Posted by: keherenf | March 20, 2008

Depression

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From a human perspective, depression is really unfortunate and can be crippling. From a public health and economic perspective, depression is equally crippling in the loss of productivity and quality of life that results from this condition. According to the World Health Organization, depression is the #1 cause of disability and the #4 contributor to global disease, projected to reach #2 within the next ten years. The more I researched not only the medical but the economical impact of this condition, I realized it was important to try and inform as many people about it as possible.

Pathology: Although there are many possible causes of depression, the commonly accepted biological model is that it results from an imbalance of chemicals in the brain. The following may also contribute to the development of depression:

  • genetics (family history)
  • traumatic event
  • physical conditions (AIDS, cancer, etc or the medications used to treat these conditions)
  • having another psychological disorder at the same time (schizophrenia,  anxiety disorde, substance abuse, etc)

Types: Within the “Major depressive disorders” includes dysthymia, seasonal affective disorder, postpartum depression, and bipolar disorder. For the purposes of this article, I will write about general depression.

Symptoms:

  • constant feelings of sadness or “the blues”
  • increased irritability
  • loss of energy
  • constant tiredness
  • decreased interest in usual activities
  • change in appetite, either increase or decrease
  • change in sleeping patterns: increase or decrease, waking up too early
  • feeling slower than usual
  • restlessness
  • inability to concentrate
  • suicidal thoughts, thoughts of worthlessness

Treatment: The first step is to see a doctor, who through questioning and various medical tests can rule out other conditions that can mimic depression (like a thyroid disorder). After being diagnosed with depression, the physician will refer the individual to a mental health professional which can then determine the appropriate course of treatment. The most common treatments are psychotherapy and/or medication depending on the severity of the depression and what they underlying causes are.

The most common type of medication are SSRI’s (Selective serotonin reuptake inhibitors) . To see how these work in the brain, watch this video by the Mayo Clinic.

**Important things to remember**

  • If you or someone you know is feeling suicidal, seek professional help immediately
  • If you or someone you know is suffering from clinical profession, seek professional help as soon as possible
  • If you or someone you know is beginning treatment for depression, know that it may take weeks or even months until full results are seen. Hang in there!
  • There is nothing to be embarrassed about if you are diagnosed with depression, or any other mental illness for that matter. It is an illness…just like strep throat or a cold…something that you would never voluntarily choose and cannot control.

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Mortality (# of deaths): Depression is strongly linked to suicide, which takes over 850,000 lives a year

Morbidity (# affected): At least 121 million people worldwide

Epidemiology: Depression does not affect one race or gender more than the other, although it may be diagnosed more frequently in areas that have better access to health care.

Public Health Aspect: I have already mentioned how disabling depression is for the world. Unlike a virus like HIV which is much harder to treat medically, depression can be very well managed with primary care. Antidepressant medication, psychotherapy, or a combination of the two can alleviate or eradicate depression in up to 80% of individuals with just basic primary care. However, less than 25% of the world’s population has access to the primary care needed to treat depression. In addition, lack of treatment has been associated with societal stigmas about suffering from depression. If we could only broaden the education of the nature and treatment of depression, I feel that there could be great improvement not only on an individual scale but a global scale as the burden of this disease is lightened.

For More Information:

WHO

Depression.com 

National Institute of Mental Health 

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Responses

  1. Super informative article…i think this will be a popular one

  2. Thank you for writing so comprehensively about this subject. I’m presently engaged in research on this as it affects a specific group of people. I would like to reference it and give you the appropriate attribution…please, can you email it to me: anthonydexter@gmail.com…Thanks

  3. Thanks for the post. I have three quick follow-ups:

    First,
    I wanted to highlight the two misconceptions about depression I most frequently encounter. A lot of people seem to associate depression with feeling sad or upset, but it can also take the form of a bored indifference to everything (which eventually can extend to an indifference about one’s own continued living). Thinking that depression involves being extremely sad can, unfortunately, greatly postpone self-diagnosis. The other widespread mistake I’ve observed is the social stigma attached to depression, viewing it as a character flaw, or moral weakness. Unfortunately I think many common varieties of Christianity in the US help perpetuate this harmful view. (Unfortunate not because religion is unfortunate, but because the mistaken view in these cases is often felt to be closely connected with one’s fundamental worldview, which makes it more difficult to change).

    Second,
    David Foster Wallace (who, sadly, committed suicide recently) wrote a short-story called “The Depressed Person” that captures, for me, a lot of the experience; particularly the feelings of excruciating banality and guilt attached to the depressed person’s self-understanding of their situation. There’s a pdf available from Harper’s magazine: http://www.harpers.org/media/pdf/dfw/HarpersMagazine-1998-01-0059425.pdf

    Third,
    my understanding of treatment options is that drugs in combination with psychotherapy are vastly more effective than either individually. In fact, I seem to remember reading that studies showed neither drugs nor psychotherapy by themselves to be statistically different from placebo. This isn’t to say that they don’t work, since placebo effects can be quite powerful; I just thought it was worth noting in case others wanted to try and follow-up on it.

    Thanks again.


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