Introduction

Clinical depression affects mood, mind, body, and behavior. Research has shown that in the United States more than 17 million people- one in ten adults- experience depression each year, and nearly two thirds do not get the help they need. The WHO Collaborative Study of Psychological Problems in General Health Care screened nearly 26,000 individuals attending primary care facilities in 14 countries and found that 10.4% of patients had current depression. The Depression Research in European Society survey involving 78,463 adults, found a 6-month prevalence rate of 17.0% for depressive disorders. Similarly, the U.S. National Comorbidity Survey found that 17.3% of the general population had experienced an episode of major depression and 24.5% had suffered from an anxiety disorder at some time during their lives. Treatment can alleviate the symptoms in over 80 percent of cases. Yet, because it often goes unrecognized, depression continues to cause unnecessary suffering. Women experience depression at roughly twice the rate of men.

Everyone has felt sad at times. Depressed individuals tend to rationalize their depression and deny their illness as something normal. They feel that their feeling of sadness has some rational foundation.

Most people believe that if they are coping with a tragic event or difficult situation, they have a right to be depressed. They also think that their depression will be relieved as soon as the tragedy is alleviated. It is true that if your feeling of sadness is associated with a stressful event in your life, you could get out of it soon enough. However, if your depression is ongoing for six months or more, then your brain chemistry may have changed as a result of the prolonged sadness. You could be clinically depressed.

Depression can strike at any age, including in childhood. Studies in the United States showed that 1.8 percent of prepubertal children and 4.7 percent of 14 to 17-year-olds have some form of depression. However, the common time of onset is early middle age, and depression is particularly rife among the elderly, as a reaction to the facts of growing older - the death of a spouse or friends, the physical limitations of age and the impending confrontation with death. Elderly widowers are particularly susceptible to suicide.

Depression is one of the most common psychiatric disorders. Because it is so common, many people feel that if they ignore the depression, it will disappear. Prolonged "depression" can result in symptoms such as decreased or increased appetite, either insomnia or hypersomnia, anhedonia (loss of pleasure), either agitation or fatigue, poor concentration, increased self-criticism and excessive guilt. This may be the clue that your illness has progressed to the stage that it needs to be treated.

If left untreated, depression may lead to suicidal ideation or attempt. Suicide is a real threat in depression. Elderly white males are in the highest risk category for suicide, although women are also susceptible. A seven-year study showed mortality in older women increased a few percentage points when they had one to two symptoms of depression. Women with more than 10 depressive symptoms had a mortality rate fivefold greater than that of women with no such symptoms.

Depressed patients have a twofold greater risk of developing diabetes than that of normal individuals.
Among those with existing diabetes, 30% also have depression. In addition, depression occurs in 50% of patients with multiple sclerosis, 40% with cancer and 60% with dementia. There is also a strong relationship between depression and cardiac illnesses. Results from a recent study (July, 2000) show that the prevalence of asthma is much greater in individuals with high levels of depression and anxiety. This study showed that adults with higher levels of anxiety and depression are more than twice as likely to develop asthma as compared to those with lower levels.

Depression was 9 times more likely to develop in patients with anxiety disorders compared with those with no other illness and 6 times more likely in patients with 2 or more chronic medical conditions.

Up to 40% of patients with cancer suffer from depression or anxiety. Patients experiencing chronic pain or side effects from chemotherapy are particularly at risk for developing depression. Studies have shown that the presence of depression or anxiety has a detrimental effect on the recovery from cancer, response to cancer therapy and the death rate of cancer patients.

Depression is also frequently found in patients with cardiac disease. Up to 33% of patients develop depression after suffering a myocardial infarction. The relationship between cardiac disease and depression is complex. There is some evidence that depression may actually lead to cardiovascular disease. Depression occurs in about half of all patients who experience a cerebrovascular accident and is associated with poor functional recovery. The patients who are depressed have a higher probability of dying after myocardial or cerebral infarction compared to those who are not suffering from depression. Thus, depression can adversely affect your recovery from illnesses such as cancer, heart disease, gastrointestinal diseases, etc. Having an optimistic attitude is one of the best treatment you can have.

Depression is very treatable with medication (selective serotonin reuptake inhibitors (SSRI), tricyclic antidepressants and monoamine oxidase (MAO) inhibitors are commonly used), psychotherapies and electroconvulsive therapy (ECT). For mild depression, there are a number of complementary therapies and herbs that are useful. Lifestyle interventions such as stress management techniques, diet and nutrition changes, exercise, etc. can make a marked difference in your outlook.

Major depression often goes undiagnosed because it is confused with the normal feelings that may arise because of a specific life situation. It is estimated that only about 20% of those with depression seek treatment. Also of concern is minor but chronic depression, also known as dysthymia, which can last two years or more. Although the exact causes are unknown, researchers currently believe that both forms are caused by a malfunction of the brain's neurotransmitters, chemicals (particularly nor- epinephrine and serotonin) that modulate moods.

Untreated depression is costly. A RAND Corporation study found that patients with depressive symptoms spend more days in bed than those with diabetes, arthritis, back problems, lung problems, or gastrointestinal disorders. The World Health Organization Global Burden of Disease Survey estimates that by the year 2020, major depression will be second only to ischemic heart disease in the amount of disability experienced by sufferers. Several studies have consistently demonstrated that individuals with depression and anxiety disorders experience impaired physical and role functioning, more days in bed due to illness, more work days lost, increased impairment at work, and high use of health services. The disability caused by depression and anxiety is just as great as that caused by other common medical conditions, such as hypertension, diabetes, and arthritis. Comorbidity of depression with anxiety or medical illness further increases the disability experienced by sufferers. 

Estimates of the total cost of depression to the US in 1990 range from $30 to $44 billion. Of the $44 billion figure, depression accounts for close to $12 billion in lost work days each year. Additionally, more than $11 billion in other costs accrue from deceased productivity due to symptoms that sap energy, affect work habits, cause problems with concentration, memory, and decision-making. And costs escalate still further if a worker's untreated depression contributes to alcoholism or drug abuse.

More business costs result when an employee or colleague has a family member suffering from depression. The depression of a spouse or child can disrupt working hours, lead to days absent from work, effect concentration and morale, and. decrease productivity.

Caution 
There is a distinct difference between feeling "depressed" and having a depressive illness. If you have low spirits for a while, don't be concerned. However, if you feel you can't lift yourself out of your misery, you should seek professional help.

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