Sen. John Fetterman's longtime struggle with depression became more "severe" in recent weeks and prompted him to seek hospital care, his chief of staff said in a statement Thursday. The Democratic senator from Pennsylvania checked himself into Walter Reed National Military Medical Center on Wednesday night to receive treatment.
Fetterman also suffered a stroke last May and was hospitalized last week due to what staff described as lightheadedness.
"I think it really brave for him to share [his depression], because it normalizes it a bit more for people who might be experiencing it and not talking about it," said Kelly Gilrain, a licensed clinical psychologist director of behavioral medicine and psychological services at Cooper University Health Care.
Gilrain is one of three health-care providers who did not take care of Fetterman but spoke to The Inquirer about depression generally. Here are answers to some common questions:
What is clinical depression?
Clinical depression is a psychiatric mood disorder that is both common and serious. A major depressive episode is defined as having multiple symptoms of depression for at least two weeks.
What differentiates depression from just feeling sad is that the disorder impairs people's ability to complete everyday tasks, such as their work and usual routines.
What are depression symptoms?
The symptoms of depression according to the American Psychiatric Association include:
1. Sadness or feeling "depressed"
2. Loss of interest and pleasure
3. Changes in appetite and weight
4. Increased fatigue and low energy
5. Inability to sit still, or slowed movement and speech
6. Feeling worthless
7. Having a hard time concentrating and thinking
8. Thinking about death and suicide
How common is depression?
Estimates vary on how many people experience an episode of major depression every year. A 2018 study in Psychiatry Journal of the American Medical Association found that one in 10 U.S. adults went through a depressive episode in the last year, and one in five are affected in their lifetimes.
The National Institute of Mental Health estimates that 8.4% of U.S. adults endured an episode of major depression in 2020, roughly 21 million people. Women, young adults, and people who identify as multiracial reported the highest rates.
During the pandemic, many adults and children saw their mental health worsen.
How is depression treated?
There are multiple options to treat depression, and every person may react differently to treatment.
At Cooper University Health Care, Gilrain uses an approach known as cognitive behavioral therapy, which is a form of talk therapy that emphasizes skills to address thought patterns that fuel depression or anxiety. Her patients work to develop skills such as being able to observe a negative thought without acting or feeling a certain way, but rather simply being aware of it.
"It's a skill that you have to harness, and you have to practice," she said.
Evidence shows that combining antidepressant medications with therapy leads to good outcomes, said Alexander Tsai, a psychiatrist at Boston's Massachusetts General Hospital and an associate professor of psychiatry at the Harvard Medical School.
When severe depression persists despite therapy and medication, other options include electroconvulsive therapy (which used to be called "shock therapy"), going into the hospital for a few hours every day, or inpatient care.
Hospitalization can also help in situations in which a patient stops taking care of basic needs, such as eating, or is at risk of self-harm.
By being admitted to a hospital, patients can receive more intensive daily therapy and have the dosage of any medications prescribed increased more quickly than when treated while staying at home, Tsai said.
"There is a wide range in terms of the treatment options that are available," he said. "I don't know that we can necessarily infer something about Fetterman's severity of illness just based on the fact that he is in a hospital."
Are depression and stroke related?
Stroke is a known risk factor for depression, and some studies estimate that a third of stroke patients suffer depressive symptoms.
There are many reasons for someone to become depressed after a stroke, said Thomas Watanabe, the clinical director of the Drucker Brain Injury Center at MossRehab, which is part of Jefferson Health in Philadelphia. The stroke can affect an area in the brain that causes the depressive symptoms. Depression can also result from the frustration that comes with a difficult rehabilitation.
Watanabe said that the stroke does not limit most treatments for depression, and that treating the mood disorder can help improve a patient's overall rehab.
"Treatment is very effective, and depression treatment won't affect recovery," he said. "Most people after stroke do get better."
