In 1995, Rene Ruballo noticed a troubling change within him. This now retired New York City police officer and father of four started losing interest in everything he once felt passionate about, including his police work and spending time with his family. At times he would ditch work and sleep all day. Other times, he’d function on only an hour’s sleep. He no longer felt he had anything to look forward to in his life.
As he grew more and more withdrawn, Ruballo’s family realized something was very wrong. “My wife and children saw that I wasn’t interested in the things we used to do,” says 43-year-old Ruballo. “If there were family outings, I used to just tell my wife, ‘You can take [the kids].’ And I would just stay home.” Ruballo’s wife urged him to seek counseling. Eventually he did get professional help, and his suspicions about the cause of his feelings were finally confirmed: He had depression.
Most people use the word depression to describe feeling sad or blue, but it is much more than that. This serious medical illness affects some 18 million Americans and can have debilitating effects on those who suffer from it. Twice as many women suffer from depression as men, but men are less likely to admit they are depressed or seek help. Across racial and ethnic lines, poor and less educated individuals suffer from higher rates of depression. And although depression goes largely undiagnosed among all ethnic groups, the disparities in treatment are stark in the African American community.
“Non-Hispanic blacks and Hispanics both have lower rates of treatment than non-Hispanic whites,” says Ronald Kessler, professor of healthcare policy at Harvard Medical School. “When they get treatment, furthermore, it is less likely to be in the specialty mental health sector and more likely to be treatment from a primary care physician or social worker or minister. This is a double disadvantage — lower overall treatment and presumably lower quality of treatment once in treatment.” Social stigmas surrounding mental health in the African American community, as well as limited access to health plans that provide direct mental healthcare, contribute to undertreatment. Public health institutions are more likely to offer poor clients medication than psychotherapy.
“There still is a stigma in the African American community that psychotropic medications are being used as a social control mechanism,” says Kessler. But depression, left untreated, can completely halt one’s ability to function day to day and, at its worst, may even lead to suicide. There were 30,622 suicides in the U.S. in 2001, 1,957 of which were committed by African Americans, according to the American Association of Suicidology. This breaks down to 5.4 African American suicides per day.
Depression is not uncommon among African American professionals and executives. “It’s very difficult for African Americans in corporate settings, where they know they are being looked at closely,” says Dr. Annelle B. Primm, associate professor of psychiatry at Johns Hopkins University School of Medicine. “They never know if they’re being responded to for who they are as a person or who they are as an African American.” She says that while the predisposition for depression is genetic, depressive symptoms may present themselves during stressful life events.
Since African American professionals usually face higher levels of scrutiny and common concerns such as the glass ceiling, stress and depression are not uncommon. “In the corporate sector, you think that people have ‘arrived,’ but they are not immune from getting the illness of depression. And if it is untreated and overlooked, there is a risk that it could end up being a fatal illness,” says Primm. She adds that black professionals often feel they have to hide their depression for fear of damaging their careers and to feel secure in their positions. “They may feel that they’ve worked so hard to get to this point. They may fear getting treatment because it may impair their upward mobility or ability to maintain their status. You don’t want to give anyone a competitive edge.”
The dangers of such behavior are great. According to Primm, it’s not uncommon for executives to try to “work through the depression,” overwork to the point of exhaustion, or begin abusing substances. “Because of the realities of racism and how we as African Americans are judged differently, the risks of admitting we are ill are very high.”
Not much is understood about the exact cause of depression, but we do know that it involves certain neurotransmitters, like dopamine and serotonin. People who are depressed often do not show enough serotonin activity, for example, and this is where antidepressant SSRI (selective serotonin reuptake inhibitor) medications might help. They include brand names like Paxil, Prozac, and Zoloft. But there are a host of other medications doctors might provide to treat varying degrees of depression.
New research is also uncovering strong links between depression and other debilitating diseases, such as cancer, heart disease, and diabetes. In fact, people with diabetes have a twofold chance of getting depressed, and people with depression are twice as likely to get diabetes. Depression and diabetes involve a common part of the brain. They also both involve the stress hormone cortisol, too much of which is damaging to brain cells.
Although depression is an equal opportunity disease, manifestation of symptoms can differ widely among ethnic groups. “It’s very unusual for an African American man to come in and say he’s ‘sad,’ because it’s not appropriate culturally for a black man to present himself that way,” says Primm.
