Ask the Doctor: Depression Prevalence; MCI and Mood; Second Strokes
Q: I’ve read a variety of statistics about the prevalence of depression. How common is it really?
A: Getting a handle on the prevalence of depression is difficult because the condition ranges from mild and fleeting depressive symptoms to major depressive episodes, which are defined as periods of at least two weeks when a person experiences a depressed mood, intense feelings of sadness and hopelessness, loss of interest in activities or interactions with friends and family, or thoughts of or attempts at suicide. Survey data in recent years estimated that about 17 percent of adult women in the United States and 10 percent of adult men reported having a history of major depressive episodes (MDEs) in their lifetime. But earlier this year, researchers developed a simulation model that found an estimated 30 percent of women and 17 percent of men had one or more MDEs in their lifetime.
There may be many more people struggling with depression who do so on their own. While we may not know exactly how much of the population is affected by depression—mild, major and everything in between—it’s clear that depression in some form is an incredibly common condition that affects millions of people.
Q: I believe my 83-year-old father meets the definition of mild cognitive impairment. Even though he has memory lapses and other occasional challenges, he seems happier than I’ve seen him in a long time. Is that normal?
A: It’s not unusual for people to become happier and more at peace as they get older. The stress and challenges of work and raising children is often replaced by the calm that comes with retirement and activities such as traveling or spending time with grandchildren. A healthy perspective about life can take over.
Conversely, the onset of mild cognitive impairment (MCI) or early dementia can often trigger frustration, impatience, sadness, and other mood changes. These may stem from struggles with memory and decision-making or from brain changes that affect mood and personality.
If your father is aware of his memory lapses or other “senior moments” and is able to shrug them off or laugh at them, he may have already accepted them as part of his journey. If he is unaware of changes to his memory and thinking skills, pay attention to how well he functions and handles his day-to-day responsibilities. Is he on top of his finances? How is his diet? Is he following through with doctor appointments? Should he still be driving? Is personal hygiene being affected? If you feel comfortable raising the issue of memory lapses or other signs of MCI, then talk with him in a patient and supportive way. Joining him on an appointment to his primary care physician or a neurologist for a screening may be appropriate.
Q: I had a stroke about five years ago. It was relatively minor, and thankfully there are few lingering effects. But what are the odds of having a second one that may be more serious?
A: Having had one stroke does increase your odds of having a second one. Some studies have found that about a quarter of all stroke survivors will have another stroke. Other research suggests the risk is much higher. One good sign in your favor is that the period of greatest risk is during the first year or so after a stroke. So by being five years out from your first cerebrovascular event, you have already defied the odds. Knowing that you are facing an increased risk of a second stroke, the best advice is to maintain consistent blood pressure control, quit smoking (if you haven’t already), take your medications exactly as prescribed, and follow a Mediterranean-style diet and do at least 30 minutes of moderate-intensity exercise most days of the week. Maintaining a healthy lifestyle will give you the best chance at avoiding a second, and possibly more serious, stroke.
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