Depression and its "Difficult" Treatment

The impact on public health and well-being of those affected by depressive illness does not stop growing. Even the most pessimistic estimates made a few years ago are falling short of the level of disability and loss of quality of life that is being observed today. Only its economic impact, considering sick leave, lost years of healthy life, direct and indirect costs of treatment and even deaths by suicide, has been quantified at around 1% of GDP. That is why it has been said that depression is the plague of the 21st century.

Depression is one of the most common psychiatric disorders with an estimated annual prevalence of between 2% to 3% for men and 8% for women, with the prevalence / lifetime being around 18%. This means that one out of every 5/6 people suffers, has suffered or will suffer from depression in their lifetime.

The limits of the disorder have been blurred and the meaning of the term 'depression' has been devalued by the colloquial attribution to disappointments, losses or setbacks such as a 'downturn' or a 'depression' that are superficial and fleeting and of course do not comply with the criteria that define the disease.

However, real depression has a great impact on cognitive and functional capacities, in other words, on the performance of the roles in the family, work or society that the patient exercises. The deficit that the process causes on attention, memory, concentration and on what we call 'executive function' is well known, which is nothing other than the ability to plan and decide so necessary in normal life.

Thus, housewives are unable to take on household tasks that are complex and require foresight, resolution and responsibility. Students cannot focus, take, or pass their assessments. In the labor field it is just as complicated, since possibilities of action, security have been lost and an attempt is made to continue maintaining the type. This is how 'presentism' is reached as an alternative to absenteeism, for fear of dismissal. A painful situation that undermines the person's self-esteem. A change in legislation and awareness among companies would be necessary to recognize this reality and promote their recovery, for example with flexible and gradual reincorporation policies that now do not exist.

Therefore, we are faced with a true disease that induces great suffering and severe limitations and in which there is a terrible paradox: despite having psychotherapy techniques and medications that are accessible to most, more than 50% of depressive patients do not receive adequate treatment.

This is due to several reasons:

• The perception that the depressed person has of their discomfort is frequently that of symptoms in the somatic sphere, such as lack of energy, fatigue, loss of appetite, headache, poor digestion, feeling dizzy,... This leads you to consult your doctor family and seek examinations and specialists who detect a suspected physical health problem.

The disease causes those who suffer from it to alter their perception of themselves and their environment in a totally wrong. They analyze their past with ideas of guilt, thinking that they did everything wrong, they see the present with pessimism and a feeling of being worthless and the future without hope, believing that they will not improve or find a solution. This emotional state of helplessness, misunderstanding and self-reproach conditions that help is not even sought or there is no efficient collaboration with professionals.

• The stigma (a wrong and unfair prejudice) that accompanies mental health problems is also present in depression. In this case, the stereotype that is applied is that the depressed person is 'weak' or 'does not do their part', when there is no open doubt about the authenticity of the symptoms. This conditions both the recognition of the disease, - which is about hiding as well as the necessary support from relatives, friends and co-workers

It is also necessary to include among the causes of late or non-existent recognition of depressive illness that the first echelon of health care, primary care physicians, are heavily overloaded with work and their coordination with the psychiatry and mental health network is not optimal at all times. There are training shortages but above all the availability and time to meet this growing demand.

A different problem is that of patients with depression who, despite receiving adequate treatment and after several attempts to change them, do not improve. These are called resistant or refractory depressions. This leads to cornification and a process of demoralization and hopelessness that increases the symptoms and repercussions of the disorder.

In these cases, historically we used to resort to specialized environments and more complex care plans. Complex therapy for depression was applied with drug associations, intensive psychological interventions and partial or total hospitalization.

The good news is that there is active work in neuromodulation and treatments like Transcranial Magnetic Stimulation have yielded positive outcomes in people suffering with depression. TMS is also a leading non-medicine treatment for depression with millions of treatments delivered.

Dr. Ahmad is a board certified physician in Internal Medicine, and currently working as a hospitalist in Buffalo, NY.