Guest column: The dangers of depression – and the importance of its care
July 14, 2014
Depression is a killer, literally. More people commit suicide due to depression than any other single cause. Remarkably, suicide is the fourth leading cause of death in the United States, ahead of diabetes, liver disease, HIV, and cerebrovascular disease in the 18-65 age group.
Depression saps the soul, dulls the mind and damages energy, drive, commitment and motivation. Depression makes you feel dumb, listless, disinterested, empty, irritable and unable to experience pleasure. What used to fire you up no longer holds interest. According to the World Health Organization, depression is the No. 1 disability in the world.
In more extreme depression, virtually nothing seems to matter: Getting out of bed, impossible; eating, irrelevant; hygiene, why bother? You are being punished for your sins and there is nothing you can or want to do to redeem yourself. Yesterday has no meaning, nor does tomorrow.
William Styron, award-winning author of several novels, wrote about his own depression in the slim volume "Darkness Visible: A Memoir of Madness." He comments, "the pain of severe depression is quite unimaginable to those who have not suffered it, and it kills in many instances because its anguish can no longer be borne."
Depression is found everywhere. It is a part of the human tapestry, known to every culture and clan, from the beginning of time. According to the National Institute of Mental Health, each year nearly 7 percent of the U.S. population evidences a major depressive disorder; 30 percent of these are classified as "severe."
Depression carries enormous ancillary social costs. Family and friends invariably suffer. Spouses worry, fret, implore, retreat and sometimes end up divorcing their afflicted spouse. Children can be puzzled, fearful, irritable and angry when mom or dad inexplicably retreat into morose withdrawal. Your employer notices declining performance, as do your employees.
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In sum, your relations with everyone in your social world is impacted, almost invariably in harmful and emotionally painful ways.
Depression produces other harmful health effects. Depressed people have poorer surgical outcomes.That's why, for elective surgeries, depression should be treated prior to surgery. Depression diminishes the effectiveness of treatment for virtually all chronic diseases, particularly diabetes, asthma, and cardiovascular diseases. Chronic pain syndromes, difficult to treat under most circumstances, are more difficult to treat in depressed individuals.
Many medical conditions coexist with depression. In fact, according to the NIMH, depression affects more than 40 percent of those with post-traumatic stress disorder, 25 percent of those with cancer, 27 percent of substance abusers, 50 percent of those with Parkinson's disease, 50-75 percent of those with eating disorders, and 33 percent of heart attack victims.
In the modern era, depression is a treatable condition. Mild and moderate depression is effectively treated with psychotherapy, particularly relationship therapies and cognitive behavior therapies. Severe depressions are best treated with a combination of antidepressant medications and psychotherapy. Some 80 percent of those who seek treatment for depression are treated successfully.
Yet, with all we know about the effective treatment of depression, only half of the population of depressed people receive treatment in any given year, and of those, more than a third receive care which is at best only minimally adequate.
Why? Certainly, stigma provides a partial explanation. People with emotional problems are not inclined to reveal them to others, including their physicians.
More important is our collective unwillingness to fund the cost of mental health care. While we purportedly have a government policy which now provides "parity" funding for mental illness comparable to physical illness, in reality, there is no parity.
For example, only 4 percent of private insurance funding goes toward mental health care. For Medicare, the figure is a paltry 2.6 percent, while for Medicaid, it settles at 9.8 percent. Reflecting the virtual absence of "insurance" for mental health care services, state and local programs spent some 20 percent of their health care dollar on mental health care services.
From my vantage point, this is an unconscionable inequity. Imagine the righteous and rightful wrath of the public if we suddenly defunded cancer care, kidney dialysis or transplant services. The same righteous indignation should apply to our unwillingness to fund mental health services.
Incline Village resident Andrew Whyman, MD, is a clinical and forensic psychiatrist. He can be reached for comment at firstname.lastname@example.org.