Who is most at risk of developing depressive illness?
- Women. Women are twice as likely as men to develop depressive illness. No-one knows exactly why, and there are many sociological and biochemical theories suggested. My personal belief is that women are more in touch with their emotions than men are, as a generalisation. Accordingly, while women may get more emotional positives out of life when things are going well, and increase the sensitivity of society as a whole to emotional issues, this increased emotional sophistication comes at the cost of increased vulnerability when things go wrong in life.
- People facing severe or multiple stresses. We can all withstand a certain amount of stress, but for everybody there comes a point where the ability of our brains to cope can be overwhelmed by the number and severity of stresses we face.
- Emotional isolation. This factor is considered one of the most important issues that determine whether or not we will develop depressive illness when faced with the stresses of life. At an emotional level, we all need someone to talk to about the practicalities and emotions of our everyday life, and those who do not have this outlet have repeatedly been shown by medical research to be at markedly increased risk of getting depressive illness. Emotional isolation can occur due to strained relationships with one’s partner, not having a partner or close friend that one sees on a regular basis, being too busy for social contact, or any other factor that leads to a lack of regular communication with human beings that are close to us.
- Women after childbirth. The combination of hormone changes, sleep deprivation and social change brought about by childbirth all combine to markedly increase the risk of depression in women after childbirth, a condition known as ‘Post Natal Depression’ (see Section 40). It is estimated that at least 10% of women develop depressive illness in the first year after childbirth, causing unwanted suffering for themselves, their partner and families, and the young baby.
- Viral Infections. There is a phrase quoted in psychiatry “after the flu comes the blues”. For many people, viral infections trigger off depressive illness, in a way we do not understand. Prolonged physical and mental symptoms after a virus infection are often due to depressive illness having been triggered off by the virus, rather than some rare physical complication having developed. Many doctors believe that Chronic Fatigue Syndrome is an illness in which post-viral depression plays a considerable role, quite apart from whatever physical aspects can be shown in this strange illness.
- Anxious or nervous People. There is considerable research evidence to show that anxiety and depression are closely linked, and those who have always been anxious or nervous people have increased risk of developing depressive illness.
- Perfectionists. The advantage of being a perfectionist is that you achieve high standards in a whole range of practicalities in life, which normally increase your chances of success and promotion, (unless you are so preoccupied with innumerable details you become swamped by the details and are unable to complete the overall task in time). However, the price of perfectionism is anxiety, and a sense of not enough control in your life. This mental outlook is a fertile breeding ground for depression when you are given an increasing number of tasks for which you make yourself responsible.
- Being timid or having low self esteem. People who are shy, quiet, or unable to adequately express their opinions (except in an explosion of temper), are liable to feel a great sense of unfairness in life. Feeling like a helpless victim markedly increases the risk of depression. In the early 1900s, Freud expressed the theory that people got depressed when they were unable to adequately express the anger they felt towards those around them, who they believed were treating them unfairly.
- Genetic predisposition. Our genes come as a package deal from our parents. While we may have inherited characteristics which please us, such as our intelligence or our physical appearance, we may also have inherited resistance to certain diseases and susceptibility to others. If one of your parents has had depressive illness, your chance of having depressive illness is increased, but it is still statistically much more likely that you will not develop depressive illness yourself. Indeed, an awareness of your possible susceptibility to depressive illness, because a parent or relative has had the illness, may encourage you to take sensible preventative measures in your own life, just as you would do if you knew there was a history of high cholesterol levels in your family.
- Previous depressive illness episodes. Unfortunately, depressive illness does tend to return. Statistically, if you have had one episode of depressive illness, you have a 50% chance of having a second episode. If you have had two episodes of depressive illness, you have a 75% chance of having a third episode. If you have had three or more episodes of depressive illness, you have in excess of a 95% chance of having a further episode of illness in your lifetime. Typically, the relapses will occur at times of stress or physical illness. For these reasons of high relapse rates, lifetime preventative treatment with antidepressants is useful for very many people. Others prefer to try to recognise the illness when it returns, hoping to pick up the early symptoms, but these are notoriously difficult to detect, until it is often too late.
- Those in frequent pain. Long-term pain is an immensely distressing and wearing problem, and most people with this problem will eventually develop depressive illness. Indeed, for many people in pain, taking antidepressants has been shown to reduce the amount of pain they experience, regardless of whether or not they have actually been diagnosed as having depressive illness.
- Long term medical illness. Many medical illnesses, especially long-term illness, gradually erode the patient’s ability to cope, leaving them very vulnerable to depressive illness. It is important to be alert for the possibility that the patient now has two illnesses, namely the original physical illness and the complicating depressive illness, rather than simply attributing every symptom the patient has to a physical cause, for which medical treatment is presumably being sought. For example, 25% of people after a heart attack will develop depressive illness, and about 40% of people after a stroke will also develop depressive illness. Understandably, high rates of depressive illness occur in those with cancer. Appropriate treatment of the depressive illness will significantly improve the quality of life of these medically ill patients.
Important Disclaimer: This site is medical information only, and is not to be taken as diagnosis, advice or treatment, which can only be decided by your own doctor.