It’s a global crisis
The experts on the commission stressed that to lower rates of depression, we need society-wide strategies that reduce exposure to adverse experiences (like neglect and trauma) beginning in childhood.
Recommendations also include focusing on lifestyle factors such as smoking and alcohol use, and risk factors like domestic violence, financial problems, or losing a loved one.
“We must put into practice evidence-based interventions that support parenting, reduce violence in the family, and bullying at school, as well [as] promoting mental health at work and addressing loneliness in older adults,”
The commission authors said the current system, which classifies people into two categories — either you have clinical depression or do not — is too simplistic.
They explained that depression is a complex condition with different signs, symptoms, severity levels, and durations.
No two individuals share the exact life story and constitution, which ultimately leads to a unique experience of depression and different needs for help, support, and treatment.
Depression is not the same as being unhappy
Maria F.Espinola PSD, assistant professor of clinical psychiatry and behavioral neuroscience at the University of Cincinnati College of Medicine, told Healthline that it’s natural to feel unhappy or dissatisfied at times.
“Depression, on the other hand, is a serious mental health disorder that interferes with your daily functioning by affecting how you think, feel, and act,” she explained.
Espinola points out that a person may have depression if they have symptoms that last for longer than 2 weeks.
Symptoms of depression can vary from person to person, but include:
- feelings of sadness, guilt, and worthlessness
- a loss of interest in activities you once enjoyed
- anxiety
- irritability, especially in men
- emotions that feel “out of control”
- difficulty falling sleeping, staying asleep or sleeping too much
- thoughts of suicide
Depression can impair your ability to work and socialize
“What distinguishes MDD from simply feeling unhappy or dissatisfied is the presence of significant impairment in one or more important areas of functioning,” said Paul Poulakos, MD, a board-certified psychiatrist in Greenwich Village, New York.
He emphasized that there’s a difference between dissatisfaction with your boss or job and persistent depressive symptoms that affect your performance.
“Someone that is feeling unhappy may still be able to get themselves to go to a particular social event or complete their work tasks effectively,” he said. “Someone with clinical depression will often be unable to complete these aspects of their daily lives with the same effectiveness or to the same standard.”
Poulakos said depression can affect health in many ways, some severe.
“Depression has been associated with increased incidence of myocardial infarction (heart attacks) and exacerbation of the cardiovascular disease,” he said. “Depression is associated with an elevated risk of stroke and hypertension (high blood pressure).”
Poulakos added that people with depression are far more likely to attempt suicide compared to those without the disorder, “which is a quite serious health consequence.”
The commission recommended interventions tailored to the needs of individuals and the severity of their symptoms.
“There are currently very successful treatments available for depression,” said Espinola.
She said that depression can be treated with psychological interventions like cognitive behavioral therapy (CBT) or psychopharmacological interventions (medications like antidepressants).
“It has been estimated that antidepressants can improve symptoms in anywhere from approximately 40 to 60 percent of those suffering from the illness,” he said.
The bottom line
The Lancet-World Psychiatric Association Commission on depression states that depression is a global health crisis.
The Commission outlined the steps needed to confront this crisis, as experts warn that mental health care is significantly underfunded.
Experts also say there are many effective treatment options, including antidepressant medications and behavioral therapy.
Poulakos added that it can take several trials of different medications before experiencing a successful response.
Depression was a leading cause of disability even before the pandemic
Espinola said that depression was a widespread problem even before the COVID-19 pandemic.
“In 2017, the WHO identified depression as the leading cause of disability around the world,” she said. “COVID worsened this problem due to economic hardship, social isolation, grief, uncertainty, and lack of access to treatment.”
Poulakos pointed out that regulations established to protect us from COVID-19, like social distancing and limiting the size of gatherings, have had a big impact.
“And in some cases have amplified the incidence, duration, and severity of depression,” he said.
Poulakos emphasized the importance of destigmatizing mental health: “Especially in the U.S., we have become used to separating physical from mental health.”
He said that this practice is “arguably perpetuated by insurance companies” that have relentlessly reimbursed less for psychiatric care than other medical conditions.
“Despite laws that have been established making this illegal,” he added.
Poulakos said there must be more pressure placed on insurance companies and more resources put in place to ensure mental health isn’t valued any less than physical health.
“We need to approach the crisis with the fervor it warrants on all fronts,” he said.
The new Commission offers hope
“This article offers an impressive call to action that outlines the steps that we need to take to tackle the current global mental health crisis,” said Espinola.
“It emphasizes the gravity of the problem by highlighting the health, social, and economic impacts of depression,” she continued.
She said the authors “brilliantly” assert the importance of addressing stigma, social determinants of health, trauma, income inequality, gender inequities, and all forms of discrimination.
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