Depression is a serious, chronic and highly disabling mental illness that affects 2.4 million people in Spain. According to the World Health Organization, in 2020, it will be the leading cause of sick leave.
Despite all the advances that Medicine has had that have allowed us to expand knowledge and improve the diagnosis and treatment of many illnesses, mental illnesses continue to have a stigma behind them that makes them more vulnerable. In the case of depression, some reasons for this vulnerability are the absence of clear diagnostic tests and the trivialisation of the disease.
Many Spaniards currently confuse this illness with a negative emotional reaction to adverse life situations, as was made clear during the presentation of the results of the Lundbeck study. What do Spaniards know about depression? , in Mallorca, prepared by a group of mental health experts on a sample of 1,700 people.
Some of the conclusions of this report that has been carried out to know the perception and knowledge of depression by Spaniards and presented by Miguel Roca, coordinator of the Psychiatry Unit of the Juan March Hospital in Mallorca and full professor of Psychiatry at the University of the Balearic Islands, are that, although 86 per cent consider that we are facing disease, there is still 12 per cent who believe that it is not. Also, nearly 50 per cent think depression can be faked. “The survey makes clear the stigma attached to depression. The population believes this disease mainly affects unstable, weak-willed and conflictive people; they point out that it can be faked.
According to Roca and Vicente Gasull, family doctor and coordinator of the Mental Health Group of the Spanish Society of Primary Care Physicians (Semergen), the reason for this trivialisation of the disease may be that it has come to be considered a typical ailment and the term depression is used to refer both to the disease itself, and the adverse and everyday emotional reactions of daily life.
“Depression is not sadness or personal weakness. It is a complex, multidimensional and heterogeneous mental illness. The somatic component is essential, which is why it is not so easy to fake it”, added Guillermo Lahera, professor of Psychiatry and Medical Psychology at the University of Alcalá and researcher at the Center for Biomedical Research in the Mental Health Network, who clarified that sadness it is possible to fake it, but the changes in circadian rhythms, which are one of the manifestations of depression, cannot.
Regarding the causes, according to the results of this study, 95 per cent of those surveyed estimate that the leading causes of depression are the appearance of adverse events, bumps in life and frustrations; 94 per cent believe that it is due to social factors such as unemployment or marginalisation.
However, although depression is a multidimensional illness, only 48 per cent affirm that biological and genetic factors are one of the causes of the disease, and practically none of the people surveyed name cognitive symptoms as part of the clinical picture of depression. These mental symptoms are what make the disease highly disabling. Patients will present, among others, difficulties in concentration, attention or memory. They will have trouble making decisions, no matter how small, and planning activities.
Can we cure depression?
Throughout life, a person has a ten per cent chance of having depression, a risk of 12 per cent in the case of women and 8 in the case of men.
As Lahera pointed out, in the vast majority of cases, depression responds to treatment, and in many patients, the symptoms disappear. The expert emphasised that with correct therapy, depressive episodes completely disappear in 2/3 of them.
“The problem is that this disease has very high rates of chronic infection and recurrence. When a person has one depressive episode, there is a 50 per cent chance of having a second; after a second, 70 per cent will have a third, and after three, 90 per cent will relapse.
Given this, the challenge for specialists is to achieve remission, minimise adverse effects and reduce relapses. But how do we define remission of depression? According to the respondents’ responses, patients give more importance to positive mental health and having an everyday life. And while this is important, Lahera explained the impact of the cognitive, emotional, and physical aspects of depression and the importance of constantly evaluating them to achieve remission. In addition, referral in depression must incorporate the dimension of functionality, that is, to what extent the symptoms have affected your work, social and family life.
“A crucial aspect of determining the evolution of the disease and its cure are the residual symptoms,” warned Lahera, who pointed out that the most frequent are insomnia, anxiety, lack of interest, irritability, fatigue, the presence of back, stomach and headache muscles, loss of libido and cognitive difficulties (attention, memory, psychomotor speed and executive function).
“Insomnia and anxiety are predictors of possible relapse and suicide risk. A harrowing moment for the patient is when he wakes up at 5 in the morning, can’t sleep, and doesn’t want to live. Ideas of death are widespread; It is not that they think of taking their own lives; the thought would be: I am suffering so much that if I have a heart attack tomorrow, I do not care,” he explained. In addition, the psychiatrist clarified that depression pulverises sexual life and causes changes in appetite. One of the characteristics of this disease is the inability to take pleasure in things, including food. Psychomotor disorders also appear, the tone of voice becomes muffled and monotonous, and patients begin to have problems constructing sentences.
“Discharge occurs when all these residual symptoms do not exist. Hence the importance of the primary care doctor and the rest of the health professionals”, concluded Lahera.
Finally, Gasull stressed that primary care physicians must involve the patient and their family in self-care and provide them with information and training on the disease so that they understand it better and have greater adherence to treatment, another of the pending issues with the disease, since, according to the results of the study, although 74 per cent affirm that they would take antidepressants if the doctor told them that they were necessary, there is a particular fear, especially among women, that they may generate dependency and that they will not be allowed be themselves, factors that can influence the abandonment of treatments before time.