Depression is a disease with a specific set of symptoms, notably a persistent feeling of sadness and loss of interest. Depression sufferers lose vitality, self-esteem and experience mood disorders. Depression is the cause of unreasonable and unnecessary suffering for millions of people, often to the point of disabling the sufferer. Depressed individuals usually struggle with completing their day-to-day tasks, feeling as if there’s no more point in living.
Depressive disorders can be found throughout the world. Depressive patients account for a significant proportion of all those requiring mental heath care and, as the majority of them remain untreated, their suffering continues to disable them and to cause losses to their families and communities. The situation is especially severe in developing countries. Lack of adequate detection and treatment is due to poorly-trained health workers, scarce resources, and insufficient knowledge.
By 2020 depression will be the second most debilitating disease, yet in many parts of the world depression is stigmatized, with many people refusing treatment for fear of social backlash. Even so, tremendous strides are being made in the study and treatment of depression, including a better understanding of its causes and how best to treat it.
In psychiatry, a major depressive episode refers to a clinical syndrome consisting of lowering of mood-tone (feelings of painful dejection), and loss of interest or pleasure in all, or almost all, activities, most of the time for a period of at least two weeks. It is experienced as a paralyzing listlessness, dejection and self-deprecation, as well as an overwhelming sense of hopelessness. It is a pathological state of conscious psychic suffering and guilt, accompanied by a marked reduction in the sense of personal values, and a diminution of mental, psychomotor, and even organic activity, unrelated to actual deficiency. As used by the layman, the word depression refers to the mood element, which in psychiatry would more appropriately be labelled dejection, sadness, gloominess, despair or despondency. Dysthymia is the state just below the threshold for major depression.
According to the Australian nonprofit organization Beyond Blue, there are different subtypes of depression depending on the symptoms, the intensity and their triggers. Some of the most common ones include manic depression, bipolar disorder, dysthymia, seasonal affective disorder (SAD) or “the winter blues” and antepartum and postpartum depression (occurs specifically in pregnant women and new mothers)
Competing explanations for the spread of extreme melancholy range from a loss of beliefs in God or an afterlife that can buffer people against life's setbacks, to the stresses of industrialization, to the distress created in women by the spread of unattainable ideals of female beauty, to disruption of brain chemicals by exposure to toxic substances. The search for an explanation is rendered more difficult by the lack of any universally agreed on cause for major depression. Indeed, there is unlikely to be any single cause.
Researchers reported in 2001 that they had identified an area on human chromosome 1 that is linked with vulnerability to alcoholism as well as to emotional disorders, primarily depression. Depending on circumstances, the gene or genes may manifest themselves in either form. The study also showed that in many cases, the incidence of depression in individuals was secondary to alcoholism.
Depression is widespread; an estimated 100 million people develop clinically recognizable depression every year; between 5 and 7% of the world's population is estimated to be depressed at any given time; in 2018 approximately 300 million people are dealing with depression.
A report from the World Health Organization shows an 18% increase in worldwide depression rates between 2005 and 2015, with the prediction that this number would continue to rise.
Even in developed, industrialized countries, depression is rampant; in the United States, between 2013 and 2016, 8.1 percent of Americans who were 20 years old and older suffered from depression in a given two-week period. In 2018, the U.S. health insurer Blue Cross Blue Shield reports diagnoses of clinical depression have increased by 33 percent in the previous five years among its 41 million privately insured members. The Blue Cross data suggests 85 percent of depression sufferers battle at least one other health condition, whereas nearly one-third of depressed people present with four or more additional health concerns. A survey by the American Psychiatric Association indicates rates of anxiety are up in the U.S., whereas data from health insurer Cigna points to increasing levels of loneliness among Americans.
Depression is costly; it is the number one cause of disability in the world. Studies on depression have produced alarming figures. A depressed person, for example, is four times more likely to suffer a heart attack than a non-depressed person is. If a depressed person does have a heart attack, he or she is four times more likely to die. Elderly people who are depressed, even mildly depressed, have a 24 percent increased risk of dying than non-depressed people. In some countries the likelihood that people born after 1955 will suffer a major depression at some point in life is more than three times greater than for their grandparents' generation. In the USA, for example, of Americans born before 1905, only 1% had suffered a depression by age 75; of those born since 1955, 6% had become depressed by age 24. Those under 40 are three times more likely to become severely depressed than are older groups. In 2000, it was estimated from surveys that 10% of Americans suffer from clinical depression; millions more were believed to suffer depressed mood that was not severe enough to earn a diagnosis but still interferes with their lives. Of an estimated 50,000-70,000 suicides in the USA each year, up to 60% occur among persons suffering from depression. Approximately 125,000 people in the USA are hospitalized each year with depression, a further 200,000 are treated by psychiatrists, and 4 to 8 million more are in need of help but do not realize it. More women than men are treated for depression, and the largest occupational group is homemakers. Up to 33 percent of people suffering from clinical depression are prone to drug or alcohol problems.
Research by the US Mental Health Foundation shows that one in four adults suffers from significant depression. Students are particularly likely to have this trouble, with 46 percent of male and 64 percent of female students significantly disturbed by depression.
In Florence, Italy, those born between 1945 and 1955 were beginning to show an increase in the rates of depression compared with previous generations by the age of 15. By the time they reached 30, their rate of depression was about 18%. In Beirut, this rise in depression understandably seemed to track political events, sharply rising during the years of the civil war and instability. Of 175,000 admissions to mental illness hospitals and psychiatric units in the UK in 1969, 66,000 were suffering from depression.
A child with at least one clinically depressed parent is 3 times as likely to develop clinical depression or a phobia at some later point in life than a child of non-depressed parents, is 5 times more likely to suffer panic disorders and abuse alcohol or drugs, and runs a greater risk of doing badly at school, and having marital and work-related problems.
Depressed people are more likely to develop heart disease and twice as likely to have a heart attack as non-depressed people. Their chance of suffering further heart attacks is also higher than for happy people.
There is growing scientific evidence that depression is to some degree controlled genetically and that the same gene is responsible for creative genius. In fact, a much higher than average percentage of poets and other artists are manic-depressives and suffer from other depression disorders. Rather than finding ways of channelling this potential creativity, society treats the disease.
While some forms of depression are clearly a result of genetic vulnerability and brain abnormality, others might have their roots in evolutionary history. Depression may have developed as a useful response to situation in which a desired goal is unattainable. Depression may help a person to disengage from what has proved a hopeless effort.
Depression represents a plea for help, a strategy for manipulating others into providing resources, a signal of submission or yielding in a conflict, or a way to conserve an organism's energy and resources in hard times.