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Author: Dr. Richard Juman

Ask most people to name the disease that causes the most death, pain and suffering worldwide, and you’ll get a list of the usual suspects — cancer, heart disease, diabetes. But you may be surprised to find out that depression is actually the most devastating illness in the world. Unfortunately, it’s also massively underdiagnosed and undertreated, and it affects us all. Understanding a little more about depression will help shed much-needed attention on a subject that is often misunderstood or downplayed.

First, take a look at a couple of rather frightening facts: According to the World Health Organization, depression is the “leading cause of disability” worldwide, and a major contributor to the “global burden of disease.” Since it’s so undertreated, the burden isn’t referring to the cost of treating this disease. On the contrary, it’s the lack of treatment that is the issue. Depression often leads to lost days at work or school and failure to thrive in other realms of life. People with depression are often caught in a vicious cycle in which their depression begins to negatively affect many different aspects of their life — from their relationships to their job performance, social life, and physical health — and then those disappointments actually fuel a worsening of depression.

The most tragic outcome of untreated depression is, of course, suicide. For the first time since World War I, when war and a flu pandemic coincided, the life expectancy in the U.S. is going down, with the opioid epidemic and suicide being major factors. Major depression, one of the most severe forms of mood disorder, has increased by 33% since just 2013. And the suicide rate is skyrocketing in commensurate fashion. It’s easy to gloss over those facts because you can’t see how they relate to you on a personal level, but that’s part of the problem.

While suicide might get more mainstream attention, that’s not the only way depression presents itself. It’s also not the only possible outcome. Depression also makes it more difficult, and much more expensive, to treat medical disorders. The cost of treating a lot of medical problems, like heart disease or even back pain, can easily double or triple if a patient is depressed. Depression also contributes significantly to the mortality rates of various significant medical disorders. Sometimes a physician finds himself asking, “I’m doing everything right for my patient, why isn’t he getting better? The answer is often an unrecognized depression.

A drastic increase in suicide, the W.H.O.’s declaration that depression is the world’s most devastating illness and a declining life expectancy in the world’s most advanced nation are all alarming pieces of information. These facts aren’t meant to simply scare you, but rather, make you more enlightened on the subject so change can happen.

So why isn’t depression getting massive attention these days?

Despite these statistics, and the recent rash of celebrity suicides, only about 20% of people with depression get any kind of treatment at all. Why is depression so often unrecognized, undiagnosed and untreated? Well, it’s a complex disease, so there are many reasons.

One factor is that depression is continuous with the human experience in a way that medical disorders are not. Unlike, for example, a heart attack, sadness is a normal part of the human condition, one that we have all experienced on occasion, particularly in response to negative life events. So it can be difficult for people to recognize when true depression strikes, as opposed to “just feeling down.”

But even when people do come to understand that they are depressed, the stigma of mental health prevents many of them from seeking treatment. Despite everything that we know about the biological underpinnings of depression and other forms of major mental illness, people are still prone to blame themselves, and to anticipate the “pull-yourself-up-by-your-bootstraps” scorn of others. Nobody tells a cancer patient to “just push through it,” but people often take this mentality with their mental health. People are reluctant to label themselves as “depressed.”

When people actually do seek treatment for depression, they often get it from primary care providers, as opposed to mental health professionals. In these settings, patients are likely to receive an anti-depressant alone, as opposed to the gold standard treatment plan of medication and psychotherapy in concert.

So what can be done?

First and foremost, we can fight the stigma. We must continue to spread the word that depression, like other forms of mental illness, is a disease that can and does impact people from all walks of life. Although some people do engage in behaviors that can precipitate depressed moods, that’s often true of cancer and heart disease as well. None of that takes away from the fact that the most severe forms of depression tend to “happen” to people, not as a result of their behavior but because of biological forces beyond their control. By the same token, although people can engage in behaviors that reduce depression, the most significant forms require more active and aggressive treatment. Depression doesn’t just go away on its own, which is important to note whether you are the person struggling with depressive thoughts or you are close to someone who you think might be depressed.

That brings us to the next thing that can be done: Ask about it. A person need go no further than their computer or phone in order to find a brief but valid screening test for depression. But our best opportunity to significantly improve our response to depression begins in primary care, the most common place that people interact with the health care system. When our primary care doctors pick up on depression, it sends a message to the patient that there is a significant issue that deserves attention. And when primary care clinicians work collaboratively with mental health professionals, the patient has the best chance of improving in terms of both mental and physical health. It’s important for both physicians and patients to speak candidly about mental health. And as a friend or family member, you should always encourage your loved ones to address their mental health with a health professional. Putting a strong emphasis on your mental health in the same way you value your physical health also goes a long way toward ending the stigma.

That’s where Bespoke Psychology gets many of our clients — from primary care clinicians who’ve identified depression in their patients. We work collaboratively with many primary care practices to ensure that our mutual clients’ physical and emotional needs are being addressed. This “integrated” model of primary care and behavioral health is the gold standard for treatment. A result that highlights the advantage is the fact that the best approach for the treatment of depression is a combination of psychotherapy and medication. But psychotherapy is the agent that produces the longest-lasting benefits, because it teaches people about themselves, about what drives their moods, and about what behaviors, activities, strategies and thoughts contribute to mood changes. Additionally, the relationship between the psychotherapist and the patient becomes a stable pillar upon which the patient can rely as they recover.

If you are a person suffering from depression or a primary care doctor who has identified it in one of your patients, please contact Bespoke to arrange a free consultation.

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