Depression: A billion-dollar market

Depression has once again been brought to public notice, candidly and courageously by Shaheen Bhatt’s recently released book recounts her personal pains and challenges with the disease. Being the daughter and sister of film celebrities, the book has received similar attention to when another celebrity had narrated her tryst with Depression. Mental health issues, unlike physical illnesses, are not easy to talk about. Such revelations from popular figures help in sending a strong message that it is okay not to be okay. It resonates with many, who can relate, acknowledge and discuss their own problems unhesitatingly and seek timely assistance.

Depression is like the common cold of mental illness, widely prevalent, yet it is the most unrecognized, misunderstood and often misdiagnosed mental health problem. Depression, unlike normal feelings of sadness, is a prolonged state of disturbed mood marked by hopeless and helpless feeling capped with low self-worth and a vague sense of guilt. As per World Health Organisation (WHO), the world has become an increasingly melancholic place. More than 300 million are depressed worldwide, with around 50 million living in India alone. It is a leading cause of illness and disability and a major contributor to the overall global burden of diseases.

Worse still, depression leads to one million suicidal deaths each year or one preventable death every 40 seconds. What causes depression remains unclear as yet. Despite being exposed to a similar environment, challenges, and negative life events, why only certain individuals suffer from depression while others sail through is still a conundrum. Depression has long been associated with chemical imbalances in the brain, particularly of the neurotransmitters serotonin, dopamine, and norepinephrine, but recent research has found it to be partly true. Nothing as catastrophic in the world environment has occurred that could have altered chemical compositions in such a large number of people.

Obvious risk of overreliance on the biochemical theory is an overuse of antidepressant medication is known to have adverse side effects and can be toxic in large doses. Even in the case of endogenous or clinical depression found in relatively a smaller number, medication is not necessarily the first line of treatment. While depression sadly remains unrecognized and undiagnosed in a large section of people, the danger of normal or mild sadness being over-diagnosed as severe depression coupled with the overuse of antidepressants is of no less concern. This practice is rampant in India as there is a high incidence of depression but an incessant dearth of trained mental health professionals.

Blame it on the overzealous and insufficiently informed doctors, the over-dependent, gullible patients who are often wrongly diagnosed, or scheming pharmaceutical companies, antidepressants who contribute a major share to the billion-dollar drug market.

Interestingly, antidepressants act as placebos in most cases. An article in PubMed, a prominent research journal, states that instead of curing, these medicines may make patients biologically vulnerable to depression in the future. It may also increase psychological dependence on medicine without the patient ever trying lifestyle changes or other safer alternatives.

Since psychotherapies like Behavioural Activation, Cognitive Behavioural Therapy (CBT), and Interpersonal Psychotherapy (IPT) are found to be equally effective, the choice of treatment should naturally depend on risk avoidance. Antidepressants should, therefore, be prescribed if at all, only as a last resort, when all other therapies fail.

Treatment should not be worse than the disease. An important research finding has been the existence of a significant correlation between depression and certain personality traits like negativity and pessimism. Individuals high on negative temperament feel like many things are the beginning of an end, making them sink into a bottomless pit of sorrow and despair. Their perception of the events, inability to cope and lack of resources make matters worse. Psychotherapy tends to help rework on these thinking style and attitudes. Addressing these personality issues and instilling mental hygiene, positive thinking, happiness development and problem management early in life serve as an effective preventive measure. Awareness, prevention, and timely intervention are crucial in dealing with the Depression.

(The writer is a professor in Psychology, author and Director, Eudaimonic Centre)