Depression: The Silent Majority

Aliases: depression

At first glance, depression might seem an odd choice for May’s theme (language), but it’s a perfect example of what happens when words fail us. It is hard to describe and hard to define, making it easy to confuse with sadness or grief. Depression is staggeringly common, but it is often overlooked; it has one of the highest rates of under-diagnosis in the developed world3,4. It is misidentified, misunderstood, and, all too often, silenced by stigma.

As of 2004, depression was the third most important cause of disease worldwide: 8th in low-income countries, and 1st in middle and high-income countries1. One out of every six people in the developed world will suffer from major depression during their lifetime, 15% of men and nearly a quarter (24%) of women3. The majority will be misdiagnosed, or receive inappropriate or inadequate treatment, if they are treated at all4.

That oversight comes at a huge cost. To state the obvious, depression is bad for your health; in addition to its symptoms, it is associated with negative health behaviors, like smoking and inactivity1, as well as an increased risk of suicide4. Without treatment, it is likely to become chronic, because the more you’ve been depressed, the more likely you are to be depressed; after experiencing one episode there is a 50% chance of having a second, and experiencing another raises the likelihood of a third, etc. And the effects of depression are not limited to the patient; it takes a toll on interpersonal relationships, and deeply affects the family and friends of the sufferer1.

Depression also puts a massive burden on society. In addition to its incalculable personal costs, depression is one of the most expensive illnesses in the US. As of 1997, depression was estimated to cost $43 billion per year; $12 billion in direct costs (usually health care costs), and $31 billion in indirect costs, with $8 billion due to premature death and $23 billion due to absenteeism from work and lost productivity4. That amount has almost certainly increased in the past 20 years. Silence and stigma have a price, and it’s high.

depression
Ugh.

Cause: Depression is a disorder that affects the parts of the brain involved in mood, thinking, sleep, appetite, and behavior (i.e. basically everything). The causes of depression are complex and not well understood; it is thought to be caused by a combination of genetic, environmental, biological and physiological factors (i.e. basically everything). There are several forms of depression; some appear to run in families, some appear to be caused by genes interacting with the environment, and others seem to be triggered by trauma1.

Consequence: Depression’s wide range of symptoms are misleading; they include things that are routine, like sadness, but depression is an intense experience that interferes with daily life2. Symptoms include depressed or sad mood, decreased interest in activities that used to be pleasurable, fluctuation in weight, inappropriate feelings of guilt, difficulty concentrating, fatigue, psychomotor agitation or retardation, and recurrent thoughts of death (things that affect… basically everything). Patients must experience at least 5 of the above continuously for at least two weeks to be diagnosed with depression1. Depression can also have persistent physiological effects, such as digestive problems like cramps, that do not ease with treatment2.

Cure: The most common treatments are medication and psychotherapy (a.k.a. talk therapy), and the earlier treatment begins, the more effective it is. Antidepressants that affect the neurotransmitters serotonin and norepinephrine, selective serotonin reuptake inhibitors (SSRIs), like Zoloft and Prozac, are the most commonly prescribed medications. SSRIs are preferred because they have fewer serious side effects compared to older generations of antidepressants, tricycles and monoamine oxidase inhibitors (MAOIs), though these are still used. Unfortunately, though they can be very successful, antidepressants can also have serious side effects, including increased thoughts of suicide. When other treatments prove ineffective, electroconvulsive therapy (ECT) and other brain stimulation therapies are sometimes used2.

References

  1. Depression. Centers for Disease Control and Prevention. 14 May 2015. Web. 4 October 2013.
  1. Depression. National Institute of Mental Health. 14 May 2015. Web.
  1. Falagas, M.E., K.Z. Vardakas, & P.I. Vergidis. 2007. Under-diagnosis of common chronic diseases: prevalence and impact on human health. International Journal of Clinical Practice, 61:1569-1579.
  1. Hirschfeld, R.M.A., M.B. Keller, S. Panico, B.A. Arons, D. Barlow, F. Davidoff, J. Endicott, J. Froom, M. Goldstein, J.M. Gorman, D. Guthrie, R.G. Marek, T.A. Maurer, R. Meyer, K. Phillips, J. Ross, T.L. Schwenk, S.S. Sharfstein, M.E. Thase, & R.J. Wyatt. 1997. The National Depressive and Manic-Depressive Association consensus statement on the undertreatment of depression. Journal of the American Medical Association, 277:333-340.

Image source: Creative Commons, http://commons.wikimedia.org/wiki/File:Paris_Tuileries_Garden_Facepalm_statue.jpg

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Suzi Claflin

I am a postdoctoral fellow studying chronic disease epidemiology.

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