The economic burden of depression


 The economic burden of depression in Sweden from 1997 to 2005

The cost of depression increased from a total of 1.7 billion euros in 1997 to 3.5 billion euros in 2005, representing a doubling of the burden of depression to society. The main reason for the cost increase is found in the significant increase in indirect costs due to sick leave and early retirement during the past decade, whereas direct costs were relatively stable over time. In 2005, indirect costs were estimated at 3 billion euros (86% of total costs) and direct costs at 500 million euros (16%). Cost of drugs was estimated at 100 million euros (3% of total cost).

The annual costs of depression in the US


It is concluded that the annual costs of depression in the US total about $43.7 billion. Of this total, $12.4 billion (28%) covered direct costs, $7.5 billion (17%) covered mortality costs, and $23.8 billion (55%) covered the 2 morbidity cost categories. Because some categories of cost have yet to be estimated, the true burden of this illness may be even greater.



Symptoms of Depression


Do you have symptoms of clinical depression?
Sure, most of us feel sad, lonely, or depressed at times. And feeling depressed is a normal reaction to loss, life's struggles, or an injured self-esteem. But when these feelings become overwhelming and last for long periods of time, they can keep you from leading a normal, active life. That's when it's time to seek medical help.

If left untreated, symptoms of clinical or major depression may worsen and last for years. They can cause untold suffering and possibly lead to suicide. Recognizing the symptoms of depression is often the biggest hurdle to the diagnosis and treatment of clinical or major depression. Unfortunately, approximately half the people who experience symptoms never do get diagnosed or treated for their illness.

Not getting treatment can be life threatening. More than one out of every 10 people battling depression commit suicide.


What are symptoms of depression?

According to the National Institute of Mental Health, symptoms of depression may include the following:

difficulty concentrating, remembering details, and making decisionsfatigue and decreased energyfeelings of guilt, worthlessness, and/or helplessnessfeelings of hopelessness and/or pessimisminsomnia, early-morning wakefulness, or excessive sleepingirritability, restlessnessloss of interest in activities or hobbies once pleasurable, including sexovereating or appetite losspersistent aches or pains, headaches, cramps, or digestive problems that do not ease even with treatmentpersistent sad, anxious, or "empty" feelingsthoughts of suicide, suicide attempts


Depression Types

All depression types are not the same. Major depression, also known as clinical depression, and chronic depression, also known as dysthymia, are the most common types. But there are also other types of depression with unique signs, symptoms, and treatment.


What Is Major Depressive Disorder?

According to the National Institute of Mental Health, major depressive disorder is characterized by a combination of symptoms that interfere with a person's ability to work, sleep, study, eat, and enjoy once-pleasurable activities.

There are times you may feel sad, lonely, or hopeless for a few days. But major depression -- clinical depression -- is disabling. It can prevent you from functioning normally. An episode of clinical depression may occur only once in a person's lifetime. More often, though, it recurs throughout a person's life.

In addition, with major depression, one of the symptoms must be either depressed mood or loss of interest. The symptoms should be present daily or for most of the day or nearly daily for at least two weeks. Also, the depressive symptoms must cause clinically significant distress or impairment in functioning. The symptoms cannot be due to the direct effects of a substance -- drug abuse, medications -- or a medical condition, such as hypothyroidism, nor occur within two months of the loss of a loved one.


What Is Major or Clinical Depression?

Most people feel sad or low at some point in their lives. But clinical depression is marked by a depressed mood most of the day, particularly in the morning, and a loss of interest in normal activities and relationships -- symptoms that are present every day for at least 2 weeks. In addition, according to the DSM-IV -- a manual used to diagnose mental health conditions -- you may have other symptoms with major depression. Those symptoms might include:

Fatigue or loss of energy almost every day.Feelings of worthlessness or guilt almost every day.Impaired concentration, indecisiveness.Insomnia or hypersomnia (excessive sleeping) almost every day.Markedly diminished interest or pleasure in almost all activities nearly every day (called anhedonia, this symptom can be indicated by reports from significant others).Restlessness or feeling slowed down.Recurring thoughts of death or suicide.Significant weight loss or gain (a change of more than 5% of body weight in a month).


Who Is at Risk for Major Depression?

Major depression affects about 6.7% of the U.S. population over age 18, according to the National Institute of Mental Health. Overall, between 20% and 25% of adultsmay suffer an episode of major depression at some point during their lifetime.

Major depression also affects older adults, teens, and children, but frequently goes undiagnosed and untreated in these populations.

Are Women at Higher Risk for Major Depression?

Almost twice as many women as men have major or clinical depression; hormonal changes during puberty, menstruation, pregnancy, miscarriage, and menopause, may increase the risk.

Other factors that boost the risk of clinical depression in women include increased stress at home or at work, balancing family life with career, and caring for an aging parent. Raising a child alone will also increase the risk.


What Are the Signs of Major Depression in Men?

Depression in men is significantly underreported. Men who suffer from clinical depression are less likely to seek help or even talk about their experience.

Signs of depression in men may include irritability, anger, or drug and alcohol abuse (substance abuse can also be a cause of depression rather than the result of it). Repressing their feelings can result in violent behavior directed both inwardly and outwardly. It can also result in an increase in illness, suicide, and homicide


What causes orTriggers Major Depression?

