The Many Faces of Depression

August 5, 2011 8:28 PM

Author: Dr. Shelley Carson is a psychologist at the National Center for Telehealth & Technology (T2).

Depression is a growing public health problem; according to the World Health Organization, it is currently the second-most pervasive illness worldwide (only heart disease afflicts more people), and by 2020, depression may be the most pervasive health problem on the planet. Depression can be deadly; depressed individuals are at four times greater risk for a heart attack than are those who do not suffer from depression. Depression also poses a high risk for suicide and self-injury; approximately 80% of individuals who commit suicide do so during a depressive episode.

Service members and their families are certainly not immune to the growing health risk of depression. Getting help early is the best way to avoid the potential health hazards. The classic warning signs of depression include:

Feeling sad or blue for an extended period of time (more than two weeks)
Losing interest in things that used to give you pleasure
Withdrawing from friends and loved ones
Having trouble sleeping – either you have insomnia or you’re sleeping a lot more than normal
Having trouble eating – either you’ve lost your appetite and are losing weight without trying or you are craving food (usually carbohydrates) and are gaining weight
Having trouble concentrating and making decisions
Feeling extremely guilty or worthless
Feeling that there’s no hope or no use to carry on
Thinking of death or suicide

Keep in mind that depressed people don’t always look “depressed.” In fact, depression has many faces. Let’s look at a few ways depression can masquerade itself.

In children, depression can be expressed as behavior problems. If you have a normally well-behaved child who suddenly starts acting up and causing problems at home or school, you should consider the possibility of depression. Children can also express depression as physical complaints, such as unexplained stomach aches, headaches, or throat problems. This is called “somatization” (expressing emotional distress as physical pain). So watch for these two things in children: sudden behavior problems or unexplained physical complaints.

Teenagers may also express depression through behavior problems. These can include promiscuous sexual behavior, drug or alcohol abuse, skipping school (truancy) or acts of delinquency (such as vandalism). If your well-adjusted teenager suddenly goes “Goth” or starts skipping school, consider the possibility of depression.

Depressed adults (especially men) may seem uncharacteristically irritable and angry. They may become irritated over small things, have a shorter fuse than normal, or act unusually aggressive. Alternately, men may become very stoic, refusing to show any emotion at all when depressed. I call this the “Mr. Spock” face of depression after Star Trek’s stone-faced Vulcan character who claimed to have no feelings. If you notice unusual anger, irritability or emotional numbness in yourself or others, consider the possibility of depression.

Finally, depression in the elderly may mimic signs of dementia. Seniors may seem overly forgetful, confused, or disoriented when depressed. While true dementia needs to be ruled out - many of these signs of mental deterioration may actually improve when seniors are treated for depression.

Knowing the classic signs of depression and additional disguises that depression often wears will enable you to seek help from a healthcare provider earlier for yourself or your loved ones. Remember, depression can change or distort the way a person views their life and is a medical illness, not a sign of weakness, and is treatable.

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Real Warriors www.realwarriors.net The Real Warriors Campaign is an initiative launched by the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) to promote the processes of building resilience, facilitating recovery and supporting reintegration of returning service members, veterans and their families.	Brainline Military www.brainlinemilitary.org Living with traumatic brain injury (TBI): help for service members, veterans, national guard, reserve, and families.	My Healthevet www.myhealth.va.gov Sesame Street Workshop’s Talk, Listen, Connect and Family Connections are multimedia initiative that guides military families through multiple challenges, such as deployments, homecomings, and changes that occur when a parent comes home.	National Center for PTSD www.ptsd.va.gov The National Center for PTSD is a center of excellence for research and education on the prevention, understanding, and treatment of PTSD. The center has seven divisions across the country.	Defense Centers of Excellence www.dcoe.health.mil The National Center for PTSD is a center of excellence for research and education on the prevention, understanding, and treatment of PTSD. The center has seven divisions across the country.	National Center for Telehealth and Technology t2health.org The National Center for Telehealth and Technology (T2) researches, develops, evaluates, and deploys new and existing technologies for Psychological Health (PH) and Traumatic Brain Injury (TBI) across the Department of Defense (DoD). T2 is a component center of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury.	Deployment Health Clinical Center www.pdhealth.mil The Deployment Health Clinical Center (DHCC) aims to improve deployment-related health by providing caring assistance and medical advocacy for military personnel and families with deployment-related health concerns. DHCC serves as a catalyst and resource center for the continuous improvement of deployment-related healthcare across the military healthcare system and the Center is a component of the Defense Center of Excellence (DCoE) for Psychological Health and Traumatic Brain Injury.	Center for Deployment Psychology deploymentpsych.org The Center for Deployment Psychology aims to promote the education of psychologists and other behavioral health specialists about issues pertaining to the deployment of military personnel. The CDP is a tri-service center funded by Congress to train military and civilian psychologists, psychology interns/residents, and other behavioral health professionals to provide high quality deployment-related behavioral health services to military personnel and their families.	Center for the Study of Traumatic Stress www.centerforthestudyoftraumaticstress.org The Center for the Study of Traumatic Stress (CSTS) is dedicated to advancing trauma-informed knowledge, leadership and methodologies. The Center’s work addresses a wide scope of trauma exposure from the consequences of combat, operations other than war, terrorism, natural and human-made disasters, and public health threats. CSTS is a part of Uniformed Services University (USU), and its Department of Psychiatry, as well as a partnering center of the Defense Centers of Excellence (DCoE) for Psychological Health and Traumatic Brain Injury.	Defense and Veterans Brain Injury Center www.dvbic.org The Defense and Veterans Brain Injury Center (DVBIC) serves active duty military, their beneficiaries, and veterans with traumatic brain injuries (TBIs) through state-of-the-art clinical care, innovative clinical research initiatives and educational programs. DVBIC fulfills this mission through ongoing collaboration with military, VA and civilian health partners, local communities, families and individuals with TBI. DVBIC is a component center of the Defense Centers of Excellence (DCoE) for Psychological Health and Traumatic Brain Injury.	National Intrepid Center of Excellence www.dcoe.health.mil The National Intrepid Center of Excellence is an advanced facility dedicated to the research, diagnosis and treatment of military personnel and Veterans suffering from traumatic brain injury (TBI) and psychological health challenges.	U.S. Department of Defense www.defense.gov The mission of the U.S. Department of Defense (DoD) is to provide the military forces needed to deter war and to protect the security of our country. The DoD engages in war-fighting, humanitarian aid, peacekeeping, disaster relief, and homeland security. The Department is currently headed by Secretary of Defense Robert Gates and is headquartered at the Pentagon.	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