Desire to be resilient can sometimes mask underlying depression

By David VergunOctober 6, 2014

Col. (Dr.) Geoffrey Grammer, Research Department chief, National Intrepid Center of Excellence, discussed the Army culture of toughness, which may mask depression, Sept. 18, 2014, at the Psychological Health and Resilience Summit at Defense Health He... (Photo Credit: U.S. Army) VIEW ORIGINAL

WASHINGTON (Army News Service, Sept. 22, 2014) -- The Army culture is one of toughness and resilience, so seeking help for depression may be very hard for Soldiers to do, said Col. (Dr.) Geoffrey Grammer.

Grammer, who is Research Department chief, National Intrepid Center of Excellence, Bethesda, Maryland, spoke Thursday, at the Psychological Health and Resilience Summit at Defense Health Headquarters, Falls Church, Virginia. His topic was "Hidden Medical Aspects of Depression."

"When people show up at a primary care facility with depression, particularly in a non-behavioral health setting, they may not necessarily say, 'I have an emotional disturbance' or 'I'm feeling down,'" Grammer said.

Instead, most find it easier to talk about their physical manifestations of depression, he said, things like insomnia, difficulty concentrating or feeling tired all the time.

Those may or may not be underlying symptoms of depression, he noted.

For a Soldier or family member, it may be "easier to focus on stomach discomfort rather than on an existential crisis," he said, adding that it's a defense mechanism.

Grammer cautioned that confronting people with symptoms -- sadness or decreased interest in activities -- and telling them that they might be depressed, could make them even more depressed and they could put up even stronger defense mechanisms.

Rather than telling them they might be depressed, it would be better to encourage them to seek behavioral or medical care for whatever symptoms they may be exhibiting and let a physician handle it.


About one in eight people will get depressed at some point in their lives, Grammer said. About 10 percent of people hospitalized for depression will complete suicide. "That's fairly significant," he said.

The most likely ages for depression are between 20 and 50, he said. Women are twice as likely to get depression as men.

Also, "if you have a family history of depression there's up to a three-fold greater risk," he said. "Also, men who are married have a lower rate and women who are married have a higher rate of depression."

The good news, Grammer said, is "most depression is mild, while a smaller percentage will be moderate and an even smaller percentage will be severe."

Not all depression is caused by stressors in life like an angry boss. There are some types of medications that have side effects that can cause depression. That's why, he said, it's important to understand the types of medicines being taken and to seek medical advice. Ruling out medications should be one of the first steps.


"Depression can beget medical illness and medical illness can actually cause depression," Grammer said, "so there's an interplay between the two."

For example, "if you have diabetes and are depressed, your total risk for medical complications associated with diabetes increases. Your glycemic control is likely to worsen. Conversely, if you have diabetes and poor glycemic control, you are at increased risk of depression."

Grammer than provided other examples of interplays between depression and illness or disease, including rhetoric arthritis, coronary disease, cancer and pain. He said there are many more.

Depression does a number of things to the body, including elevating cortisol levels, which leads to a number of problems. Depression can also cause severe cognitive deficits such as memory problems, he noted. Unfortunately, even once the depression is resolved, these cognitive effects often linger and can even worsen. The important thing to do is to prevent more episodes of depression or things can quickly spiral.


A number of treatment options for depression are available, Grammer said.

One option that a lot of people choose is to simply do nothing, he said. About 40 percent of depressed people will get better on their own, but some could go on to develop major depression.

Not treating depression can lead to loss of productivity, he noted. Last, year, there was an estimated $83 billion in lost productivity in U.S.

Also when people are depressed, it affects their family members and co-workers and can even lead them to become depressed as well.

"Depression feeds on itself," Grammer said. "Every time you have a depressive episode it increases the risk that you'll have more. People with three depressive episodes have a 90 percent chance of having more." For these people, "treatment might need to be indefinite, even after symptoms are resolved."

Treatment for mild to moderate depression often responds well to psychotherapy, he said. Cognitive behavioral therapy and interpersonal psychotherapy are good. So is lifestyle modification such as that advocated by the Army's Performance Triad, which focuses on improved sleep, activity and nutrition.

But treating severe depression is much more difficult, he said. "Psychotherapy or behavioral modification alone may not resolve" it. Also, there's no conclusive evidence that one type of antidepressant medication is better than another. It's is best to consult with a physician.

Finally, it is important not to confuse other illnesses such as bipolar with medication. Drugs for these are different than for severe depression. Again, he urged, people who may be suffering from depression to seek medical care and advice.

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