Introduction to Depression

Causes of Global Burden of Disease

2004

• LRTIs
• Diarrheal diseases
• Unipolar depression
• Ischemic heart disease
• HIV / AIDS

2030

• Unipolar depression
• Ischemic heart disease
• Road traffic accidents
• Cerebrovascular disease
• COPD

MDD:

• 2004: #3 cause of global burden of disease
• 2020: #2 cause of global burden of disease
• 2030: #1 cause of global burden of disease

MDD = major depressive disorder; LRTI = lower respiratory tract infection; HIV = human immunodeficiency virus; AIDS = acquired immunodeficiency syndrome; COPD = chronic obstructive pulmonary disease

1. World Health Organization. The Global Burden of Disease: 2004 Update. WHO, 2004.
2. World Health Organization. World Health Organization Website. Mental Health. Depression. What is depression? Available at: WHO Mental Health.
   Accessed October 28, 2011.

The Leading Causes of Disability Worldwide

• All causes
  • Total Yrs of Disability (Millions): 472.7

1. Unipolar Major Depression
   • Total Yrs of Disability (Millions): 50.8
   • Percentage of total: 10.7
2. Iron Deficiency Anaemia
   • Total Yrs of Disability (Millions): 22.0
   • Percentage of total: 4.7
3. Falls
   • Total Yrs of Disability (Millions): 22.0
   • Percentage of total: 4.6
4. Alcohol Use
   • Total Yrs of Disability (Millions): 15.8
   • Percentage of total: 3.3
5. COPD
   • Total Yrs of Disability (Millions): 14.7
   • Percentage of total: 3.1
6. Bipolar Disorder
   • Total Yrs of Disability (Millions): 14.1
   • Percentage of total: 3.0
7. Congenital Anomalies
   • Total Yrs of Disability (Millions): 1.3
   • Percentage of total: 2.9
8. Osteoarthritis
   • Total Yrs of Disability (Millions): 13.3
   • Percentage of total: 2.8
9. Schizophrenia
   • Total Yrs of Disability (Millions): 12.1
   • Percentage of total: 2.6
10. OCD
    • Total Yrs of Disability (Millions): 10.2
    • Percentage of total: 2.2

What is Depression?

Depression is not:

• “Weakness of character”
• “Madness”
• “Something that will pass”
• Incurable
• Inevitable

Depression is …

• Persistent low mood for at least two weeks plus at least 5 of the following:
  • Poor appetite or weight loss or increased appetite or weight gain
  • Loss of energy or tiredness to the point of being unable to make the simplest everyday decisions
  • An observable slowing down or agitation

Depression is …

• A markedly diminished loss of interest or pleasure in activities that were once enjoyed
• Feelings of self-reproach or excessive or inappropriate guilt over real or imagined misdeeds
• Complaints/evidence of diminished ability to think or concentrate
• Recurrent thoughts of death, suicide, suicidal thoughts without a specific plan, or a suicide attempt or plan

Depression: A SAD FACE (S)

• A - Appetite
• S - Sleep
• A - Anhedonia
• D - Depressed mood
• F - Fatigue
• A - Agitation
• C - Concentration
• E - Esteem
• S - Suicidal

Montano, J Clin Psych 1994

Depression: Risk Factors

• Age: Peak age of onset 20-40 yrs
• Gender: Female 2 X higher
• Family history: 1.5 to 3 X higher
• Marital status: Divorced, separated, widowed
• Married vs. unmarried???

Depression: Risk Factors

• Personal history of depression
  • 1 episode - 50% relapse
  • 2 episodes - 75% relapse
  • 3 episodes - 90% relapse
• Postpartum: up to 1 in 10 women
• Chronic medical illness

Functional Impairment in MDD

• MDD impairs occupational and social functioning

  • 87% exhibit at least moderate impairment
  • 59% exhibit severe or very severe impairment

• MDD is associated with:

  • Increased number of disability days
  • Decreased work productivity, psychosocial disability

• MDD and work productivity:

  • Impact on function at work is substantially higher than missed work days
  • Absenteeism represents only a small fraction of workplace cost

1. Druss BG et al. Am J Psychiatry. 2001;731-34.
2. Judd LL, et al. Arch Gen Psychiatry. 2000;57:375-80.
3. Kessler RC et al. JAMA. 2003;289:3095-105.

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• Social
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