--you'd see some things that you might consider a normal part of aging. So if you saw a person with those problems, you might think 'Oh, she's just getting older' when in fact she has a major depression."
The effects of depression on the body are so powerful that often they can make you appear more than a decade older than your natural age. "Some people who are chronically depressed can look very old and have stooped shoulders, furrowed lines around the eyes and all the other things that make a person looked aged. I've seen some depressed people who look like they're in their sixties when they're actually 35 or 40," says Harry Prosen, M.D., chairman of the Department of Psychiatry and Mental Health Sciences at the Medical College of Wisconsin in Milwaukee.
What's Getting Us Down
All of us feel sad at one time or another. The death of a loved one, divorce, the loss of a job or another hardship can leave us feeling so down that we doubt we'll ever be up again. While most of us do pull out of it, lots of others don't. During her lifetime, a woman has an 8 to 12 percent chance that she will suffer from a major depression, meaning she has five or more symptoms of depression for at least two weeks, including feelings of worthlessness or thoughts of death and suicide.
Over a lifetime, women are twice as likely as men to be diagnosed as having major depression. That difference mystifies researchers, says Dan Blazer, M.D., Ph.D., professor of psychiatry at Duke University Medical Center in Durham, North Carolina. But heredity, biological differences and a disparity in our society's expectations of how men and women should behave may contribute to the gap.
"There's a theory of depression that revolves around anger," says Kimberly Yonkers, M.D., assistant professor of psychiatry and gynecology at the University of Texas Southwestern Medical Center at Dallas. "According to this theory, women tend to repress their anger, turn it inward and, as a result, get depressed. Men, on the other hand, outwardly express their anger and rage by getting aggressive." However, it could also be that women are just more likely than men to talk about their emotions and seek treatment for depression, Dr. Yonkers says.
Is It All in the Family?
You're not the only one who gets depressed. Grandma, Mom, Dad and your brother all regularly tumble into a funk that they can't seem to shake. Coincidence, or is there something going on here? "It's clear that people with family histories of depression are much more likely to suffer from depression than people who don't have family histories of depression," says Alan Mellow, M.D., Ph.D., assistant professor of psychiatry at the University of Michigan Medical School in Ann Arbor. "There is well-documented evidence that like cancer, diabetes and high blood pressure, major depression has a genetic component." Okay, so you can't choose your parents. But knowing that your family has a history of depression should help you understand why you may feel particularly on the downside more often than other people, Dr. Mellow says. If you are feeling unusually blue, especially if you have a family history of major depression, you should consider seeking counseling and asking about antidepressant drug therapy. |
The Physical Price
Even mild sadness that lasts only one or two days can make you more susceptible to many of the illnesses and changes in appearance that are considered a part of aging. "Certainly, depression takes its toll on people physically. We don't know all the mechanisms that are involved, but we do know that the general well-being of the body is thrown out of whack when a person is depressed," Dr. Blazer says.
Decreased muscle tone is one of the most immediate physical changes that occurs when you begin to get depressed. "That causes muscles to sag and contributes to the sad facial expressions and poor posture that you see in depressed people," says Elmer Gardner, M.D., a psychiatrist in private practice in Washington, D.C.
But the changes caused by depression can be more than skin-deep. Researchers believe depression can weaken the immune system, accelerate hardening of the arteries and trigger some forms of arthritis.
If you're depressed, your immune cell activity can drop to the levels of a person who is 25 to 30 years older, says Michael Irwin, M.D., associate professor of psychiatry at the University of California, San Diego, School of Medicine. Dr. Irwin has not studied depression in women, but in a study of depressed men in their early forties, he found they had natural killer cell activity that looked remarkably similar to men in their seventies who weren't depressed. Natural killer cells are the part of the immune system that protects you from viruses such as herpes simplex, the cold sore virus, and these killer cells are normally less active as we age.
"Depression triggers a lowered immune response, but we still don't know to what extent that leads to sickness," Dr. Irwin says. "We do know, however, that the viruses that natural killer cells help protect us against are more common in people who are depressed."
