Scicurious at Neurotic Physiology is publishing a bunch of "Back to Basics" posts that are well worth a read, and I found her series on depression particularly interesting. In Depression: Part 1, Scicurious explains why we should care about this disease:
Right now, depression is thought to occur in 21% of women and 13% of men worldwide, with 18 million people affected in the US (this is according to the lecture I had in 2006 on it, though other people say it's 8-17% of the total population). It's a big deal for research, depression is second leading cause of disability, and antidepressants are the third best-selling group of pharmocotherapies in the world. Not only that, the economic burden is 12.4 billion dollars a year in medical, psychiatric, and pharmacological care, and that's not counting decreased productivity, work absences, and mortality costs for depression-related suicides (well, ok, it's not that much when compared to the cost of the Iraq war). Regardless of its issues in modern society, depression is both a significant emotional and economic burden, and something that goes very far back in human history.
That got me interested in finding out a bit more about disability caused by depression.
In 1990, the World Health Organization published its first Global Burden of Disease study, which used information from member states to quantify the health effects of 100+ diseases and injuries. The report introduced the DALY - disability-adjusted life year - which the WHO defines as "the sum of years of potential life lost due to premature mortality and the years of productive life lost due to disability." In 2004, they published an update, and the table of the leading causes of burden of disease is on page 44 of the PDF.
Worldwide, WHO found that depression (unipolar depressive disorders) is third on the list of diseases ranked by DALYs - it accounts for 4.3% of total DALYs. (Lower respiratory infections and diarrheal diseases come in first and second, accounting for 6.2% and 4.8% of DALYs, respectively.) The rankings differ when you look at countries grouped by income. In low-income countries, depression is eighth on the list, accounting for 3.2% of DALYs. In both middle-income countries and high-income countries, depression tops the list, accounting for 5.1% of DALYs in middle-income countries and 8.2% of DALYs in high-income countries.
Depression is a worldwide problem, and widespread successful treatment of depression would noticeably reduce the global burden of disability. To learn more about research into depression and the development of treatments, check out Scicurious's fascinating posts on pharmacotherapies, how to study depression in rodents, the serotonin system, the serotonin theory of depression, and genetic vulnerabilities and predisposition for depressive disorders.
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Funny - the one time I called into work sick and told the truth and said I was struggling with depression was the day I was fired. I know that this prejudice exists throughout the States and even more so internationally, so I wonder how they calculated the years of labor lost because of depression, a disease I've struggled with all my life that is still viewed as something more akin to laziness or weakness than a disability. I also wonder what kind of productivity WHO measures - I've been able to perform many of my economic functions in a passable manner, but many of the pleasures of life remain a bitter mirage and I've yet to pass many of the milestones of life that my healthier friends seem to reach with ease. What is life for if not to produce pleasure, meaning, love, and... something undefinable? How is a deficit in these areas quantified?
I had weird symptoms of depression - I lost my short-term memory and my ability to come up with words. Thank god for psychopharmacologists and psych meds. I'm on so many I can't keep them straight, but I can function nearly normally now. I was lucky, because my best friend's husband was a psyciatrist who had a great resident, who became an attending and my psych (my friend's husband once, somewhat out of the blue, asked her how I was doing with my then psychiatrist, to which the answer was NOT WELL, and he set me up with his former student). Were it not for that piece of luck, I'd have killed myself years ago--not that I felt depressed, but I wouldn't have been able to live with the effects of the depression much longer.
Re #1 there is much evidence that Lincoln was clinically depressed most of his adult life, yet he was able to function. Depression was called melancholy at the time. Yet Lincoln definitely functioned at the highest level. Is happiness an ephemerial state and some level of near depression the common state of man? If you follow Marx quote on religion one could draw that conclusion as opiates are a way to temporarily mask the symptoms.
Or the fact that Jefferson said that we could pursue happiness, not that we could have it?
Lyle - depression is more than unhappiness! There can be high-functioning periods and individuals (as with most mental illnesses), but the possible symptoms include things like memory and cognitive impairments, exhaustion, and weakened immune system, that are impossible to compensate for with any amount of willpower.
So how did people 150 years ago and more deal with it, or is it a new disease? If it is old as I suspect people had to deal with it before modern psych one way or another? This is a question I never have seen discussed or was it just hidden away in the corner. Melancholy has been known for at least 2000 years as the Greeks recognized it. Or has our richer society allowed depression to become worse as food was not as scarce?
Depression like symptoms can come from many an ailment, injury, accident and disease. It's not always somethings that just appears on it's own, called melancholy. Plus, some people are genetically predisposed to develop depression like cycles of emotions or thoughts to stimulation that others easily compensate for or overcome. Many times it's overlapping with obsessive/addictive behaviors too.
Medicating it away isn't the answer for all(considering the quickly FDA approved and hawked pills that later are investigated for inducing suicides) and mostly helps kick start a person out of their cycle, IMHO. I've had a TBI for over decade and most suffers of that fall into manic/depression cycles and PTSD. Help from friends, family and social connections help alleviate and exercise and good diet (my main efforts). (High sugar/carbs with poor insulin metabolism can negatively effect people's moods and mentality.) Realizing you have the problem and getting help to find what ways you can rebalance your life to a more livable and acceptable one by your standard is the first step. Accepting you can't always be butterflies and sunshine every minute or others is another thing.
Thanks Liz for raising this important yet most ignored and widely misunderstood problem.
Thanks so much for the shout-out, Liz! I'm glad you liked the posts!
I don't know ehere to start....Scicurious basically restates the DSM and misses other clinical manifestations of depression (dysthimia, depressive phases of bipolar and cyclothyimic disorders). The alck of a definitive biological marker of depression and the klack of cross-culturally nomed behavioral measures (no to mention the lack of data wityh what we have) makes it impossible to do anything resembling a reliable or useful worldwide estimate of prevelance. Depression manifests itself in different ways across cognitive, social, psychophysiological, and motor domains across cultures and across the lifespan. Although anti-depressant medication and psychotherapy have limitations (some get only transient benefit from either or both), the degree of impairment and disability would be difficult to estimate, wben within the US. A great many people function fairly well even with recurrent episodes of clinically-significant depression. What you've done is simply made it easy to take as gospel, a very superficial treatment of a significant mental health problem,