The impact of depression

Depression is a serious medical condition that warrants meticulous attention to ensure adequate care of those afflicted with the condition. Depression is a potentially fatal condition because it raises the risk of suicide. According to the National Institute of Mental Health, about 16 million adults over 18 years of age were afflicted with at least one major depressive episode in 2015. This represents about 6% of the US population. These patients have depressed mood or loss of interest or pleasure for at least two weeks. In addition they have disturbances of sleep, energy, appetite, concentration and self image.

According to the latest information from the American Psychiatry Association, Major Depressive Disorder is estimated to cost as much as $210.5 Billion per year. Depression is estimated to become the leading cause of disability in 2020.

Depression has a major adverse impact in the lives of people (Kessler, 2012). Depression can lead to;

·         Decreased educational attainment

·         Lower income

·         Teenage pregnancy and childbirth

·          Unemployment

·         Low productivity

Further, depression hampers the ability of an individual to maintain healthy workplace and personal relationships. At the work place, depression has a negative impact through two recognized pathways;

·         Absenteeism- not showing up for work.

·         Presenteeism-low productivity while at work.

For employers, depression does not just lead to lower productivity; it also leads to increased health care costs. Over 60% of health care costs attributed to depression are spent managing conditions that are related to depression (Greenberg, 2015). Depression is associated with anxiety disorders, adjustment disorders, and post-traumatic stress disorder. More strikingly, depression is associated with non-psychiatric conditions such as Chronic pain, Sleep problems, Hypertension and Diabetes Mellitus.   

Ideally, mental health interventions should focus on activities and educational services that can prevent depression, however, current efforts to prevent depression are modest at best. Some of these activities include;

·         Healthy diet

·         Regular exercise

·         Leisure including engaging in practices such as meditation

·         Reasonable work hours.

Invariably, there’s a subset of patients that will require medication with anti-depressants. It is important to note that Psychotherapy is preferred over drugs especially in individuals younger than 18.  Anti-depressants are a major class of drugs that include;

·         Tricyclic anti-depressants (TCAs)

·         Tetracyclic anti-depressants (TeCAs)

·         Monoamine oxidase inhibitors (MAOIs)

·         Select Serotonin re-uptake inhibitors (SSRIs).

·         Norepinephrine reuptake inhibitors (NRIs)

·         Serotonin antagonists and reuptake inhibitors (SARIs)

·         Serotonin modulators and stimulators (SMS)

·         Serotonin-norepinephrine reuptake inhibitors (SNRIs).

·         Norepinephrine-dopamine reuptake inhibitors (NDRIs).

·         Atypical anti-psychotics

Before the prescription of anti-depressants, the severity of the depression should be determined. The Beck depression inventory is the most widely used psychometric test to determine the severity of depression. It is based on 21 questions and has undergone a number of revisions since its introduction in 1961. There are many other Psychometric tests that have been validated as sensitive and specific for Depression. Practicality is the key to determining which inventory a practitioner or provider would adopt. In addition to practicality, screens that generate anxiety, energy level, and cognitive data should be considered because of the expansive nature of depression. Some depression screening tools have to be administered by the provider or practitioner while some can be partially administered by a computer or electronic system. For example, the PHQ 2 and PHQ 9 have to be administered and scored by the practitioner. Patient administered inventories can be delivered by paper or through electronic devices such as ipads and similar devices.

There are some potential advantages of electronic administered systems;

·         Time sparing for the physician or provider

·         Patient privacy may lead to more honest answers.

·         Increase in number of questions and scope of data collection.

·         Portability of the electronic report.

However, provider supervision is a requirement to ensure that the patient understands the questions and that the correct response is made.

Overall, it is important that providers institute a practical system for screening for depression. Positive patients can be managed by the provider or can be referred to a Psychiatrist or Psychotherapist for further management. Each provider should discuss depression preventing activities with their patients with the intent on enrolling them on one or more activities that can prevent depression.