Getting a grip on depression

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Depression is, by far, the most common mental-health disorder. Harvard University projects that depression will be the No. 1 source of lost workdays in developed countries by 2020. Untreated depression is believed to represent a graver threat to productivity through work days lost than cancer, heart disease, AIDS or violence.

It can be devastating for a family, particularly for children who don't understand what is going on, who wonder whether they have something to do with it, who are called on to be caregivers, who might be affected so much by a parent's depression that they themselves are susceptible.

Yet its effects - on health, on other family members as well as the economy - have been underestimated, even ignored, until recently. The Canadian Business and Economic Roundtable on Mental Health is urging companies to take a closer look at the business case for dealing with depression. But, as it acknowledges, encouraging employers to create an environment in which workers can be open about mental-health issues will be a challenge.

Part of the problem is that depression is so poorly understood; and when there is poor understanding, there is often stigma. It is not, as some believe, a passing mood or personal weakness. Clinical depression is a complicated, potentially lethal illness affecting a person's thoughts, feelings, behaviour, appearance and physical health. You can't just snap out of it.

Depression, which can appear at any age, affects one in four women and one in 10 men during their lifetime. Depression is the illness underlying the majority of suicides. Symptoms of depression include a noticeable change of appetite and sleeping patterns, a loss of interest in activities formerly enjoyed, loss of energy, feelings of fatigue, hopelessness and inability to concentrate or think, as well as recurring thoughts of death or suicide.

The good news is that, in more than 80 per cent of cases, depression responds to treatment, which usually includes a combination of medication and psychotherapy. But more than half the people with depression don't receive treatment because their symptoms are so disabling that they cannot go for help, or the depression is misdiagnosed and not properly treated.

The bad news is that more than half of people who suffer from depression don't seek help. Unfortunately, many people are embarrassed, or fear being perceived as weak, or simply do not recognize depression as a treatable illness. More's the pity, because it can't be overcome by will power.

Prevention is a joint responsibility. There was some hopeful news in the first large-scale depression-screening day last fall in Montreal, initiated by AMI-Quebec, the Alliance for the Mentally Ill, and based on a similar project in the United States. Of the more than 500 people screened at six sites, more than 40 per cent showed symptoms consistent with a major depressive episode; they were given referrals to doctors. One-third had not previously sought help for their condition. Another screening day will be held on Oct. 5.

Workplace education programs are needed to raise awareness of depression, with co-operation from mental-health or community organizations to make available information on depression and provide employees with referrals to treatment.

Poor working conditions don't directly cause depressive illness, but undue pressure and stress at work (from bosses who bully to uncertainty about the future) can combine with other problems - a troubled marriage, for instance - and make people more vulnerable to depression.

Although many companies have employee-assistance plans, they're used by only about 7 per cent of workers, mainly because of confidentiality worries. This won't change until work environments become places in which people are not afraid of raising the issue.