One would think that an illness that affects 17.3 million people and is closely correlated with suicidal ideation, drug use disorder, and drastic drops in productivity is taken very seriously. One would think that, given the impact depression has on our lives, it would be our collective responsibility to identify and treat it in friends, family members, and all of society. But the reality is much more cynical. While many identify depression as a serious problem, there’s a stark stigma against mental illnesses in general, and even primary care physicians fail to properly address their own bias against mental health problems.
The simple truth of the matter is that, either consciously or subconsciously, most people don’t take depression as seriously as other chronic conditions, such as chronic pain, diabetes, hypertension, or heart disease. Patients with depression are less likely to get adequate care, adequate follow-up care, or even find the care they need to begin with. A mere fraction of people approximated to have major depressive disorder seek or receive treatment and even fewer go through with the treatment they receive. Depression is a severe mental illness – and it is treatable.
Recurring, Chronic, Manageable, and Undertreated
Depression is often recurring, sometimes chronic, and sometimes very severe. Yet it is always serious, affecting more than just the mind. While primary care physicians are not specialized to treat patients with depressive disorders (and are often not equipped with the proper tools needed to do so), they are more often than not the first professionals a person is likely to go to in the event that they suspect they are depressed.
While some effort is being made to help screen for depression among people through their regular checkups, there’s not much effort in actually treating the depression once it has been identified – despite the fact that depression is very treatable.
It takes courage to go to a professional about your mental health issues, even today. While much progress has been made on educating the public about mental illness, there’s still a prevailing stigma in society that depression is not as serious as other illnesses, and that many of symptoms presented by people with depression are character faults rather than a part of the condition.
This stigma makes it difficult to convince the many teens and adults who struggle with depressive symptoms to come forward and seek help. Cost is another issue. Effective and timely treatments for depression are not always covered by health insurance.
These factors all come together to highlight a serious problem: depression, like many other mental illnesses, is recognized yet often left untreated, partly due to lack of resources and partly due to bias and ignorance.
Depression Is More Than Sadness
To make an argument for why depression requires just as much care as any other physical chronic condition, it’s important to understand what depression is, and how it affects daily life.
Depression, or major depressive disorder, is a mental illness characterized by a long period of sadness with several social and psychiatric factors. Because the primary means of diagnosing someone with depression is the consistency and duration of their low mood, depression can often be one of several illnesses, caused by either physical or mental problems, or it could be a condition all on its own.
Some people respond to therapy alone, yet most with major depressive disorder do not. This is because the mechanism for depression is more complex and not simply environmental. Eliminating stress or training better coping habits often isn’t enough to make symptoms go away.
The resulting symptoms of a depressive disorder range from prolonged sadness to hyperalgesia, anhedonia, low sex drive, lack of focus or concentration, inability to perform at work, irritability, memory issues, high anxiety, and more.
How Depression Works
While high stress is one of the factors that triggers a depressive episode, depression itself doesn’t need any triggers, and exists separate from any external stimuli. It occurs wholly within the brain, as a result of differences in the way the brain perceives and processes certain chemicals and signals in comparison to other, mentally healthy individuals.
These brain differences occur in the limbic system, and essentially lead to faulty mood regulation. While not singlehandedly at fault for all depressive cases, they account for a good chunk of the pie of factors in most cases of major depressive disorder. This is why simply feeling better is not an option for someone with a ‘clinical depression’.
If the brain is a computer, then depression is both a hardware and software issue. Internal and external factors determine how and why a person is depressed, and treatment requires that both be addressed. The widespread symptoms of a depression (including physical ones such as unexplained pain) are a result of how depression is a complex disorder that involves faulty neurotransmission, problems with hormone management, and other relatively little differences that affect the bigger picture and greatly distort a person’s mood.
Sometimes, these changes are largely genetic in nature. Sometimes, they occur due to recurring or early trauma. Most times, it’s a unique combination of both.
Different forms of depression account for different factors and unique characteristics. In individuals who experience strictly seasonal depression, a lack of exposure to UV light can trigger depressive symptoms. Light therapy can help these people continue to do well mentally through the winter months. Premenstrual dysphoric disorder (PMDD) describes a set of severe depressive and anxiety symptoms experienced in the weeks preceding menstruation, sometimes due to a neuroendocrinological issue. The list goes on and on, and each condition requires a different approach.
Depression is Physical and Mental
Depression often plays a hand in a patient’s physical and mental state, and its treatment is important not only for improving a person’s mood, but to uplift their quality of life, and help them heal physically and mentally.
There’s a need for increased access to depression treatment, including alternatives to the first line treatment of antidepressants. Other medications, and non-pharmacological treatments such as transcranial magnetic stimulation play a critical role in helping millions of Americans who don’t respond to SSRIs, SNRIs, and other common antidepressants.
While depression is complex, much progress has been made in identifying different treatments. But in order to effectively reach more people, people must understand how widespread depression can be.