Reducing the Burden of Depression

Abstract

M DE is identified as prevalent, disabling, and a major determinant in the burden of disease. Nevertheless, waiting rooms are not full of individuals whose primary complaint is depression. How can this be? I will use data from the Australian NMHWS to illustrate some of the issues. MDE is a syndrome of low mood, loss of interest, and other symptoms. There are no laboratory tests for MDE and diagnosis has depended on a trained clinician asking individuals about their symptoms. The DSM-IV 1 lists 5 criteria to satisfy the diagnosis. The first criterion lists 9 symptoms, 5 of which must be present and at least 1 of the 5 must be depressed mood or loss of interest or pleasure for the diagnosis to be met. All must be judged to be significant by an experienced clinician in terms of severity, duration, abnormality, distress, and impairment. In addition, the diagnosis requires that the symptoms do not present as a mixed manic episode and MDE, do cause clinically significant distress and are not owing to substance use, general medical condition, bereavement, psychosis, and that there has never been a hint of mania. A total of 20 pieces of information is required before a clinician can safely make the diagnosis.

Clinical trial of adjunctive celecoxib treatment in patients with major depression: a double blind and placebo controlled trial

“…By 2020, major depression is predicted to be the second leading cause of disability worldwide. [21] Full remission is achieved in fewer than 50% of patients. Therefore, antidepressant or medications that achieve a better rate of success are urgently needed.…”

Web Use Behaviors for Identifying Mental Health Status

“…The growth in mental health disorders has resulted in negative consequences accounting for 37% of all years lived with disability from disease [5]. Besides, mental health disorders also weaken individual subjective well-being [6], social adaptability [7] and even physical health condition [8].…”

Randomised controlled trial of the clinical and cost effectiveness of a specialist team for managing refractory unipolar depressive disorder

“…Depressive disorder is associated with significant functional impairment that can be restored following effective treatment [3]. Depressive disorder is persistent [4], possibly due to the fact that people with depression often do not seek treatment following relapse; when they do, it is rarely effective [5]. A longitudinal pattern of frequent recurrences with increasing severity can occur which leads to social damage and possible neurobiological changes which may be difficult to reverse [4].…”

“…There is evidence that many patients with unipolar depression in secondary care mental health services may not receive such an approach [5]. In STAR*D where treatment was delivered under optimal conditions, 40 per cent of patients failed to respond to first or second line treatment s for depression [9].…”