Fetterman’s hospitalization: What is clinical depression?

By Sandee LaMotte, CNN

Democratic Sen. John Fetterman of Pennsylvania voluntarily checked himself into a hospital on Thursday “to receive treatment for clinical depression,” according to a statement by Adam Jentleson, his chief of staff.

“While John has experienced depression on and off during his life, it only became severe in recent weeks,” Jentleson wrote.

In May, during his campaign, Fetterman suffered a stroke as he faced off against Republican Mehmet Oz for the Senate seat.

“After what he’s been through in the past year, there’s probably no one who wanted to talk about his own health less than John. I’m so proud of him for asking for help and getting the care he needs,” his wife, Gisele Barreto Fetterman, tweeted.

“I think it’s fantastic that Sen. Fetterman was working with a provider that recommended he get a higher level of care, and that he was able to access services quickly,” said Kristen Carpenter, chief psychologist in the department of psychiatry and behavioral health at Ohio State University College of Medicine.

“Many patients struggle and suffer with these symptoms for a long time before seeking or getting the help they need,” she added. “At a minimum, you can have relief faster when you’re linked for care.”

Depression after a major illness such as stroke is not uncommon, according to the American Stroke Association.

“After a stroke there are biochemical changes within the brain structure which might put him more at risk for depression,” said stress management expert Dr. Cynthia Ackrill, a fellow at the American Institute of Stress.

“After you’ve had a stroke, it takes more work to do what you did before,” Ackrill added. “So you’re more tired and more stressed, and we know that chronic exposure to the cortisol that comes from stress puts you more at risk for depression.”

Risks for depression

No one knows the exact cause for depression, and why it is worse in some people than others, according to the US Centers for Disease Control and Prevention.

“It may be caused by a combination of genetic, biological, environmental, and psychological factors,” the CDC noted.

Having a family member with depression raises the risk; so do traumatic experiences such as physical abuse or sexual assault, financial problems and a major life change, such as losing a loved one, the CDC said.

Depression is also more common after having a heart attack or being diagnosed with cancer or chronic pain, and people with anxiety disorders are more likely to suffer from depression, too, the CDC said. Substance abuse, such as alcoholism, is also linked to depressive symptoms.

Feelings of depression can be a side effect of many medications, including common ones such as beta blockers used to treat high blood pressure, some proton pump inhibitors used to treat acid reflux, steroids used for inflammation and pain, hormonal contraceptives and more. A 2018 study found over 37% of US adults used medications that might lead to depression.

Symptoms of depression

Symptoms of depression include an ongoing sad, anxious or vacant mood, along with “feelings of hopelessness, pessimism, guilt, worthlessness or helplessness,” according to the American Stroke Association.

Other symptoms include fatigue and decreased energy; less interest or pleasure in daily activities, including sex; changes in appetite and weight; trouble with memory, concentration, planning and decision-making; sleep changes, such as insomnia or oversleeping; and thoughts of death or suicide.

Read more: Inside the depressed mind — fighting yourself in a world with no color

Depression can be mild, moderate or severe. Clinical depression, also called major depressive disorder, is the more severe form of depression.

To be diagnosed with clinical depression “an individual must have five depression symptoms every day, nearly all day, for at least 2 weeks,” according to the National Institute on Mental Health.

“One of the symptoms must be a depressed mood or a loss of interest or pleasure in almost all activities. Children and adolescents may be irritable rather than sad,” the institute noted.

“We all experience times of sadness, or lack of interest in things we usually enjoy, or other sorts of depressive symptoms,” Ohio State’s Carpenter said. “However, when someone slips into a major depressive episode that means those symptoms are present daily, for most of the day, and they are functionally impairing — meaning they inhibit one’s ability to work, to interface with their families and loved ones, and to engage in the usual activities of living.”

Treatments for depression

There are a number of treatments for depression, including antidepressant medications, psychological therapy or a combination of both. Antidepressants typically take between four to eight weeks to work, and it’s not uncommon to try a variety of medications before finding the best for that individual, Carpenter said.

“There are higher levels of care like hospitalization, which provides services available all day to help get you on your recovery journey faster.”

If depression fails to respond to first-line treatments, providers may suggest other medications such as esketamine, Carpenter said. Delivered as a nasal spray by doctors, esketamine is a newer US Food and Drug Administration-approved medication for treatment-resistant depression.

“It often acts rapidly — typically within a couple of hours — to relieve depression symptoms,” according to the National Institute on Mental Health.

“If you have what we refer to as a treatment-resistant depression, we may use things like TMS — transcranial magnetic stimulation — and we still use ECT, or electroconvulsive therapy. So there really is a large compendium of therapies available,” Carpenter said.

“The key is getting care. The vast majority of people will have their symptoms remit with proper treatment through psychotherapy and/or medication.”

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