Senator John Fetterman of Pennsylvania has voluntarily checked himself into Walter Reed National Military Medical Center to receive inpatient treatment for clinical depression.
Fetterman also had a stroke last year. Strokes may be associated with depression and stress.
Fetterman is receiving praise for speaking out about his battle with depression.
Senator John Fetterman, 53, voluntarily checked himself into Walter Reed National Military Medical Center last week to receive treatment for clinical depression, according to a statement released by his chief of staff Adam Jentleson, and shared on social media by his wife, Gisele Barreto Fetterman.
Fetterman was evaluated by Brian Patrick Monahan, MD, the attending physician of the United States Congress and the United States Supreme Court, who recommended inpatient care at the Center. Fetterman has experienced depression throughout his life, but it became severe in recent weeks, the statement specified.
What is clinical depression?
According to the Mayo Clinic clinical depression is considered a more severe form of depression, also referred to as major depression or major depressive disorder. Generally, it can have a profound impact on someone’s daily life, causing problems at work or in social situations. It can affect anyone of any age.
According to Sarah Berger, PhD., a licensed clinical psychologist and director at Capitol Psychological Services in Chevy Chase, Maryland, clinical depression can’t be diagnosed through any one single test, but is defined by “two or more weeks of sadness, irritability, and/or loss of interest in things that used to be important to oneself.”
Berger also says it’s “often accompanied by increased feelings of guilt, lower self-esteem, decreased energy, trouble sleeping, changes in appetite (eating more or less than usual), decreased concentration, increased agitation, or psychomotor retardation (moving or speaking slower than usual).” At its most severe, it can lead to thoughts of death, self-harm, or suicide, Berger says.
Clinical depression is not uncommon. According to the National Institute of Mental Health, it is estimated that 8.4% of Americans (or 21 million) experienced at least one major depressive episode in 2020 alone—and Berger thinks that number may be increasing.
Clinical depression can show improvement with proper treatment—especially a combination of medication and psychotherapy. Electroconvulsive therapy (ECT) is also effective for many patients, particularly those who do not respond to medication or who are suicidal.
If you have patients with clinical depression, or if you suspect your patient is living with it, be in communication with their psychologist or psychiatrist, or refer your patient to a specialist. Beyond counseling and medication, encourage your patients to embrace healthy lifestyle habits, which can improve both their physical and mental health.
A 2021 study found that physical activity, a healthy diet, and reduced use of tobacco and alcohol were associated with lower odds of experiencing symptoms of depression Some health conditions themselves can present as clinical depression, so be sure to run any necessary labs, like tests for thyroid-stimulating hormone (TSH) or vitamin deficiency, to rule out underlying conditions.
Fetterman’s other health struggles
Depression is not the only health issue Fetterman has struggled with. In May 2022, Fetterman—who has atrial fibrillation, a decreased heart pump, and cardiomyopathy—had a stroke while on the campaign trail, days before he won the Democratic primary in Pennsylvania.
In a somewhat cautionary tale, Fetterman said that the stroke was not unprecedented, according to news reports. In 2017, he was advised by a doctor to follow up on health concerns but did not. He also did not take the medications he was prescribed.
“I should have taken my health more seriously. The stroke I suffered on May 13 didn’t come out of nowhere. Like so many others, and so many men in particular, I avoided going to the doctor, even though I knew I didn’t feel well. As a result, I almost died,” Fetterman said in a statement released last year.
Life transitions and impact on health
It’s not uncommon for stressful life transitions—like running for a seat in the Senate, as in Fetterman’s case—to be linked to exacerbated health problems and mental health issues, Berger says. For one, stress is linked to the risk of stroke.
Life changes can also trigger or exacerbate depression, says Berger. “Major life changes, even positive ones, bring about a huge source of stress for an individual—making them more vulnerable to depression.
"Individuals with a prior diagnosis of depression are more susceptible to depression after a life transition or medical situation."
— Sarah Berger, PhD
Periods of stress and change also make it harder to lean on or turn to your healthy habits. “Some of the biggest buffers for depression include sleep, exercise, and social support—and all of these factors may be harder to access during life transitions,” Berger adds.
In addition, Berger cites adjustment disorder with depressed mood as another diagnosis patients may have. This includes experiencing depressive symptoms during a life change. “This may turn into clinical depression if it lasts for more than six months,” Berger says.
Is there a link between depression and stroke?
An important note in Fetterman’s case is that he had been living with depression for most of his life—it didn’t only present after his stroke. In fact, there is a connection between stroke and mental health issues that physicians should be aware of.
According to an article in General Hospital Psychiatry, post-stroke depression (PSD) is a common condition, occurring in 18 percent to 33 percent of patients. However, the journal says that PSD is “vastly under-diagnosed and under-treated.”
People at higher risk for PSD include those with certain characteristics: a history of a recent stroke, a past history of multiple or severe strokes, a history of psychiatric illness, and injury to the frontal/anterior areas or basal ganglia. In addition, females, patients with limited social support, and those with serious disabilities are also at risk for PSD.
Some aspects of PSD may be linked to the grief patients feel after experiencing a loss of function. They may struggle with their new loss of memory, speech, or mobility, Berger says. “Having to adapt to that loss can be challenging, to say the least.”
Normalizing mental health issues
Fetterman’s openness about his health issues not only brings light to the need for prompt medical care but also reveals the clear links between mental health, physical health and life transitions.
“It is very important for public figures to speak truthfully about these matters,” Berger says. “Clinical depression is very isolating and poorly understood, [so] if public figures can speak out about this more, then more people are aware of it and may feel more willing to seek treatment.”
You can further normalize these issues by having open and honest conversations with your patients about both their physical and mental health needs.