Major Depression: The Numbers — What Do They Mean?

From the National Institute of Mental Health (NIMH), the official facts and figures on major depression:

Major Depressive Disorder is the leading cause of disability in the U.S. for ages 15-44.

Major depressive disorder affects approximately 14.8 million American adults, or about 6.7 percent of the U.S. population age 18 and older in a given year.

While major depressive disorder can develop at any age, the median age at onset is 32.

Major depressive disorder is more prevalent in women than in men.

Feeling paranoid. Conspiracy theories are for the birds and bird-brained, but I’d like to inject one possible thought regarding these numbers. It has been suggested that the psychopharmaceutical industry may influence the way such numbers are presented. Given the torrent of stories regarding what Big Pharma is willing to do to promote it’s interests, it’s not inconceivable that such influence could be at play. Could be. Pure speculation. Just something to consider. I’m not making any claims, just innuendo. More facts and figures, less suspiciousness, to follow.

Certainly I’ve read this about the World Health Organization (WHO) numbers, who characterize depression as the soon-to-be number one disability in the world. Of course, antidepressants — in stratospheric numbers — could be marshaled to address such an epidemic. It’s worth noting that the NIMH lists psychotherapy as the first antidote to depression, followed by medication. The NIMH site also lists possible side effects and risks of antidepressant medication.

AIDS drugs, a counterargument. One counterargument against the idea that pharmaceutical companies stand to gain from a worldwide epidemic of depression is the case of AIDS drugs. These companies did not show a great willingness to reduce costs of drugs, regardless of need or ability to pay, particularly in the case of South Africa’s virulent AIDS epidemic. AIDS drugs are reputedly more expensive to produce than most other drugs. So there might not be much of a profit incentive for distributing antidepressants. Nevertheless, in the case of antidepressants, cheaper generics might be distributed without big profits.

The WHO rationale for prevalence of depression:

…statistics underestimate the burden from non-fatal conditions such as neuropsychiatric disorders. The World Health Organization has introduced a new concept of measuring suffering of populations based on time lived with disability which has been described as, Disability-Adjusted Life Year (DALY)… 10% of the disease burden was due to neuropsychiatric conditions… A large proportion of the burden of disease resulting from neuropscychiatric conditions is attributable to unipolar major depression, which was the fourth leading cause of overall disease burden in 1990, while in adults aged 15-44 years, it was the leading cause of DALYs lost wordlwide. The disease burden resulting from depression is estimated to be increasing both in developing and developed regions.

WHO facts and figures:

About 450 million people suffer from mental or behavioral disorder

33% of the years lived with disability are due to neuropsychiatric disorders

Four of the six leading causes of years lived with disability are due to neuropsychiatric disorders (depression, alcohol-use disorders, schizophrenia and bipolar disorder)

Nearly 1 million people commit suicide every year

About 25 million suffer from schizophrenia

50 million suffer from epilepsy. About 40 million or 80% are assumed to live in developing countries

More than 90 million suffer from an alcohol or drug-use disorder

One in four families has at least one member with a mental disorder

More useful questions. Perhaps more useful than jumping to paranoid conclusions is to wonder how these organizations are defining depression. Are peoples that are displaced due to genocide, have faced starvation, felt the economic pressures of globalization — are these people depressed? Or unhappy? Who decides, at NIMH and at WHO, what the criteria for depression are? (It turns out that the NIMH have a pretty clear and sound definition of depression that distinguishes from the blues.) What funding pressures might either of these organizations be under? Could Big Pharma lend a hand?

Kalea Chapman, Psy.D.

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