Depression As An Illness
Depression has been determined by the World Health Organization (WHO) as one of the most disabling disorders in the world. It affects roughly 25% of women and 10% of men at some point in their lifetime. It is thus estimated more than 340 million people worldwide and more than 18 million people in the USA alone suffer from depression at any particular time. In addition to its widespread prevalence, depression has a strong tendency to recur. A high recurrence rate may be associated with genetic vulnerability, early symptom onset, poor diagnosis and treatment and inadequate emphasis on prevention.The overwhelming burden of depression may also be compounded by comorbidity with medical disorders such as diabetes, stroke and cardiovascular disease and other psychiatric disorders such as anxiety disorders, substance abuse and alcoholism. Untreated depression often leads to personal, marital, familial, career and financial difficulties, and is associated with a high rate of suicide, approaching 15% of patients with major depression in some studies. Part of the reason depression is such a high burden is that most patients with depression have never been diagnosed, let alone treated. Of those who are treated, the treatment is often inadequate and does not address future depressive episodes.
Although the exact causes of depression remain unknown, the current thinking is that depression is a brain disorder that is in part hereditary and is often assciated with current or early life stress. This combination of genetic and environmental factors causes specific changes in brain chemicals such as serotonin, norepinephrine or dopamine that may explain some of the depressive symptoms. It is also feared that the more frequent the episodes, the higher the likelihood that some form of brain damage in the form of brain tissue degeneration will occur. This however may be reversible with treatment.
The good news about depression is that safe and effective treatment is now available for most forms of the disease. The most adequate treatment is a combination of pharmacotherapy and psychotherapy. Pharmacotherapy with medications such as a selective serotonin reuptake inhibitor (SSRI) or "new generation" antidepressants along with cognitive bevavioral therapy (CBT) will provide symptomatic relief for most patients with depression. Other forms of somatic therapy such as electroconvulsive therapy (ECT) can be given to patients who are catatonic, who have failed or could not otherwise tolerate pharmacological treatment. Medications are also available to "prevent" recurrent episodes of depression or mania, particularly in patients who suffer from bipolar affective disorder. These "mood stabilizers" include lithium and anticonvulsant medications such as valproic acid.
As scientists are trying to learn more about brain mechanisms associated with depression, drug companies are working hard to develop newer antidepressants that will lessen the burden of the illness. Several exciting new compounds loom on the horizon. There is also experimental evidence that psychosocial treatment can be effective. Yes, there is light at the end of the tunnel, even for the most depressed individuals.
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