Depression has been determined by the World Health Organization(WHO) to be of the most disabling disorders in the world. It affects about 25% of women and 10% of men at some point in their lifetime. It is thus estimated that 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 coexisting 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 produces 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 disease that is in part hereditary and is often associated 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.
Fortunately, safe and effective treatment is now available for depression and other mood disorders. 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 behavior therapy (CBT) will provide symptomatic relief for most patients with depression. Medications are also available to "prevent" recurrent episodes of depression or mania, particularly in patients who suffer from bipolar disorder. These "mood stabilizers" include lithium and anticonvulsant medications such as valproic acid and lamotrogine.
As scientists are trying to learn more about brain mechanisms associated with depression, researchers 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.
Think you may be depressed?
Take an online Depression Screening Test.Adapted with permission from the University of Michigan Depression Center Web site.
