Global leaders are calling for greater action against depression. How does the condition affect sufferers and how can it be treated?

Global leaders, policy makers, industry professionals and academics called on countries around the world to do more to help the 350 million people suffering from depression during the ‘Global Crisis of Depression: The Low of the 21st Century’ summit back in November 2014. Participants, who included former UN secretary general Kofi Annan, urged healthcare systems, businesses and the general public to work together to fight the mental health condition.

The World Health Organization describes depression as a leading cause of worldwide disability. “Depression is predicted to go from fourth to second place as a contributor to the global burden of disease,” Mr Annan told delegates. “Women are twice as likely to suffer as men, meaning mental health can influence childhood and cast a shadow from one generation to the next.”

The scale of the problem 

It is estimated that more than a quarter of the working population have suffered from some form of mental illness, including depression, at some point. This represents a huge strain on economic productivity and social welfare.

According to Norman Lamb MP, minister of state for care and support at the Department of Health, depression costs the UK economy between £70 and £150 million a year. “Treating depression in primary care is both feasible and cost effective,” says Mr Annan. “We have to target the lack of resources, and deal with social stigma and lack of community understanding.”

What is depression? 

Depression manifests in a range of symptoms, the most widely recognised being a prolonged feeling of sadness. “Everyone feels sad from time to time,” explains Sam Challis, information manager at mental health charity MIND.

“But problems occur when these feelings last for several weeks, affect day-to-day life, have no obvious trigger or cause harm, such as an individual self-harming or contemplating suicide.” People often trivialise depression, yet the symptoms can be complex and extremely debilitating. Depression often causes feelings of sadness, hopelessness and disinterest.

Other psychological symptoms include:

• Low self-esteem
• Feeling tearful, guilt-ridden, irritable, intolerant of others, anxious or worried
• Lacking motivation
• Indecisiveness
• Having thoughts of self-harm or suicide.

“The primary physical symptom is fatigue,” explains Sam. “Some people also eat less – or more, if food becomes their only way of getting pleasure.” Other common physical symptoms of depression include unexplained aches and pains, and lethargy, despite sleeping well. Depression can vary in severity from mild cases, where the condition has some impact on a sufferer’s daily life, to moderate, where it has a significant impact, and severe, where it becomes almost impossible for the sufferer to cope and may cause psychotic symptoms.

What are the causes?

The reason why depression is triggered in the first place is a controversial subject among the medical profession. “A lot of research suggests that there is a genetic link. However, no gene has been identified,” explains Sam.

“Sometimes depression runs in families, but it’s a question of nature versus nurture. Some adopted individuals have depression like their birth parents, while their adoptive parents don’t.” Another theory is that depression develops in individuals who have a chemical imbalance in their brain. Antidepressants work to restore a healthy balance, but many experts dispute this theory.

Treating depression in primary care is both feasible and cost effective

Whatever the real reason, Sam says that the risks of depression are well known: “No one knows the cause, but we know the risks – bad diet, street drugs, abusive home, etc.” Depression is also a recognised side effect of a range of medications, and it often develops after a person is diagnosed with a chronic condition.

“Poor physical health can lead to depression and depression can lead to poor physical health,” explains Mary Baker, immediate past president of the European Brain Council. “Look at diabetes – if a patient with diabetes is depressed, they may miss hospital appointments and they may muddle their medication and suffer secondary symptoms, such as the loss of a limb.”

Commonly prescribed acne medication, and some psychiatric and antipsychotic drugs can also exacerbate symptoms. “All drugs have potential side effects, but it’s critical that people continue to take them as advised,” warns Sam. “It’s a lottery and it’s tough on the patient, but it’s more about giving information than avoidance.”

How is it treated?

Treating depression can be complex, as symptoms and severity vary significantly among sufferers. Although some patients only suffer one incident throughout their life, most experience multiple episodes. “Depression can be chronic and managed,” says Sam.

“It’s something people can get over if they’ve had the right support. Therefore, it’s important to have a combination of support options – some that deal with the episode there and then, and some that teach techniques for the future.” Treatments for depression are still evolving, but they usually focus on lifestyle changes, talking therapies and medication.

“For most people, self-treating or treating with the aid of friends and family is the best approach,” advises Sam. “Talking to family and friends, exercising more, getting out into the daylight, trying sports therapy or eco therapy, and even something as simple as planting flowers in the garden can be effective.”

According to NICE guidance, talking treatment, such as cognitive behavioural therapy (CBT), should be the first-line treatment option. However, many patients are prescribed antidepressants first. “If a person decides to visit a GP for a mental health condition, they often have to overcome a certain reluctance in order to do that, so they want to leave with something concrete, but it’s not a great first-line treatment,” explains Sam. In mild to moderate cases where people are able to work, Sam recommends joining a mindfulness group, taking up more exercise or reading self-help CBT books before requesting treatment.

Yet according to Simon Wessely, Professor of Psychological Medicine at the Institute of Psychiatry, efficient prescribing is critical. “GPs should prescribe antidepressants because there is very little availability of alternative therapy,” he says. “We need big expansion to meet the needs of future generations.”

Despite the prevalence of depression, many sufferers are reluctant to take antidepressants because of social stigma, which Sam blames on the media: “Antidepressants are not ‘happy pills’, they don’t make a person smile or change their personality. They’re actually quite mild and just enable the person to have more energy.”

Fear of developing an addiction is another common concern. “Antidepressants are not addictive in the sense that heroin is, but discontinuation can have effects,” explains Sam. “It should be okay, however, providing there is medical supervision and it is done gradually.” Another issue with antidepressants is that it can take four to six weeks for them to have an impact.

They can also cause distressing side effects, such as a change in appetite, altered sexual function, and limb desensitising or shaking. “One day, treating ‘depression’ will be just as absurd as treating ‘cancer’,” says chair of NICE, David Haslam. “There are lots of different types of cancer and no one treatment will work for all.”

Living with depression 

It is important for people who are prone to depression to follow the NHS’s healthy lifestyle guidelines. This means eating a balanced diet that contains at least five portions of fruit and vegetables a day, not smoking, and doing at least 150 minutes of moderate intensity aerobic exercise every week. In terms of alcohol, Sam advises that patients stick to the recommended maximum of three to four units a day for men and two to three for women, unless alcohol is a trigger, in which case they should consider abstaining completely.

“A lot of men selfmedicate with alcohol, which works in the short-term, but alcohol is a depressive in the longterm,” explains Sam. “It is a legal and available drug that can interact with medication and reduce REM (rapid eye movement) in sleep, which is a no-no for depression sufferers.”

Sam also urges sufferers to share their diagnosis with their employers, insisting that in medium to large-sized companies, it will almost certainly have been encountered before. “If a person needs treatment because they are ill then the employer has a responsibility to decide a reasonable course of action,” says Sam.

“People have a right to ask – whether that means starting later, time off to go to appointments or having access to a quiet room if needed.” Under the 2010 Equality Act, all employers must make reasonable adjustments to enable the employment of people with disabilities, including those with a diagnosed mental health condition. If someone is unable to work, depending on their circumstances, they may be eligible for benefits such as statutory sick pay or incapacity benefits.