Veterans and Depression

Depression causes sadness, a lack of interest in activities, withdrawal from others, and little energy. Depression may also cause people to feel hopeless about their futures and even consider suicide as a solution. According to the National Institute of Mental Health (NIMH), depression is one of the most common mental disorders in the United States, as it carries the most substantial burden of disability among mental and behavioral disorders. In 2014, the NIMH estimates that some 15.7 million adults in the U.S. had at least one severe depressive episode in the past year. This number represented about 6.7 percent of all U.S. adults. Most people who experience depression need treatment to gain relief. The good news is that depression is very treatable. The VA estimates that about 1 in 3 Veterans visiting primary care clinics has some symptoms of depression; 1 in 5 has severe symptoms that suggest the need for further evaluation for major depression; and 1 in 8 had significant depression, requiring treatment with psychotherapy or antidepressants.

Depression among Veterans and Non-Veterans

A team from two research institutions examined data on 7,000 men ages 50 or older in a study that found that Veterans are no more likely to have depression or anxiety than non-Veterans. Veterans, especially those who have served in combat, generally experience more stress and trauma in their lives than non-Veterans, the team had expected to see higher rates of depression among Veterans. Instead, they found just the opposite. Older Veterans generally scored better than non-Veterans. Eleven of the Veterans reported elevated rates of depression, compared with 12.8 percent of non-Veterans. For anxiety, 9.9 percent of Veterans reported high levels, versus 12.3 percent for non-Veterans. These differences were not considered statistically significant. However, Vietnam Veterans were twice as likely to have elevated depression and anxiety than World War II or Korean War Veterans.

Depression and heart disease: The Heart and Soul Study

The Heart and Soul Study is a project led by VA that helped to determine how psychological factors influenced the outcomes of patients with coronary heart disease. A total of 1,024 patients, including 440 Veterans, were enrolled in the study between 2000 and 2002. Researchers have followed these patients to understand the association between psychological factors and cardiovascular events. A 2008 paper by researchers provided evidence that linked depression and heart disease may be poor health behavioral factors associated with depression, such as lack of exercise and increased smoking rates. Researchers found that among 667 patients with coronary heart disease and depressive symptoms were linked to a range of lifestyle risk factors that included smoking, low levels of physical activity, poor sleep quality, and inadequate medical adherence patterns. This research showed that each of these lifestyle factors significantly worsened over five years in depressed individuals over those who were not depressed.

Depression and Heart Attack Risk

By examining the health histories of more than 350,000 Veterans over seven years, researcher teams found that those with depression are at a 40 percent higher risk than others for having a heart attack. Generalized anxiety and panic disorder seem to raise the risk to a similar extent, and posttraumatic stress disorder (PTSD) also increases the risk, but to a lesser degree. Researchers are continuing to study whether treating these mental disorders reduces the risk of heart risk.

Iraq and Afghanistan Veterans with Depression

Many Iraq and Afghanistan Veterans have developed mental and behavioral conditions because of their combat experiences or other war-zone stressors. A 2015 study by researchers at the VA, three such situations that cause the highest level of difficulty in Veterans when they occur together. The three states are depression, PTSD, and traumatic brain injury (TBI). Patients displaying those conditions were called the "deployment trauma factor," have higher disability scores than those with any other three-diagnosis combinations. The disabilities considered include difficulty in getting around, communicating, getting along with others, and self-care. Other common problems that appeared to help predict disability included anxiety conditions other than PTSD, pain along with sleep difficulty, and substance abuse.

Non-drug treatments for Depression

Telemedicine Talk Therapy — In 2015, a study found that talk therapy delivered by two-way video calls was an effective treatment delivery process for older Veterans with depression. In this study, a research team recruited 241 Veterans aged 58 or older with major depression. The Veterans were randomly assigned to receive telemedicine or same-room psychotherapy. Both groups received treatment: behavioral activation, a talk therapy that emphasizes reinforcing positive behaviors. Findings discovered that telemedicine psychotherapy produced similar outcomes to that of in-person therapy. After a year, 39 percent of telemedicine patients and 46 percent of in-person therapy patients were no longer depressed, according to clinical interviews on depressed older adults who have barriers to mobility, stigma, or are geographically isolated.

Transcranial Magnetic Stimulation — Researchers at eight VA medical centers throughout the nation are conducting a cooperative study to determine if repetitive transcranial magnetic stimulation (TMS) helps Veterans with depression, potential PTSD, or substance abuse who are not responding adequately to medication. The therapy has already been approved by the Food and Drug Administration to treat refractory (treatment-resistant) depression. In TMS, clinicians take an electromagnetic coil, charge it with electricity, and apply it to specific points on the skull. The result is a targeted magnetic field that can affect brain cells in a particular area. Participants in the study receive a 30-minute session of this kind, five days per week, for six weeks. Researchers use the electronic coil to stimulate the participants' prefrontal cortex, the part of the brain responsible for emotions and mood regulation.

The VAST-D Study

Several types of depression medications, or antidepressants, are used to treat depression and components of the disease (such as bipolar disorder). These drugs improve symptoms of depression by increasing the availability of brain chemicals called neurotransmitters. It affects chemicals that help regulate the brain's circuits that affect emotions. Often, the first antipsychotic medications that physicians choose for their patients do not work well. Different drugs and dosages must be tried to find the right combination. The VA Augmentation and Switching Treatments for Improving Depression Outcomes (VAST-D) study, a VA cooperative study, is actively underway at 34 VA facilities throughout the nation. Researchers are working to determine the next steps for outpatients experiencing major depressive disorders who have not had satisfactory outcomes to standard first-step treatments. The team will attempt to determine the best resolution to other antidepressants versus augmenting the first medication that was prescribed. Researchers will also look at the results of augmenting the first medication with atypical antipsychotics, a newer generation of drugs used to help treat depression.

New and Ongoing Research

VA researchers are making valued headway in treating, screening, and diagnosing depression and other mood-affected disorders such as persistent despair, bipolar disorder, and seasonal affective disorder. Researchers have developed models that allow family interventions and social support to help veterans recovery from mood disorders or depression.

So, be aware of these facts on depression that can affect you and your brother/sister veterans out there. They are very real and can sneak up on you quickly if you are not aware of them. Be proactive and stay busy to prevent any symptoms.

Reference:

Veterans Affairs (2019). Depression. Retrieved from https://www.research.va.gov/topics/depression.cfm

Bushatz, A. (2020). Caregiver Help: Veteran Substance Abuse and Depression. Retrieved from https://www.military.com/spouse/military-life/wounded-warriors/caregiver-help-veteran-substance-abuse-and-depression.html

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