The Who, What and Why of Depressive Disorders Part 1

“Depression can seem worse than terminal cancer, because most cancer patients feel loved and they have hope and self-esteem.”

– David Burns

Have you ever wondered why some people are always sad or grumpy? What makes certain people see the glass as half full while others find the negative in every situation?

What is Depression? If I Get Sad Does That Mean I Have Depression?

Emotions are important to alert us when something may not be right. For instance, if we are being mistreated or in a relationship that is not functioning optimally, our mind wants us to know that something is off. This allows us to try to improve the situation or escape it before more damage occurs. Sometimes these emotions become excessive and extreme. When this happens it can negatively impact our friendships, family life, work, and school functions and may mean that we have a depressive disorder. Depressive disorders cause persistent sad, empty, withdrawn or irritable moods. These feelings are often accompanied by decreased motivation, increased physical complaints, and changes in sleep, appetite, and cognitive function.


Children don’t always have the same signs of depression as adults. Clues that they may be suffering from depression include changes in personality and deviations from their normal behavior. This may manifest as refusal to go to school, dropping grades, substance use or engagement in illegal or culturally inappropriate activities.


The elderly have a very high rate of depression, with some estimates of up to 50%. Depression in this age group often goes unrecognized as people attribute personality changes to old age. Not infrequently, older individuals are misdiagnosed with dementia, when in fact they are depressed. It is important to differentiate these two conditions because they have very different treatments.





Depression is quite common. In fact, about 17% of people will suffer from a depressive disorder in their lifetime. Almost all countries and cultures have a 2:1 female to male ratio. This is attributed to hormonal differences, childbirth and rearing responsibilities and behavioral models of learned helplessness. The exception to the 2:1 ratio is Jews. For unknown reasons, Jewish men have twice the rate of depression as the general population and a 1:1 ratio compared with Jewish women.(1)


The average age of onset is 40 years, but it is increasingly being diagnosed in children and adolescents. Proposed explanations for this trend include higher rates of substance use and the rise of social media engagement with resultant cyber bullying and a decrease in genuine friendships. It is more common in people who lack close relationships and are unmarried. Positive prognostic factors include strong friendships, stable families and lack of substance abuse. Depression spans all socioeconomic statuses, but is more common in rural areas than urban ones.


Does it Ever Get Better?

Untreated depression is likely to improve within 8 months, but sometimes takes up to 18. When treated, depression generally resolves within 3 months. After a first episode, 60% of people will have a second episode and there is a 20% chance of it becoming a chronic disorder. Men are more likely to develop chronic depression. In chronic depression there is usually at least a couple of years between episodes and each episode tends to last longer and be more severe than the previous one.  These numbers are lower for people who continue taking antidepressants even after their symptoms have resolved. Not all depressive disorders are the same. Some forms are less severe, but more chronic. Other types only occur during specific seasons or events such as childbirth or menstruation. The important thing to remember is that these disorders are common, and with the right treatment, the episodes can be substantially shortened.


What are your thoughts? How does this information compare to your own experience or that of someone you know? Please post comments and questions below. Stay tuned for the next post which will explore the causes of depression.


(1) Study showing Jewish males are at increased risk of depression


Ariel Mintz, MD
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2 Comments on “The Who, What and Why of Depressive Disorders Part 1

  1. Dear Dr. Mintz:
    Thank you for sponsoring this forum.
    If I am an expert in anything, it is in childhood abuse, neglect, and depression. My first concience suicide attempt happened at age three. Then suicidal ideation started about age 20. Through a series of life events, I had two suicide attempts. I have expert available care. That’s what has kept me alive. Each day is a struggle. My family history and genetics place me at greater risk. Unfortunately, I feel as if I have a self destruct button in my being. My doctors want to publish a case study partly including my situation. Depression gets worse with age. It is really a miracle that I’m still alive. I despise my situation. During my birthday, I dress in black. There is nothing to look forward to. I am doomed to another year of this he’ll. Not everyone gets better from depression or post traumatic stress. The conditions cycle and are sometimes manageable. Other times are spent looking for exits or ” catching the train.” I ask that you be carefully judicious when presenting some type of panacea hope. Individual chemistry, experience, internalization of events and emotional pain all play an interactive role in the suicide experience. Shalom, Shoshana

    1. Hi Shoshana,

      Thank you for sharing your experience. I cannot imagine all the struggles you have been through and I commend you for continuing to push forward despite all that. You are correct that not all people recover from depression. However, I do believe that hope is something that people need to hold onto. Even if you have been afflicted with depression and trauma for decades, you never know what the future might bring. There is always hope of new treatments coming out or a fundamental change in your life. Think back to all you have accomplished and even the fact that you are alive despite everything you have been through. That alone should give you hope that just maybe there is a chance that your future will be brighter than your past. I wish you a refuah shleima.

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