The ill that depression does

Depression is a health problem that we cannot ignore. About 8% of adults will have major depression some time in their lives, and globally, it is the chief cause of years with disability, actually the fourth cause of disability-adjusted life years (DALYs) 1. According to the National Institute of Mental Health (NIMH), 6.7 million women and 3.2 million men had a major depressive disorder in the US alone in 1998. In Canada, studies showed that 7.9% to 8.6% of adults over 18 years old who lived in the community had major depression at some point in their lives, and within a year, 4-5% of the populace will have major depression1. A New Zealand Mental Health Survey published in September 2006 showed an overall lifetime prevalence rate of 16.0% for major depression2.

Indeed, depression is present in every country, and imposes a significant economic burden directly via healthcare costs, hence increased health spending, and indirectly as lost work productivity, not to mention its emotional burden on the affected individuals and their families. Unlike in the past, when we thought that children could not have depression because of their relatively under-developed, superego, we now know that children also do, and that the behavioral patterns we once termed ‘depressive equivalents’, or in older youngsters attributed to ‘adolescent crisis’ could be evidence of imminent or in fact ongoing depression. Considering that some depressed individuals attempt and might even complete suicide, we all should be vigilant and seek professional help promptly for depression, either in children or in adults.

This is even more so considering recent findings regarding the role that depression plays in many medical illnesses. It increases the risk for coronary heart disease for example, and its link with acute coronary syndrome (ACS) is under vigorous investigation3. British researchers, who evaluated the chronological link between self-reported depression and the start of ACS resulting in hospital admission, found that patients were 2.5 times likelier to have experienced acute, circumscribed depression in the 2 hours prior to ACS onset, and 5 times more to have moderate to severe depression than during the same period in the preceding day. These findings, which are in keeping with earlier ones that anger sets off ACS, are not just important reminders of the dangers anger and depression pose to our health, but also underscore the need to recognize and treat depression in all its forms, promptly and appropriately, and in particular to prevent it becoming recurrent/chronic.

Depression, according to a recent study, also plays a role in osteoporosis and increases fracture rates6. However, it is unclear how it does this and if its treatment would improve the problem, although the study suggests a link between improvement in depression and bone mass on treatment with antidepressants, an important link that future studies might cement. Depression increasingly features in other conditions and even in age groups in sometimes-controversial manner. We used to think for example that pregnancy protects against psychiatric disorders, but we now know that the risks for major depression in women, who in general are twice at risk as men for depression, both pregnant and non-pregnant, are similar, between 10% and 15%.

Yet, we continue to face the dilemma of the dangers of under-treating depression during pregnancy, for example, the increased risks of fetal growth retardation and preterm births, vis-à-vis the effects of antidepressants on the fetus, some found to have blood levels comparable to those of their mothers’. Indeed, the FDA raised concerns in 2006 of the heightened risk of fetal cardiac effects due to such exposure, concerns that have prompted calls by some for the use of alternative treatment modalities such as cognitive behavior therapy (CBT), ECT, repetitive transcranial magnetic stimulation, and therapeutic light to treat depression in pregnancy. The call for the use of such alternative treatment modalities for young people is also stronger more so due to the conflicting results of research on the increased suicidality some antidepressants, the SSRIs, reportedly cause. Thus, depression continues to cause as much grief as it possibly could, in many different ways.




References

1. Available at: http://www.phac-aspc.gc.ca/publicat/miic-mmac/chap_2_e.html Accessed on February 6, 2007

2. Oakley-Brown, M. A., Wells, E., Scott, K. M., & McGee, M. A. (2006). Lifetime prevalence and projected lifetime risk of DSM-IV disorders in Te Rau Hinengaro: The New Zealand Mental Health Survey. Australian and New Zealand Journal of Psychiatry, 40, 865-874. [p.867]

3. Steptoe A, et al. Acute depressed mood as a trigger of acute coronary syndromes. Biol Psychiatry 2006 Oct 15; 60:837-42

4. Yirmiya R et al. Depression induces bone loss through stimulation of the sympathetic nervous system. Proct. Natl Acad Sci USA 2006 Nov 7; 103:16876-81.