Stickiness of the blues: Chronicity of depression

Abstract

Byline: G. Swaminath You cannot prevent the birds of sadness from passing over your head, but you can prevent their making a nest in your hair Chinese Proverb Song Sung Blue Depression is an important global public-health issue. This is because of the relatively high lifetime prevalence ranging from 2 to 15% and also because it is associated with substantial disability.[sup] [1] After the development of the metric Disability Adjusted Life Years (DALYs) as a measure of non-fatal outcomes of many diseases, depression came to be considered a disease with significant burden. The basic concept was that the years lost due to the disease would be added to the Years Lived with the Disability (YLD) due to the disease itself.[sup] [2] Rated the fourth leading cause of disease burden in 2000, depression accounted for 4*4% of total disability adjusted life years (DALYs).[sup] [3] It is also responsible for the greatest proportion of disease burden attributable to non-fatal health outcomes, accounting for almost 12% of total years lived with disability worldwide. [sup] [1] Without treatment, depression has the tendency to assume a chronic course, be recurrent, and over time to be associated with increasing disability.[sup] [4] Early detection, proper management with proactive follow-up could reduce the socio economic burden of depression, and help rationalise health care rather than ration it.[sup] [5] In comparison with other chronic diseases such as diabetes, asthma, angina and arthritis in terms of decrement in health status, depression impairs health status to a substantially greater degree [sup] [3] . A significant number of patients with chronic diseases have comorbid depression. The presence of depression and its treatment is clearly related to the outcome of these chronic diseases. In addition, comorbidity with depression significantly worsens the health state of people with chronic diseases. Interestingly, comorbid depression worsened health status in chronic diseases when compared with the health status in the chronic diseases either singly or in combination, but without depression.[sup] [3] This puts depression on par, if not higher than other chronic diseases in damaging health, so health care providers should carefully note the presence of depression in view of the marked health effects.[sup] [3] This caution has been reiterated in an National Institute of Mental Health (NIMH) research paper on comorbidity: Finding ways to improve detection and treatment of depression in the primary-care setting is an important NIMH research priority.[sup] [6] A Medicine for Melancholy Though depression responds excellently to pharmacologic and behavioral treatments, both individually and in combination, it remains, stigmatized, under-recognized, and under-treated in primary care settings.[sup] [4] Depression lasts for a median of eight weeks (mean 16 weeks), with only 5% not responding within a year[sup] [7] owing to the increased frequency of spontaneous remission, the sensitivity of depressed patients to treatment as well as the encouraging effects of being in treatment.[sup] [4] After improvement 50% relapse within one year and most within two years. Of those patients who have one episode of major depression, 50-85% will go on to have a second episode, and 80-90% of those who have second episode will go on to have third one.[sup] [8] A 15 year follow up study showed that a fifth of depressives recovered and remained continuously well, three fifths recovered but had further episodes and a further fifth either committed suicide or were always incapacitated.[sup] [7] Depression is a chronic recurrent disorder; with single depressive episodes (ICD-10 F32) being surprisingly rare and most people with depressive illness meeting the criteria for recurrent depressive disorder (ICD-10 F33).[sup] [9] However, people seldom seek help for their first attack of depression and the first treated episode is often the third or fourth actual episode. …