Depressive illnesses, like other chronic medical conditions such as diabetes and heart disease, present their own challenges.  Despite a great deal of progress towards understanding both the psychological and physiological origins of mood disorders, nearly a quarter (22%) of Americans identify depression as a sign of personal weakness. Amid social stigma and limited awareness, patients often confront the challenge of discovering whether their feelings are beyond the realm of normal in the face of social pressures to appear strong, stoic, or happy.

Depression is one of the most common illnesses facing Americans, and suicide is the third most common causes of death among the young adults. Yet in addition to stigma, there are a range of barriers facing individuals with mood disorders in America.

Onset - Age, Childbirth, Co-morbidity

Depression does not always begin in the teen years, however; it can appear less predictably during later adulthood. Since gene expression is influenced by a number of both environmental and internal biological factors, depression can also be triggered in a variety of ways later on in life. Pregnancy and childbirth often lead to transient but very serious depression, but nearly 80% of women affected do not receive treatment. Hormonal changes associated with menopause and other life changes can also bring about depression. Among adults of all ages, the stress of being diagnosed with a serious illness such as cancer can sometimes cause depression in people who had never previously exhibited symptoms. Conversely, the stress of depression can aggravate or complicate other conditions, such as cardiovascular disease, and lead to increased medical spending and increased suffering.

In general, depression and bipolar medications are only effective for approximately 35-45% of patients, and some studies report even lower efficacy rates. Pregnancy and breast-feeding bring added complications and restrictions on treatment options. Many depression medications can have side-effects, and others can lead to unwanted dependency when used inappropriately. Yet without treatment, symptoms of depression can be overwhelming. Over 30,000 people commit suicide each year, and over 95% of suicide victims are said to have been sufferers of mental illness.

Regardless of onset or other complications, many people are effectively treated, and continue to lead healthy lives despite their depression. For others, depression is a lifelong battle, from which there seems to be no relief. 

Treatment - Relapse, Resistance, and Misdiagnosis

Some degree of the mental health crisis in America could be solved through improved diagnostics. According to the National Institute of Mental Health (NIMH) in 2009, depression or bipolar disorder is misdiagnosed or completely missed as often as half the time by current standards of assessment.  There are also no early screening tests for adolescents, though depression is increasing among children.

For a variety of reasons, adherence to depression medication is low, resulting in high rates of relapse. Relapse is also high (47% within two years) among patients who receive evidence-based psychotherapy instead of medication. However, despite the inadequacy of medication and other treatments, depression is widely considered to be easily treatable, and is therefore often handled by primary care physicians rather than psychiatrists. For this reason, naturalistic studies are difficult to carry out, patients are difficult to monitor, and treatments are often wrongly prescribed. This situation impedes efforts toward treatment improvement, while universally accepted multi-disciplinary approaches and real-time clinical care management guidelines currently do not exist.  On account of all these factors, there is a notable lack of adequate response for patients whose depression does not respond to initial treatment.

Gaps in treatment have their roots in our society’s view on depression, bipolar illness and mood disorders. The disparity between public research funding for cancer vs. mental health is a clear indication that depression has been devalued as a serious disease.  The World Health Organization (WHO) reports that depression is the leading cause of disability in the world, and in the United States, depression is one of the most common diseases, affecting more than one in five Americans at some point during their lives. It is also one of the most prevalent causes of lost productivity in the economy, and more than twice the number of people in the US are affected by depression alone than are by cancer. Still mental health research receives an eighth of the funding that cancer research does.

1 Kessler, R., Chiu, W., Demler, O., & Walters, E. (2005). Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry, 62(6), 617-27.