Twenty-five hundred years ago, well before Christ, Hippocrates, the Greek father of medicine, identified melancholia as a common condition of dark mood and physical malaise. He even attributed melancholia, which today we think of as clinical depression, to a biological disturbance, namely an excess of a bodily fluid he called “black bile.”
Melancholia — severe depression that is no passing phase or simply a bad day — continues today to haunt the human condition. No race, ethnicity, age or socioeconomic group is spared its grip. We find depression in every country on Earth. It causes great psychic pain, physical distress, and functional impairment. It aggravates any coexisting chronic health condition, including asthma, heart and lung diseases, diabetes, Parkinson’s and other neurological disorders and pain syndromes.
Depressed patients also have twice the risk of developing cardiac and artery disease (CAD) and stroke. They are four times more likely to die within six months of a myocardial infarction (MI or heart attack). They are three times more likely to be non-compliant with treatment — a reflection of how the illness diminishes our ability to, or interest in, taking care of ourselves, as well as its harmful effects on the body’s stress response, immunity and hormones.
Those people with diabetes and depression average health expenditures that are four times greater than those who are not depressed. Individuals with major depression make an average of twice as many visits to their primary care physicians as do non-depressed patients — not for their depression, but for myriad other symptoms, which are explainable when the depression is uncovered.
Depression is highly associated with the excessive use and abuse of alcohol, prescription pain and tranquilizing medications, and illegal substances. The dysphoria of depression prompts its sufferers to seek relief through these substances. But any relief is short lived and the user finds himself in a deeper hole.
Depression, as well, is found in more than 80 percent of people who take their lives by suicide. The vast predominance of people over 60 (still the highest risk group, especially among men) visited their primary care doctor’s office in the past month. In other words, a chance to reach them was lost.
Yet of the estimated one in 15 who suffer with this condition annually (one in six lifetime) fewer than half are diagnosed properly or at all, and only half of those get any treatment. One in eight gets good care. This is not because of bad doctors or bad patients. It is the unfortunate consequence of stigma, persistent views of a disease as a character fault, and a very broken health and mental health system. (See my two viewpoints in JAMA: “Fixing The Troubled Mental Health System,” and JAMA Psychiatry: “What Does It Take For Primary Care Practices To Truly Integrate Behavioral Health Care?”) Depression is a treatable disorder. Like any serious illness, it takes comprehensive, ongoing, scientifically based care, an effective working patient-clinician relationship, and the support and patience of loving others.
It is hard to turn away from depression after losing (as their family, friends, and we the public just did) two iconic figures — Robin Williams and Philip Seymour Hoffman. We have in the wake of their respective tragedies, a moment to face squarely the demon of depression, and to try to ensure the fate of others affected is not a deadly one.
There was a time when you or a loved one would have gone to a family doctor and you would not have had your blood pressure measured. A time when we did not measure blood sugar (much less the ongoing measure of glucose control, the hemoglobin A1c), or cholesterol. A time when “care paths” were places to walk in shaded glens, not treatment protocols. That not need to be the case today.
The Huffington Post will be adding its voice to improving the recognition, care, and social acceptance of people suffering from depression. An effort like this, of course, pertains to the many other mental disorders that exist — but let’s start with this most common one.
Stronger Together will take a 360-degree view on what it’s like to live with depression in America today. We want to lessen stigma by fostering a conversation that includes all voices. We want to hear from people who struggle with depression — what do they wish others knew about their condition? What are they proudest of in terms of their management of the disease and their lives? There also will be articles from our staff, essays and blogs on personal experiences from thought leaders, as well as op-eds from mental health professionals.
Some day we will look back and wonder how we did not measure and treat depression, and other behavioral health disorders more effectively. We are on the transformation road now. It will be uphill and bumpy. So is all change.