Often, African American men and women will display their depression as anger or irritability instead of sadness. Changes in eating habits and complaints of chronic pain that no physical evidence can substantiate may also be red-flag indicators of depression in African Americans.
Large-scale studies have typically shown African Americans have a lower rate of depression than the majority population. “Non-Hispanic blacks and Hispanics both have a significantly lower lifetime risk of ever becoming clinically depressed than non-Hispanic whites, but they also have higher risks of chronicity once they become depressed,” says Kessler. But Dr. William Lawson, chair of the department of psychiatry at Howard University, says there might be a different reason that African Americans appear to have a lower risk for depression.
“We have different idioms of distress,” says Lawson. “It’s not always easy to convince others of the importance of cultural competence training. We speak a common language and we live in the same geographical area [as whites], so it is assumed that [even though] we may look a little different, we’re really just white people when you scratch away the skin. But there are some profound cultural differences that are persistent and important, that need to be looked at.” For one thing, admitting depression is a cultural taboo among African Americans. Lawson says he has worked with black churches where people were more ready to accept people with HIV than those who were depressed. In addition, since most African Americans will seek help from their primary care physician when faced with symptoms of depression before seeing a mental health professional, they are more likely to be given medication and nothing else.
“If a patient comes in and sits down and you give them pills, they’re not going to take them,” says Lawson. “African Americans will often prefer psychotherapy over medication, and the research shows that psychotherapy is just as helpful.” In fact, the combination of psychotherapy and medication has frequently been shown to be effective in treating major and chronic depression. Lawson notes that there is a strong ne
ed for African Americans to be included in more clinical trials to determine how medications might affect them specifically. He also says that African Americans should generally be prescribed lower doses of some antidepressant medications because they metabolize them differently and therefore have higher instances of side effects.
“With respect to African Americans, falling prey to mental illness places you in a vulnerable position, and we’re already in a vulnerable position,” says Boris Thomas, a psychotherapist and social worker based in Chicago. Thomas acknowledges that the situational differences African Americans experience in this country because of race can be significant stressors that may cause depression in some people. “There’s a great deal of pressure to succeed in society, but there’s also pressure on that person to manage issues of race. Being depressed can feel like it affirms some kind of weakness.” But he urges people to get control of depression because ignoring the symptoms will not make them go away. They might even get worse. “Understanding that other people have similar problems, or ‘universalizing’ an ailment, can be a great help and reduce the sense of isolation,” he says. “In this regard, group therapy can be very effective.”
For Ruballo, the changes he experienced were not subtle, and people who are truly depressed will be able to identify the severity of what they are feeling. “I was very outgoing [before]. I was very happy. It was a big change from being an extrovert to an introvert,” he says. “Sometimes the kids felt that they had done something [wrong]. It wasn’t them.”
Ruballo had the support of his family when it came to seeking professional help, but many people don’t have that support and delay treatment. If seeing a therapist is intimidating, talk to your primary care physician or consider group counseling. Talking to friends and family, even your minister, can be comforting. But ultimately, if you are experiencing prolonged symptoms (for more than two weeks) such as sleep disturbance, appetite changes, irritability, lack of concentration, or suicidal thoughts, you may have depression, and you should seek professional treatment.
Symptoms of Depression
The three most severe forms of depression are major depression, chronic depression (dysthymia), and bipolar disorder. Types of depression differ by duration and degree of symptoms. Sufferers of major depression tend to have all or most of the following symptoms and may even experience chronic physical symptoms such as headaches, stomachaches, and muscle tension. Other symptoms include:
- Persistent sad or empty mood
- Feelings of hopelessness or worthlessness
- Fatigue or loss of energy
- Sleeping too much or having insomnia
- Poor concentration
- Increased or decreased appetite
- Feeling anxious or irritable
- Inability to focus
- Suicidal thoughts
If you think you may be depressed, the first step is to examine your daily life and see if there are any changes in your routine. Are you getting enough sleep or too much sleep? Are you isolating yourself from friends? Are you eating properly? First, make sure you are taking care of your basic needs and then assess if there have been any major changes in your life, whether personal or professional, that may be creating anxiety or throwing you off balance. For additional information and resources, visit blackenterprise.com.