Depression can also stimulate atherosclerosis, a buildup of fatty deposits on artery walls that contributes to coronary heart disease, says George Kaplan, Ph.D., an epidemiologist and chief of the Human Population Laboratory of the California Department of Health Services in Berkeley.
Rheumatoid arthritis is yet another disease that can be aggravated or even triggered by depression, says Sanford Roth, M.D., a rheumatologist and medical director of the Arthritis Center in Phoenix. "It's not unusual for a person who suffers a devastating loss of a parent or spouse to develop a disease like rheumatoid arthritis," Dr. Roth says. "Because rheumatoid arthritis may be associated with a genetic root, these people probably had the potential to develop the disease all along. It just took a depressive episode to open it up."
Are You Really Depressed?
Here's a list of symptoms, according to the American Psychiatric Association, that may help you determine the severity of a depression. If you have five or more of these symptoms in a two-week span, or if you have felt depressed for more than two weeks, you should seek the help of your doctor or a qualified therapist. * You feel sad most of the day and have lost interest in pleasurable activities, including sex. * You feel tired or lack energy to do day-to-day chores. * You feel restless and can't sit still. * You either have insomnia or sleep more than usual. * You have difficulty concentrating or making decisions. * You have fluctuations in your appetite or weight. * You feel hopeless, worthless and guilty. * You think about death and suicide. |
Climbing into the Light
So now that you know depression can have a serious impact on how you age, what can you do to prevent or treat it? Plenty, doctors say.
Keep in mind that severe depression--one that persists for more than two weeks--may require a doctor's care and treatment with antidepressant drugs. But if your depression lasts a few days and doesn't appear to be interfering with your activities, here are a few suggestions that may perk you up.
Keep a goal in sight. "People who have dreams and visions of accomplishment are less likely to be depressed than those who don't have short- and long-term goals," says Dennis Gersten, M.D., a psychiatrist in private practice in San Diego. Write down a list of goals. Divide the list into sections that include things you want to do this week, this month, within a year and within five years. Put the list in a prominent place, such as on your refrigerator, and check off the goals as you achieve them. Try to update your list at least once a month.
Get busy. "If you can keep yourself busy, it will help, because staying active can prevent you from dwelling on whatever is making you feel unhappy," says Linda George, Ph.D., professor of medical sociology at Duke University Medical Center.
Keep laughing. Humor is your best ally, Dr. Prosen says. Clip cartoons and funny articles out of newspapers and magazines and put them in a file you can flip through when you feel low.
Lean on family and friends. They've helped you survive bad relationships and other disasters; now they can help you through this bleak time. "That doesn't mean you're asking them to solve your problems for you," Dr. George says. "It just means you're asking them to listen, let you get things off your chest and be supportive."
Put your negative thoughts on paper. Writing down your feelings when you're depressed can help you recognize faulty thought patterns and help you find ways to replace those thoughts with more uplifting ones, Dr. Peterson says. For every negative thought you write down, such as "I'm the worst person in the world," also write down a positive one, such as "I have imperfections, but I also have a lot going for me." After a while, the positive thoughts may replace the negative ones.
Stay away from booze. Although it may be tempting to drown your sorrows in a few glasses of wine, don't do it, Dr. Yonkers warns. Alcohol is a depressant that can drag you further into the dumps. "Excessive drinking will also disrupt your sleep and may drive your friends and family away from you just when you need their support the most," she says.
Sweat it out. "Exercise is a fabulous way to relieve depression," Dr. Gersten says. "Aerobic exercise such as walking, running, swimming or bicycling cranks up your brain activity and can reverse the effects of even a major depression." He suggests exercising at least 20 minutes a day, three times a week.
Keep the credit cards in your purse. "Some people who get depressed try to break out of it with the credit card prescription," Dr. Yonkers says. "They think that if they go shopping and buy something, it's going to pick them up. But often they end up feeling guilty because they make major purchases they can't afford and that depresses them even more." If you are depressed and do go shopping, set a spending limit before you go, and pay in cash.
Be a good actress. A great way to fend off depression is to act happy for an hour, Dr. Yonkers says. Then try it for another hour and so on. By the end of the day, you might be surprised to find you're not faking it anymore.