Some common triggers or causes of major depression include:

Grief from losing a loved one through death, divorce, or separation.Social isolation or feelings of being deprived.Major life changes -- moving, graduation, job change, retirement.Personal conflicts in relationships, either with a significant other or a superior.Physical, sexual, or emotional abuse.


How Is Major Depression Diagnosed?

A health professional -- such as your primary care doctor or a psychiatrist -- will perform a thorough medical evaluation. The professional will ask about your personal and family psychiatric history. You may also have to complete a depression screening test.

There is no blood test, X-ray, or other laboratory test that can be used to diagnose major depression. However, your doctor may run blood tests to help detect any other medical problems that have symptoms similar to those of depression. For example, hypothyroidism can cause some of the same symptoms as depression, as can alcohol or drug use and abuse, some medications, and stroke.


How Is Major Depression Treated?

Major or clinical depression is a serious but treatable illness. Your doctor may recommend that you take an antidepressant medication to control symptoms. He or she may also suggest psychotherapy, or talk therapy, in which you address your emotional state.

Sometimes, other medications are added to the antidepressant to boost its effectiveness. Certain medicines work better for some people. It may be necessary for your doctor to try different drugs at different doses to determine which medicine works best for you.

There are other treatment options for clinical depression -- such as electroconvulsive therapy, also called ECT or shock therapy -- that can be used if drugs prove ineffective or symptoms are severe.


Can Major Depression Be Prevented?

Once you have had an episode of major depression, you are at high risk of having another. The best way to prevent another episode of depression is to be aware of the triggers or causes of major depression (see above) and to continue taking the prescribed medication to avoid relapse. It is also important to know what the symptoms of major depression are and to talk with your doctor early if you have any of these symptoms.


What Is Chronic Depression or Dysthymia?

Chronic depression, or dysthymia, is characterized by a long-term (two years or more) depressed mood. Chronic depression is less severe than major depression and typically does not disable the person. If you have dysthymia or chronic depression, you may also experience one or more episodes of major depression during your lifetime


What is atypical depression?

Atypical depression is a type of depression with certain specific characteristics. A person with classic major depression has at least five of the following nine symptoms:

sadness or depressed mood most of the day or almost every dayloss of enjoyment in things that were once pleasurablemajor change in weight (gain or loss of more than 5% of weight within a month) or appetiteinsomnia or excessive sleep almost every dayphysically restless or rundown that is noticeable by othersfatigue or loss of energy almost every dayfeelings of hopelessness or worthlessness or excessive guilt almost every dayproblems with concentration or making decisions almost every dayrecurring thoughts of death or suicide, suicide plan, or suicide attempt

In general, people with atypical depression don't have as many of the symptoms that people with classical depression may have. They tend to have first experienced depression at an early age, during their teenage years.

Despite its name, atypical depression is probably rather common. Some doctors believe that it is underdiagnosed.


What are the symptoms of atypical depression?

The main characteristic of atypical depression that distinguishes it from major depression is mood reactivity. In other words, the person with atypical depression will see his or her mood improve if something positive happens. In major depression, positive changes will not bring on a change in mood. In addition, diagnostic criteria call for at least two of the following symptoms to accompany the mood reactivity:

sleeping too much (hypersomnia)increased appetite or weight gainhaving a more intense reaction or increased sensitivity to rejection, resulting in problems with social and work relationshipshaving a feeling of being weighed down, paralyzed, or "leaden"

A doctor will investigate physical causes for any of these symptoms. That will include a physical exam and tests to look for a problem such as hypothyroidism. With hypothyroidism, having low levels of thyroid hormone can lead to symptoms that include depression and weight gain.


What causes atypical depression?

Depression is believed to be the result of a chemical imbalance in the brain. These chemicals -- neurotransmitters that facilitate communication between brain cells -- include dopamine, serotonin, and norepinephrine. While the exact cause of depression is unknown, there are risk factors for depression, including:

a family history of depressiona significant loss -- from death, divorce, or separation -- that results in griefinterpersonal conflicts and related emotions such as guiltany type of abuse -- physical, sexual, or emotionalany type of major life event such as moving, changing or losing a job, graduating, retiringany type of serious illness such as cancer, heart disease, stroke, or HIVdrug or alcohol abuseisolation or exclusion from family, friends, or other social groups


How is atypical depression treated?

Doctors are likely to recommend psychotherapy (talk therapy) and/or medications for atypical depression. There are different types of psychotherapy and medications available for treatment. You may be referred to a specialist such as a psychiatrist, psychologist, or other licensed professional for care.


What Is Bipolar Depression or Manic Depression?

Bipolar disorder -- sometimes referred to as manic depression -- is a complex mood disorder that alternates between periods of clinical depression and times of extreme elation or mania. There are two subtypes of bipolar disorder: bipolar I and bipolar II.

With bipolar I disorder, patients have a history of at least one manic episode with or without major depressive episodes.

With bipolar II disorder, patients have a history of at least one episode of major depression and at least one hypomanic (mildly elated) episode.


How Is Seasonal Depression (SAD) Different From Other Types of Depression?

Seasonal depression, often called seasonal affective disorder or SAD, is a depression that occurs each year at the same time. It usually starts in the fall or winter and ends in spring or early summer. It is more than just "the winter blues" or "cabin fever." A rare form of SAD, known as "summer depression," begins in late spring or early summer and ends in fall.