Depression and Other Issues
What Other Issues are Commonly Linked to Depression?
Depression is one of the leading causes of disability in adults ages 15 to 44. In a given year, 6.7% of the US adult population will experience an onset of major depressive disorder. As one of the most common mental health conditions, depression often presents with other behavioral, mental health, and emotional issues. Comorbidity between depression and anxiety, another common mental health condition, is 60%. The following article will explore the most common comorbid issues linked to depression, and how the interplay of each can worsen symptoms if the conditions are left untreated.
What are the most common comorbid issues linked to depression?
Anxiety disorders are the most common comorbid issues linked to depression. Often, anxiety symptoms precipitate the onset of a depressive episode. Recent studies show that up to a quarter of all adolescents suffer from an anxiety disorder. Left untreated, these children are at high risk of engaging in substance abuse.
It is not well understood why depression and anxiety are so frequently linked, but there are two distinct theories now widely circulated within the field of psychiatry.
1. The two conditions have similar biological mechanisms in the brain.
Because the mechanisms in the brain are similar in depression and anxiety, researchers theorize that this might be the reason why the two conditions often present together.
2. The symptoms often overlap, so patients meet the criteria for both conditions.
Many of the diagnostic symptoms of depression and anxiety are the same or overlap. For example, both anxiety and depression can cause sufferers to experience insomnia and other problems falling or staying asleep. In some cases, people who experience an external stressor will present with symptoms of anxiety and depression at the same time.
For most clinicians, recognizing one disorder is a straightforward process. But when a person presents with comorbid conditions, it can be incredibly difficult for patients to receive an accurate diagnosis. Also, medications and other treatment methods for one condition may contradict another, making treatment of comorbid conditions even more difficult. So, patients have a difficult time at the start of getting the right diagnosis, and then treatment for two different mental health conditions can be even harder to find, although not impossible.
For clinicians to give a patient with comorbidity an accurate diagnosis, they need to spend a lot of time with the patient, research any collateral sources of information, and also speak to close friends and family members. The healthcare system is fragmented and can make the process of diagnosis and treatment difficult. Also, most research studies on mental health conditions are focused on patients with only one condition. Treatments, therefore, are guided by research outcomes based on one illness.
Substance abuse disorder is another condition that is commonly linked to depression.
Recent studies indicate that one-third of patients with major depressive disorder also have a comorbid substance abuse disorder. Comorbid substance abuse and depression increase the risk of suicide in untreated patients. Alcohol abuse is commonly associated with major depressive disorder.
Treating comorbid depression and substance abuse with medication is known to be effective, but differential treatment methods for these disorders are also understudied as well. Overall, the risk of comorbid depression with substance abuse disorder is 8.3% for U.S. adults.
Who is most at risk of developing depression when they already have another disorder?
Men are twice as likely than women to develop comorbid depression and substance abuse, while women are more likely to suffer from anxiety and comorbid depression. Lower socioeconomic status and being African American increase the risk of developing depression and substance abuse disorder in adulthood. Dropping out of high school is one of the most significant risk factors for developing comorbid depression and substance use disorder. Family conflict and adverse childhood conditions also increase the risk of comorbidity for both conditions.
What can someone do to treat comorbid depression that is linked to other issues?
Comorbid depression, anxiety, and substance abuse can be effectively treated with a combination of different medications and therapies. SSRIs and SNRIs are often used in conjunction with CBT and one-on-one therapy in the treatment of depression and comorbid anxiety. TMS therapy is becoming more and more common in treating comorbid depression and anxiety. For patients suffering from substance abuse and depression, inpatient rehab along with medication, and therapy are effective treatment methods.
Unfortunately, though, there is a segment of the population of comorbid individuals who will present with treatment-resistant depression. Between 10% and 30% of depression patients will not improve, or only show a partial improvement with medication.
What can someone do if they have treatment-resistant depression?
Deep brain stimulation techniques for treatment-resistant depression and comorbid mental health conditions have proven promising for patients. For years, electroconvulsive therapy (ECT) was the first line of treatment for treatment-resistant depression. It is still used today, but the side effects on memory and cognition can affect patients’ quality of life. Transcranial magnetic stimulation (TMS) techniques are as effective as ECT, but they do not cause the unpleasant side effects on memory and cognitive functioning common with ECT treatment.
In TMS therapy, a magnetic coil is placed over the head and used to target specific areas of the brain that are known to affect depression and other mental health disorder symptoms. Each treatment session takes about an hour, and patients can return to their normal activities the same day.
Up to 60% of patients with treatment-resistant depression who undergo TMS experience a significant, meaningful alleviation of symptoms. One-third of patients will experience a full remission of symptoms after therapy. Most treatment methods for depression and comorbid symptoms do experience a recurrence, but TMS patients often feel better for months after treatment. The length of time for recurrence is over a year in TMS patients. It is safe for TMS patients to receive subsequent rounds of treatment for a recurrence of symptoms.
Although comorbid conditions are not always well understood, there is hope. Most patients respond well to a combination of medication and therapy. For those with treatment-resistant depression and comorbid mental health conditions, deep brain stimulation techniques are highly effective.