Spirit of the Age

Falling interest rates, collapsing confidence and sluggish activity all command the attention of economic policy makers. Seen in people rather than countries or markets, the same symptoms cause much less of a stir. That’s why there is so little outcry about the fact that there are 330m people around the world suffering from depression, 90% of whom won’t get adequate treatment. The disease afflicts more people than heart disease – far more than AIDS – and most cases are not even diagnosed. If this were a disease of the body, an environmentally caused cancer or an infectious epidemic, these figures would be at the center of outrage campaigns around the world. But because depression is a slippery, silent illness, few cry out.

In many ways, depression is a disease like many other. Something in the outside world affects some aspect of the body’s make-up and a normally healthy process becomes a problem. In cancer, it is growth that goes awry, spreading uncontrolled as the body’s checks and balances break down. In depression it is a feeling that runs amok. As a cancer is a malignant growth, so depression is a malignant sadness.

In the cases of depression, though, there is a further dimension to the problem. Tumorous growths can be seen, scanned, perhaps excised; malignant sadness can only be felt. The bit of the body that malfunctions in depression is the one which produces feelings and thoughts; depression is real but it is also subjective. And as a disease of the mind it is terribly sensitive to the attitudes people have towards it. In most of the world those attitudes are negative, dismissive or – most widely – profoundly ignorant of the very possibility that such feelings can be seen as a disease.

There is at present no blood exam, no urine test, no scan that can tell you if someone is suffering from depression. So doctors rely on checklists of symptoms, most commonly those of America’s Diagnostic and Statistical Manual. According to the DSM, depression comes in 39 different flavours and three sizes: mild, moderate and severe. Major depression is distinguished by at least two consecutive weeks of low mood and little pleasure, along with a combination of weight fluctuation, sleep disturbance, fatigue, poor concentration, guilt or low self-esteem and suicidal thoughts.

Using tests doctors have found that rates of major depression throughout the world range between 4% and 10% of the population, and the chance of developing it at some point runs between 10% and 20%.

Experts have no doubt that a lot of human potential is lost because of depression. The most obvious loss is through suicide. Studies in America show that 15% of severely depressed people kill themselves and that two-thirds of sufferers contemplate suicide. The WHO puts the global total of suicides attributed to depression at 800,000 a year – more than a quarter the number that dies of tuberculosis. You might think this would get governments interested, but it doesn’t. The TB deaths are identifiable and the cases that lead to death treatable, suicidal depression is harder to spot and deal with.

Whether countries fuss about depression or not, it costs them a lot. Estimates by Ernst Berndt at the Massachusetts Institute of Technology put the annual costs of depression in America at $44 billion, as much as coronary heart disease. This amounts to roughly $6,000 for each depressed worker, with employers paying 70% of the bill.

Medical treatment accounts for $12.6 billion – the cost of drugs, doctors and therapists. Suicide adds a further $7.5 billion to the bill, through lost manpower. But 55% of the cost of depression is due to lower productivity because of absenteeism and poor performance at work, where low energy, poor concentration, associated physical illness and illicit drug abuse – depression often leads to narcotics as a form of self-medication – take their toll.

While governments turn a blind eye to depression, people suffering from it are getting organized. They are finding new ways to talk to each other, to doctors and to the world around them about how they feel and what they need.

Patient groups can achieve a lot both medically and in terms of acceptance. But there is a long way to go. Public figures willing to admit depression are rare, and a belief that people’s feelings are their own fault still prevails. Anti-depressants, despite the fact that they can help both patients and economies, are often not treated as necessary parts of health-care budgets. One depressed woman in Britain explains the attitudes she encounters like this: “I’ve had depression since I was a teenager, and no amount of therapy or religion has brought me relief. Anti-depressants work, and I will keep taking them for as long as they keep the floods at bay. Some, who know my condition, behave as though I have a dangerous addiction. Do they worry that a diabetic is dependent on insulin? Of course not, because diabetes is seen as a real disease and depression isn’t. The day I reveal my depression, without fear of disdain or discrimination, will be the day I’m cured.” A disease of the mind cannot be cured with chemicals alone; attitudes must change too.

(From ‘The Economist’, abridged)