Depression

Article excerpt

When sorrows come, they come not single spies, but in battalions.
--William Shakespeare, 1564-1616

The Global Burden of Disease (GBD) project began in 1992 to create an epidemiological assessment so that estimates of the mortality or disability from a condition are developed as objectively as possible. GBD researchers created a new measure for calculating disease burden, called Disability Adjusted Life Years (DALYs), which allows for lost years of healthy life regardless of whether the years are lost to premature death or disability. In 1996 the first results of the project were published, surprisingly revealing mental illness to rank second in the overall burden of disease. The GBD report found that in the United States, mental disorders account for more than 15 percent of the overall burden of disease from all causes, ranking higher than even the burden associated with all forms of cancer, and affecting at least one in five Americans.

The report showed that our health care system had greatly underestimated the burden of mental illness, the very health that is indispensable for an individual's personal well-being, family and interpersonal relationships, and contribution to community or society. Using the GBD measures, the projected change in rank order of DALYs for major depressive disorder in 2020 is second only to ischemic heart disease; it is projected to be higher than cancer, cerebrovascular disorders, and the effects associated with road-traffic collisions.

DEPRESSION AND OVERALL HEALTH

Mental health is generally defined as that state of successful performance of mental function, resulting in productive activities, fulfilling relationships with other people, and the ability to adapt to change and to cope with adversity. Mental illness refers to all diagnosable mental disorders, or those health conditions characterized by alterations in thinking, mood, or that behavior associated with distress and/or impaired functioning. During the past few decades, an extraordinary level of productivity has been achieved in scientific research on the brain and behavior, the development of an extensive range of effective mental health treatments, and a transformation of society's attitude towards mental health care in general. Today in the United States, approximately one in six adults, and one in five children, obtain mental health services either from health care providers, the clergy, social service agencies, or schools in a given year.

More than eighteen million Americans suffer from depression, a mental illness that affects one's thoughts, moods, feelings, behavior, and physical health. Many times stressful events can trigger a bout of depression, whereas other times depression appears to occur spontaneously, with no identifiable specific cause. Although it is possible for depression to occur only once in a person's life, more often it occurs in repeated episodes during a lifetime. In addition, depression may occur as a chronic condition that requires treatment for an entire lifetime. Depression has long been known to be a risk factor in the development of coronary disease; people with major depression are about four times more likely to die of cardiac disease than those without it. It is linked with complications stemming from diabetes and actually can decrease the efficacy of insulin therapy. Studies suggest that it may cause a 10 to 15 percent increased risk of bone density loss over time. In addition, patients with cancer, Alzheimer's disease, or Parkinson's disease who also suffer from depression may have a worse prognosis.

TYPES OF DEPRESSION

The main types of depression include major depressive disorder, dsythymia (pronounced dis-THI-me-uh), adjustment disorder, bipolar disorder, and seasonal affective disorder. Major depressive disorder is a mood disturbance lasting two or more weeks. Dysthymia is a milder, more continuous depression that persists for at least two years. …