BEHAVIORAL MEDICINE
When Joy Turns To
Sorrow By Arthur Middleton, M.D., FAPA
Why aren’t you dancing with joy at this very moment is the only relevant spiritual question.
W
– Vilayat Khan
e are all familiar with feelings of sadness. It is a common experience that often results from loss or unexpected negative life events. Failing an important test, financial events such as a home foreclosure or loss of a job are examples that are familiar to many. The individual who is depressed will often have difficulty in concentrating, anxiety, and for some, thoughts of death or suicide. The Centers for Disease Control and Prevention (CDC) has reported on a World Health Organization report that unipolar depression was the third most important cause of disease burden worldwide in 2004. According to the CDC, 6.7% of U.S. adults experienced a major depressive disorder in the past twelve months. It was also reported that lifetime major depression was reported in 11.7% of women versus 5.6% in men. Noting that depression affects men and women, albeit greater numbers in women, the experience is the same for both sexes. However, the context is quite different for women. In investigating the statistical gap in male versus female depression, it has been observed that girls are affected at an earlier age than boys. This has been hypothesized as due to an onset of earlier puberty in girls followed by hormonal changes. Young women may also experience depression as a result of premenstrual syndrome or PMS. In close association to PMS is Premenstrual Dysphoric Disorder or PMDD. This is a condition associated with symptoms of depression in addi-
28 | CONNECTIONS MAGAZINE |
tion to irritability and the experience of tension prior to menstruation. Of those so affected, estimated as between 3% and 8% of women (during the times they have menstrual cycles), the symptoms occur approximately 5 – 11 days before a typical menstrual cycle. The following fictional clinical vignette is presented to highlight the issue of depression in women. JT is a 32-year-old married mother of a newborn son, age 3 months. Her husband is a construction worker, and she is an office manager for an office supply store. JT and her husband had carefully planned for this pregnancy, making certain that they were prepared for their child and could set aside time to enjoy what they believed would be the best time of their lives. While there was planning for things they could control, other life events presented a challenge. Her husband, 15 years older than JT, had a 10year-old son from a previous marriage who was living with them. And shortly after JT learned she was pregnant, her husband was laid off. JT had concerns about her husband’s emotional state owing to his past history of substance abuse, but he had been treated in a comprehensive rehabilitation program and had maintained his sobriety (from both alcohol and cocaine) for three years. JT had worked with her employer to make certain that her job was secure as she planned to take extended maternity leave to be with her child and felt confident this would be the case. She enjoyed a good working relationship with her office staff who were supportive and encouraging during her pregnancy. Despite the obstacles that surfaced, JT and her husband felt they were dealing with these issues and continued to look forward to the birth of
www.connections-magazine.com
