THE GLOBAL BURDEN OF DEPRESSION  
   
Depression is a common illness that you are likely to have encountered, either in yourself, your parents, your children, your spouse, your relatives or your friends, at some point in life. World Health Organisation (WHO) estimates that it is a condition that affects around 121 million people around the world. The actual figure, although, is likely to be much more than this estimated figure, as in most parts of the developing world depression does not get duly recognised. This is primarily due to a lack of public awareness about the existence of depression, the perception of a social stigma associated with the diagnosis and treatment of depression and the lack of sufficient resources for outreaching the treatments for depression in to the community. 

 Depression presents with low mood, loss of interest, inability or reduced ability to have pleasure from enjoyable activities, poor confidence, loss of self worth, poor self esteem, feelings of guilt, self blame, bleak and pessimistic views about the future, ideas or acts of self harm or suicide, poor sleep, loss of or increase in appetite, loss of libido, low energy, and poor concentration. Depressive symptoms are quite often identified by the individuals themselves, although in some circumstances it may go unnoticed by the person experiencing it. In a lot of cases, the presentation for treatment is delayed until the problems become unbearable for the individuals themselves or for their families, or when there are significant consequences socially or at the work place. This may be due to a lack of awareness regarding the presence of an underlying illness or a fear of stigma associated with getting help for depression. This behaviour in individuals experiencing depression or their families jeopardises the chances of early and effective treatment. 

Depression is an illness that causes tremendous personal, social and economic burden on the individuals, families and the society. It can become chronic or recurrent and lead to substantial impairments in an individual's ability to take care of his or her everyday responsibilities. At its worst, depression can lead to suicide, a tragic fatality associated with the loss of about 8,50,000 lives every year (WHO). In the year 2000, WHO identified depression as the leading cause of disability and the 4th leading contributor to the global burden of disease. At the time it was projected that by 2020 depression would take 2nd place. But today, in the middle and high income countries it has already reached the first place, and globally it has reached the 2nd place. At the rate at which this is going, it would not be surprising at all, if depression becomes the number one contributor to the global burden of disease by the year 2020. 

 Research has shown that depression results in a tremendous economic burden, amounting to several billions of dollars each year in the US alone. At present, this is likely to be closely matched in other parts of the world as well. This economic burden is brought on mainly by the loss of work productivity in these individuals. With effective treatment one can recover from a depressive episode within 4 – 6 weeks, resulting in a significant improvement in their productivity and their quality of life. Studies have shown that, standard form of treatments of depression with antidepressant medications and psychotherapy not only reduce the depressive symptomatology, but also reduce the massive burden of illness. In spite of this, it is unfortunate, to say the least, that depression gets under recognised and undertreated in most parts the world. The current observation is that, in some countries, fewer than 10 % of those affected with depression are receiving effective treatment. In order to reduce the burden of a depressive illness, early recognition and treatment is very important. This raises the desperate need for public awareness about depression. An awareness of what depression is, what its consequences are, and the knowledge that it is very much a treatable condition is the 1st step towards reducing the burden of this illness. As socially responsible individuals, one should take the initiative to educate oneself, so that this massive but preventable burden on the individuals, families and society can be minimised. 

 Dr Aju Abraham Consultant Psychiatrist
 
   
 
   
 
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