In a growing world of misinformation, it is important to distinguish fact from myth. Particularly on the topic of mental health, there are many misconceptions with what is true or false when discussing mental disorders. To keep this discussion focused, this post will be dealing with misconceptions pertaining to major depressive disorder (MDD). MDD is a common mental disorder that is characterized by a depressed mood or a loss of pleasure/interest in activities, for most of the day, nearly every day, for at least two weeks (World Health Organization). With this simple definition, The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), goes more in depth to the symptoms that one with MDD would experience. Having five or more symptoms from the DSM-5 is required to be diagnosed with the disorder. This already addresses a common misconception that MDD is equivalent to sadness. Sadness is simply one possible symptom of MDD with the DSM-5 going more in depth with potential symptoms a patient may face. Within MDD, there are many more misconceptions that are discussed as if they were known statistical fact when in reality much of our understanding of mental disorders is still being explored every day. This blog post will work to address a two of these misconceptions, addressing studies that have explored these exact issues. Beginning with the implications of race within the disorder and following with “depression being in your mind”.
For a number of societal reasons, the sentiment that MDD is a “white person disease” has been spread and has led to many other ethnicity groups feeling underrepresented in mental health advocacy. An organization has gained traction through social media with the hashtag #DepressedWhileBlack, leading the founder Imade Nibokun to have an interview with Vice discussing the community that has formed around her project. Nibokun speaks of her experience of being raised with the thought process that “white people are weaker than black folks due the oppression [black people] have faced for hundreds of years”. In a study by Dunlop et al. (2003), the prevalence of depression among preretirement adults from different racial and ethnic backgrounds was analyzed through survey answers to a Health and Retirement Survey. Dunlop found that depression is more prevalent in minority groups, African American and Hispanic populations, than White Americans. The findings of Dunlop et al.’s study corroborates with a main sentiment of Nibokun’s #DepresssedWhileBlack, dealing with the intersecting experiences of being an African-American while simultaneously having MDD. Nibokun anecdotally mentioned that her worst depression episodes were triggered by unemployment and historically African-Americans experience unemployment at much higher rates than white people. MDD is a complicated disorder that can manifest due to several factors, but in no way should race be a determining factor for whether or not someone can experience MDD.
A common way to disregard patients suffering from MDD is the saying “it is all in your head”. The biggest issue with this saying is that it belittles people suffering from MDD, implying if they had a stronger will they could just get over it. MDD can physiologically change your nervous system to prevent you from being able simply “get over it”. These changes can feature a disturbance in the several neurotransmitters such as serotonin and dopamine that can lead to pathogenesis of the disease (Pan et al., 2018). Treatments for MDD typically attempt to target this neurotransmitter imbalance by introducing selective serotonin reuptake inhibitors (SSRI) that would lead to a greater number of serotonin existing at neuronal synapses. These have varied results in terms of effectiveness but contribute to oppose the hypothesis that depression is all in the mind. Differing from the neurotransmitter focus, there is a cytokine theory of depression in which inflammatory signaling molecules in the brain can also cause depressive symptoms (Zainal and Newman, 2021). A cytokine is an immune cell that is focused on affecting other immune cells to induce the inflammatory response in response to pathogens in our bodies. An increased prevalence of cytokines in our brain was found to positively correlate to MDD developing up to 9 years later. Major depressive disorder extends beyond our mind and moves into the brain, requiring more than will power to overcome.
Dunlop, D. D., Song, J., Lyons, J. S., Manheim, L. M., & Chang, R. W. (2003). Racial/ethnic differences in rates of depression among preretirement adults. American journal of public health, 93(11), 1945–1952. https://doi.org/10.2105/ajph.93.11.1945
Mayo Foundation for Medical Education and Research. (2019, September 17). Selective Serotonin Reuptake Inhibitors (SSRIs). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/depression/in-depth/ssris/art-20044825#:~:text=SSRIs%20treat%20depression%20by%20increasing,reuptake)%20of%20serotonin%20into%20neurons.
Pan, JX., Xia, JJ., Deng, FL. et al. Diagnosis of major depressive disorder based on changes in multiple plasma neurotransmitters: a targeted metabolomics study. Transl Psychiatry 8, 130 (2018). https://doi.org/10.1038/s41398-018-0183-x
World Health Organization. (n.d.). Depression. World Health Organization. Retrieved April 4, 2022, from https://www.who.int/news-room/fact-sheets/detail/depression
Zainal, N. H., & Newman, M. G. (2021). Increased inflammation predicts nine-year change in major depressive disorder diagnostic status. Journal of Abnormal Psychology, 130(8), 829–840. https://doi.org/10.1037/abn0000716.supp