Introduction of depression
Clinical
depression affects mood, mind, body, and behavior. Research has shown that in
the United States
more than 17 million people- one in ten adults- experience depression each year,
and nearly two thirds do not get the help they need. The WHO Collaborative Study
of Psychological Problems in General Health Care screened nearly 26,000
individuals attending primary care facilities in 14 countries and found that
10.4% of patients had current depression. The Depression Research in European
Society survey involving 78,463 adults, found a 6-month prevalence rate of 17.0%
for depressive disorders. Similarly, the U.S. National Comorbidity Survey found
that 17.3% of the general population had experienced an episode of major
depression and 24.5% had suffered from an anxiety disorder at some time during
their lives. Treatment can alleviate the symptoms in over 80 percent of cases.
Yet, because it often goes unrecognized, depression continues to cause
unnecessary suffering. Women experience depression at roughly twice the rate of
men.
Everyone has felt
sad at times. Depressed individuals tend to rationalize their depression and
deny their illness as something normal. They feel that their feeling of sadness
has some rational foundation.
Most people
believe that if they are coping with a tragic event or difficult situation, they
have a right to be depressed. They also think that their depression will be
relieved as soon as the tragedy is alleviated. It is true that if your feeling
of sadness is associated with a stressful event in your life, you could get out
of it soon enough. However, if your depression is ongoing for six months or
more, then your brain chemistry may have changed as a result of the prolonged
sadness. You could be clinically depressed.
Depression can
strike at any age, including in childhood. Studies in the United States showed
that 1.8 percent of prepubertal children and 4.7 percent of 14 to 17-year-olds
have some form of depression. However, the common time of onset is early middle
age, and depression is particularly rife among the elderly, as a reaction to the
facts of growing older - the death of a spouse or friends, the physical
limitations of age and the impending confrontation with death. Elderly widowers
are particularly susceptible to suicide.
Depression is one
of the most common psychiatric disorders. Because it is so common, many people
feel that if they ignore the depression, it will disappear. Prolonged
"depression" can result in symptoms such as decreased or increased appetite,
either insomnia or hypersomnia, anhedonia (loss of pleasure), either agitation
or fatigue, poor concentration, increased self-criticism and excessive guilt.
This may be the clue that your illness has progressed to the stage that it needs
to be treated.
If left
untreated, depression may lead to suicidal ideation or attempt. Suicide is a
real threat in depression. Elderly white males are in the highest risk category
for suicide, although women are also susceptible. A seven-year study showed
mortality in older women increased a few percentage points when they had one to
two symptoms of depression. Women with more than 10 depressive symptoms had a
mortality rate fivefold greater than that of women with no such symptoms.
Depressed
patients have a twofold greater risk of developing diabetes than that of normal
individuals.
Among those with existing diabetes, 30% also have depression. In addition,
depression occurs in 50% of patients with multiple sclerosis, 40% with cancer
and 60% with dementia. There is also a strong relationship between depression
and cardiac illnesses. Results from a recent study (July, 2000) show that the
prevalence of asthma is much greater in individuals with high levels of
depression and anxiety. This study showed that adults with higher levels of
anxiety and depression are more than twice as likely to develop asthma as
compared to those with lower levels.
Depression was 9
times more likely to develop in patients with anxiety disorders compared with
those with no other illness and 6 times more likely in patients with 2 or more
chronic medical conditions.
Up to 40% of
patients with cancer suffer from depression or anxiety. Patients experiencing
chronic pain or side effects from chemotherapy are particularly at risk for
developing depression. Studies have shown that the presence of depression or
anxiety has a detrimental effect on the recovery from cancer, response to cancer
therapy and the death rate of cancer patients.
Depression is
also frequently found in patients with cardiac disease. Up to 33% of patients
develop depression after suffering a myocardial infarction. The relationship
between cardiac disease and depression is complex. There is some evidence that
depression may actually lead to cardiovascular disease. Depression occurs in
about half of all patients who experience a cerebrovascular accident and is
associated with poor functional recovery. The patients who are depressed have a
higher probability of dying after myocardial or cerebral infarction compared to
those who are not suffering from depression. Thus, depression can adversely
affect your recovery from illnesses such as cancer, heart disease,
gastrointestinal diseases, etc. Having an optimistic attitude is one of the best
treatment you can have.
Depression is
very treatable with medication (selective serotonin reuptake inhibitors (SSRI),
tricyclic antidepressants and monoamine oxidase (MAO) inhibitors are commonly
used), psychotherapies and electroconvulsive therapy (ECT). For mild depression,
there are a number of complementary therapies and herbs that are useful.
Lifestyle interventions such as stress management techniques, diet and nutrition
changes, exercise, etc. can make a marked difference in your outlook.
Major depression
often goes undiagnosed because it is confused with the normal feelings that may
arise because of a specific life situation. It is estimated that only about 20%
of those with depression seek treatment. Also of concern is minor but chronic
depression, also known as dysthymia, which can last two years or more. Although
the exact causes are unknown, researchers currently believe that both forms are
caused by a malfunction of the brain's neurotransmitters, chemicals
(particularly nor- epinephrine and serotonin) that modulate moods.
Untreated
depression is costly. A RAND Corporation study found that patients with
depressive symptoms spend more days in bed than those with diabetes, arthritis,
back problems, lung problems, or gastrointestinal disorders. The World Health
Organization Global Burden of Disease Survey estimates that by the year 2020,
major depression will be second only to ischemic heart disease in the amount of
disability experienced by sufferers. Several studies have consistently
demonstrated that individuals with depression and anxiety disorders experience
impaired physical and role functioning, more days in bed due to illness, more
work days lost, increased impairment at work, and high use of health services.
The disability caused by depression and anxiety is just as great as that caused
by other common medical conditions, such as hypertension, diabetes, and
arthritis. Comorbidity of depression with anxiety or medical illness further
increases the disability experienced by sufferers.
Estimates of the
total cost of depression to the US in 1990 range from $30 to $44 billion. Of the
$44 billion figure, depression accounts for close to $12 billion in lost work
days each year. Additionally, more than $11 billion in other costs accrue from
deceased productivity due to symptoms that sap energy, affect work habits, cause
problems with concentration, memory, and decision-making. And costs escalate
still further if a worker's untreated depression contributes to alcoholism or
drug abuse.
More business
costs result when an employee or colleague has a family member suffering from
depression. The depression of a spouse or child can disrupt working hours, lead
to days absent from work, effect concentration and morale, and. decrease
productivity.
Caution
There is
a distinct difference between feeling "depressed" and having a depressive
illness. If you have low spirits for a while, don't be concerned. However, if
you feel you can't lift yourself out of your misery, you should seek
professional help.