October is National Depression and Mental Health Awareness and Screening Month, what does this really mean? Let’s get the facts: Depression is the leading cause of disability in the US among people ages 15-44, it ranks among the top 3 workplace issues and contributes to a whopping estimated economic loss of over 200 billion dollars. Depression is also closely tied to suicides, the second leading cause of death in ages 15-44 and a yearly contribution of 250,000 people that become suicide survivors. Depression is, arguably, an illness of hope and motivation, an internal state where despair reigns. The good news is that we have treatment options to help. It is estimated that 80% of people who seek treatment experience some improvement within 4-6 weeks. This is very encouraging but still not enough because those who seek treatment are only about a third of those who suffer from depression, hence, the importance of awareness and screening.
As we gain more insight and knowledge about its biology, we have learned that there are many causes that can trigger and/or sustain depression, including psychological, environmental, infectious, autoimmune, nutritional and genetic, among others. While a large majority of patients could derive some benefit, full remission is much harder to achieve. It is imperative that we consider a broad set of options when thinking about the diagnosis and treatment of depression to achieve remission and avoid the dreaded label of “treatment-resistant.” Although significant resources have been devoted to mood disorders research, progress has been slow. Our current definition of depression has been developed from clinical observations and not from biology, therefore, the intricacy of brain processes is hard to disentangle. Traditionally, we have recognized depression subtypes as melancholic and atypical but now we are also identifying anxious and irritable depression as better defined entities. What this means is that the underlying biology is likely different, thus, the different symptom profile. However, these “phenotypes,” still remain too broad to understand specific biological intricacies. Depression treatment should be as personalized as possible, always driven by the biopsychosocial formulation we’ve learned, however, the “bio” section should include: sleep, neurological causes, infectious diseases, nutritional deficiencies, endocrine disorders, medications, alcohol and other substances, malignancies, etc.
Lastly, we also need to remember that about two thirds of those suffering in silence are not getting the treatment they need. Let’s become the instruments of change, to raise awareness, to root out stigma and help those with the medical condition called depression, access the support and interventions to overcome their illness.