Wednesday, August 13, 2014

(En)lighten up: The biology of depression

The sad thing about depression (besides the fact that is is depressing), is most people (even people with clinical depression) don't give a damn about this particular disease, until someone like Robin Williams takes the fast and horrible way out. 

We will mourn the loss of an influential person, a great artist like Williams, and then tune into our next flavor of the day, and the hands of time keep spinning while the list of quiet casualties (i.e., the not famous, living their lives of quiet desperation - thank you, Mr. Thoreau) keeps rising. And by casualties, I don't necessarily mean suicides. For people who have struggled with a major bout of depression, it can be a pretty serious wound by itself, with plenty of side effects. 

Taking the "lighten the hell up" approach doesn't usually work. But this isn't about eliciting cheap and temporary sympathy for these folks (most of whom lead the most ordinary of lives, content the great majority of the time). It's about awareness, and understanding a widespread issue (and maybe supporting whatever measures and efforts there are to reduce the bad shit). 

Since the news broke about Williams' suicide, the responses have run the gamut from one extreme to another, from criticism that he took the coward's way out, to the deepest sympathy. Personally, having faced the D-demon myself, I fall into the latter category. I certainly can't empathize with a person who was as globally beloved as Robin Williams, but can definitely understand the problem of facing the dark defenseless and hopeless. 

Depression is a complex thing. It isn't a case of the blues, not just that. Nor is it exactly like addiction, as some cyber-therapists have alleged -- admit you have a problem and deal with it, damn it ... go to a 12-step program! The thing is, as with most disease, of course you have to admit a problem and deal with it, otherwise, the disease generally wins. Like with cancer or diabetes or so many other things. 

With that in mind -- the squishy nexus of biology and depression -- here's a link that might help you better understand the biology behind depression:

There's also this:

This also is really interesting:

Some of what we know is, at least 15 million adults in the U.S. suffer from a major depressive disorder in a given year; people with depression are four times as likely to develop a heart attack than those without a history of the illness (and after a heart attack, they are at a significantly increased risk of death or second heart attack); there is a high prevalence of depression that co-occurs with other illnesses (cancer, AIDS, Parkinson's); major depressive disorder is the leading cause of disability in the U.S. for ages 15-44 (and the leading cause of disability worldwide among persons five and older -- FIVE!!??); depression ranks among the top three workplace issues, following only family crisis and stress (which often lead to depression ... such a vicious cycle); its annual toll on U.S. businesses amounts to about $70 billion in medical expenditures, lost productivity and other costs; oh, and there are more than 30,000 suicides in the U.S. each year, at least two thirds of them caused by major depression (Robin Williams, hello!). 

The good news is, about 80 percent of those treated for depression show an improvement in their symptoms generally within four to six weeks of beginning medication, psychotherapy, attending support groups or a combination of these; but here's the thing: Despite its high treatment success rate, nearly two out of three people suffering with depression do not actively seek nor receive proper treatment and an estimated 50% of unsuccessful treatment, or non-treatment for depression is due to medical non-compliance (including financial factors). 

Meanwhile, smart people are working on the problem. Here's something about research that Georgia Tech is involved in:

The bottom line is, most folks haven't read this far because, quite honestly, depression isn't sexy (as opposed to liver disease and ribosomes and molecular biology and the other sexy stuff you're used to reading on this blog). Most folks just don't care, and they won't, until someone like Robin Williams takes himself out (to wit, this blog entry), and even then, most folks  are typically wired to a 24-hour news cycle, in which today's celebrity suicide gives way to tomorrow's new shiny thing. 

Good luck out there, be kind to each other. The world will keep spinning either way, at least for another four billion years or so. How it spins and how nice the ride is for the humans tethered to the big blue ball depends on the lot of us.

P.S. Here's a blog post by yours truly, of a more personal (and hopefully helpful) nature:

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